A Shipment to Lebanon Bolsters Diabetes Care for 1,200 Children

Last week, Michele Abi Saad, managing director at the Chronic Care Center in Baabda, near Beirut, could hear and feel missile strikes nearby. It didn't stop her or the center's staff from going to work. Staff members "are coming and putting themselves in danger to make sure that our patients are receiving their appropriate treatment," Abi Saad said.

That's because thousands of pediatric patients depend on them for survival.

"We have many families who are displaced," she said. "If I put myself in the shoes of the patients, already the war is very stressful, and having this uncertainty of finding their medications also. I think the Chronic Care Center really is a secure place, and they really depend on us, and they have confidence in us that we will support them."

Staff members described a 12-year-old boy whose family is currently displaced after their newly rebuilt home was destroyed a second time. So was his father's shop and livelihood. While the family struggles to regain their footing, the boy continues to receive free insulin and supplies to manage his diabetes, which would otherwise be unaffordable in a country still plagued by longstanding economic collapse.

Without insulin, people with Type 1 diabetes can quickly fall into medical crisis, and the Chronic Care Center provides comprehensive care to thousands of children and youth with Type 1 diabetes.

When the conflict began in late February, Abi Saad was immediately concerned about the Chronic Care Center's supply of insulin. In particular, 1,200 children and youth who receive care at the center have no other means of getting insulin.

"We cannot run out of insulin because those patients, they depend on us," she explained. "I am keen, whenever we have any crisis, to act in an immediate manner." Abi Saad reached out to Direct Relief, which works actively in Lebanon and has shipped more than $251 million in medicines and other medical support to in-country providers since 2020.

Urgent Need, Complex Logistics

At the organization's California headquarters, staff prepared 5,700 packs of a rapid-acting analog insulin for shipment to Lebanon - enough to support all 1,200 of those young patients for the next six months.

Because insulin must be consistently stored and transported within a narrow range of refrigerated temperatures, carving out a reliable shipping lane and meticulous logistics for delivery and monitoring were essential.

And doing so amid regional conflict presents even more challenges.

Despite the complexity, the Direct Relief shipment arrived at the Chronic Care Center on April 7. This donation is part of Direct Relief's larger emergency support to Lebanon amid the conflict. Additional support includes medical aid for Beirut health providers, including emergency medicines, treatments for infectious and chronic diseases, and supplies to support safe births, currently being prepared for shipment, and an emergency grant to support dialysis patients at the Al Hamshari Hospital in Saida.

The Chronic Care Center, which has received $3.4 million in insulin and modular cold storage from Direct Relief, is a member of the International Diabetes Federation, a global network of diabetes associations that work to improve care and access. Direct Relief, also a transnational member of the federation, serves on its Disaster Committee, which pools information and targets medical support to people with diabetes in crisis settings.

While responding to Abi Saad and her center's needs, Direct Relief also coordinated with committee members on efforts in Lebanon and the wider region, maintaining a locally focused response while contributing to global knowledge-building.

"We Are Always There For You"

Across Lebanon, about 1.3 million people have been displaced by the hostilities, and many of the Chronic Care Center's patients and families are among that number. Clinicians must find creative ways to get insulin to patients, such as through neighbors and contacts, and monitor their care from a greater distance.

A 17-year-old girl, currently displaced from her home for the third time in two years, struggles to refrigerate insulin and receive an appropriate diet in the school-turned-shelter where her family is living. The Chronic Care Center provides social and emotional support to the family, and distributes smaller levels of insulin more frequently, reducing the family's need for refrigeration.

Another beneficiary of the clinic, a family with seven children, displaced from southern Lebanon, struggles to procure housing because many landlords won't rent to displaced families, Abi Saad said. Three of the children have Type 1 diabetes. If the family had to pay for their medications, she explained, the cost would equal an average salary in Lebanon. Receiving free medicine and supplies through the Center has been indispensable, especially as their mother also has cancer.

Staff at the center, including endocrinologists, nurse educators, dietitians, social workers, and administrators, have been showing up for work every day, even during active conflict. The center was briefly forced to close because of the conflict, but only for one day. And families call daily to ask if insulin is still available, Abi Saad reported.

"We always tell them, 'Don't worry, we are always there for you,'" she said.

Abi Saad's experience in crisis has served her well. She procured insulin and managed the center throughout the Covid-19 pandemic. The 2020 Beirut port explosion destroyed medical supplies and damaged hospitals and health facilities. A devastating economic crisis and runaway inflation. Widespread shortages of insulin and other lifesaving medicines. Repeated outbreaks of conflict. A health system that had once been the lodestar of the Middle East but is now overburdened, underfunded, and increasingly understaffed as skilled providers leave the country.

In particular, she told Direct Relief, a history of emergency response has taught her to begin stockpiling quickly and to assume the disruption will be long-term.

"We have no clue how long this situation will be," she explained. "This is why I was really keen at the beginning, really at the first day, to contact our suppliers to make sure that I have everything and to contact our partners."

Abi Saad said staff know what to do in these settings. Every child coming in for care will see a social worker who can help manage social services or mental health impacts. Clinicians know which children need greater flexibility and monitoring because of displacement.

"This is not the first war in Lebanon, so we became somehow resilient," she said

Kelsey Grodzovsky contributed reporting to this story.