To the leaders of this world, 

This letter comes urgently from a unified network of diabetes associations and advocates, in a heartfelt, humanitarian request for prompt medical aid in Gaza. Because supplies of fuel, electricity, and water have been cut off in the midst of airstrikes and an impending ground invasion, there is a dire need for a humanitarian corridor through the Rafah crossing to provide critical medical aid to the people in Gaza immediately. 

In line with the appeals from the United Nations, the World Health Organization (WHO), UNRWA, Unicef, we appeal for the United States to use its role to demand a humanitarian crossing to allow crucial life-saving supplies into Gaza. 

As a consequence of the present aggression, with frequent airstrikes occurring, reports state that 340,000 people have been displaced. 45% of people killed in Gaza have been women and children with a total of 1,100 lives lost and another 5339 injured as reported by UNRWA in the past 5 days. Gaza's health system was already under-resourced before the airstrikes began. Attacks on healthcare facilities and ambulances have been recorded by WHO, resulting in deaths and injuries of health workers. Imposing a blockade on Gaza for humanitarian aid is against international law and is a crime against humanity and a war crime according to the Geneva Convention. 

For a person living with a serious chronic condition such as insulin dependent diabetes, lack of access to life-saving medication will result in the death of people living with diabetes in Palestine in a matter of days. Due to the current conditions, it is impossible for people in Palestine with diabetes to obtain critical supplies. 

Access to Pharmacies and Medical essentials:

• Medical facilities are at risk of being bombed; all pharmacies are closed. A person with a serious medical condition currently has no means by which to collect critical medications.
• One full 250 units/ml pen of the most common rapid acting insulin lasts an average of 5-6 days, depending on physiological needs and total daily doses. Those who have a higher insulin resistance in their body require higher doses of insulin and may use a full pen of insulin within 3-4 days.
• In the absence of insulin, people with diabetes will first suffer from DKA, then a diabetic coma, and then death.
• To make this insulin last for a longer duration, people will ration their supplies by taking less insulin than required resulting in consistently higher blood glucose levels and risk of high ketones / Diabetic Ketoacidosis (DKA) and potential of a diabetic coma; long term organ damage/complications.

Insulin Storage:

• Unused insulin vials, cartridges or pens should be stored in a refrigerator between 36-46 Fahrenheit. If stored properly these will remain 'good' until the expiration date. Opened vials of insulin should be maintained at room temperature between 56 to 80 Fahrenheit. Insulin that is not maintained at these temperatures does not work efficiently, leading to elevated blood sugars.
• In Gaza, there is currently no electricity supply.
• The present temperatures at day within the Gaza strip are averaging 78 – 82 Fahrenheit. 

Insight from the Palestinian Ministry of Health:

According to the Palestinian Ministry of Health the statistics in Gaza taken in 2018 shared there are approximately 68,000 people with diabetes living in the Gaza strip. 

Call for action:

• Demand a humanitarian crossing through the Rafah crossing to provide critical medical aid immediately.
• Allow the humanitarian aid organizations including Unicef, UNRWA, WHO, Anera, PCRF along with other CBOs to provide medical and humanitarian aid including food and water to the people of Gaza.
• Work with internal health institutes / organizations in the aftermath of the damage caused by these attacks, to assess and support access to medical care for people living with diabetes in Gaza.

This letter is signed in collaboration by:

Saira Khan-Gallo - person living with diabetes for 27 years, parent of 2 children with diabetes and wife to a person living with diabetes for 30 years.

 
Eritrea Mussa, a person living with diabetes for 22 years.

Noor Al Ramahi, Palistinian and person living with diabetes.

Sources: 

World Health Organization Emergency Situation Report
UNRWA situation report 
Gaza Inter-Agency Contingency Plan 
UN statement
https://www.ochaopt.org/page/mapping-lifesaving-humanitarian-services