At dawn another day of Israel’s assault on Gaza, 20‑year‑old Hamza al‑Ghazali from the Zeitoun district south of Gaza City headed out again to find an insulin pen.
This was not his first trip between pharmacies and clinics seeking a dose; the search has become a routine part of his life since the war began in October 2023, when Israel tightened limits on medicine and medical supplies entering Gaza.
Hamza understands that postponing an insulin dose can be fatal. Type 1 diabetes demands strict daily treatment and constant monitoring, but under war and blockade, managing it has become a daily, high‑risk battle.
Hamza recalls that his health was steadier before the conflict. Previously, he could buy insulin from pharmacies for 25–35 shekels (about $8.50–$12) per pen, and sometimes even less.
“I started to know all the pharmacies, and they also knew me, because I was always buying insulin pens,” Hamza says.
That changed dramatically with the war and tighter limits on medical supplies. A single insulin pen now costs 75–100 shekels (roughly $25–$34), and because Hamza requires six to seven pens each month, he has tried to stretch each pen’s use as long as possible.
Fight for survival
The hardship faced by Gaza’s diabetes patients is worsened by border restrictions on medicine imports, which have caused a severe shortage of insulin, glucose meters, and test strips.
Hamza points out that this shortage has created an unstable medical reality; sometimes medicines that have been stored for long periods or kept in poor conditions show up for sale, raising worries about diminished efficacy or uncertain quality because there are no alternatives.
A year earlier, when an Israeli blockade on food imports triggered famine in northern Gaza, Hamza had to eat whatever he could find.
But for Hamza, the challenge was not only obtaining enough food; he also needed to balance the limited insulin he could obtain with whatever nourishment he could secure.
Eating more without enough insulin can push his blood sugar to dangerous heights, while cutting food intake to conserve insulin risks severe, potentially fatal hypoglycemia (low blood sugar).
“I was afraid for myself during the shelling in northern Gaza,” said Hamza. “We were under siege. If the house was bombed, I might survive under the rubble, but die from low blood sugar. And if I ate without insulin, my sugar could rise dangerously. I was living between two fears all the time.”
He adds that his fear extends beyond losing insulin; he also worries about losing his glucose meters and test strips, which he needs daily to monitor his condition. Whenever he is forced to evacuate, the first item he grabs is his “diabetes bag”.
Equipment shortages
Glucose test strips have become scarce, restricting Hamza’s ability to check his blood sugar each day and compelling him to gauge his condition based on physical symptoms alone.
Hamza notes that a glucose meter costs between 250 and 300 shekels (about $85–$120), but the real obstacle is the lack of test strips.
Without test strips, the meter is useless, prompting some patients to purchase new devices repeatedly. Hamza estimates that over 80 % of diabetes patients in certain areas cannot test their blood sugar regularly—a situation he calls a “medical disaster” because it reduces treatment to daily guesswork.
According to the Palestinian Ministry of Health in Gaza, between 70,000 and 80,000 diabetes patients in the enclave are at risk owing to the severe shortage of insulin and test strips, compounded by the collapse of medical follow‑up services and poor nutrition.
Endocrinology and diabetes specialist Dr. Adli al‑Ghouti says that roughly 2,500 children in Gaza live with Type 1 diabetes and are in a highly critical state.
Due to insulin shortages, inadequate storage conditions, and frequent power outages, a genuine crisis is unfolding.
Al‑Ghouti warns that deteriorating insulin quality, expired stock, and improper storage can all diminish effectiveness, giving a false sense of security while blood sugar stays uncontrolled—potentially leading to severe complications such as diabetic ketoacidosis, a life‑threatening emergency.
“Taking an expired dose of insulin may cause significant harm inside the body, while giving a temporary impression of improvement,” Dr al-Ghouti said.
Diabetes can no longer be managed easily in Gaza. With insulin shortages, scarce testing tools, rising costs, and worsening nutrition, even the most basic elements of care have become a daily struggle for survival.
