Moussa is 10 years old and enjoys the same things other 10-year-old boys enjoy the world over. He spends his free time building Lego blocks with his siblings, colouring comics, and playing football with his schoolmates. Such activities, though seemingly ordinary, represent his way of triumphing over the challenges he faces daily. Moussa is living with diabetes while navigating the harsh conditions of the town he has been forced to call home.
In 2013, Moussa and his family had to flee their home in Syria, and this journey led them to Arsal, a remote town located in northeastern Lebanon. According to local community leaders, nearly 77,000 refugees from Syria are now living in the town, and are desperately seeking basic necessities such as food, shelter, clean water, and medical care.
Moussa was diagnosed with type 1 diabetes at the age of three and takes insulin every day to control his blood sugar levels. For Moussa and his family, the precariousness of the living conditions in Arsal add to the challenges of treating this chronic, life-long condition.
The family—Moussa, his mother, father and four siblings—all live together in a single room. Early on in his treatment, Moussa’s insulin was provided in a glass vial, and it was then injected with a syringe by his mother. Each time she drew up the insulin from the vial, she would worry about the accuracy of the dose that she was injecting into her son. Getting the dosage wrong could result in Moussa experiencing complications such as hypoglycaemia, a condition where blood sugar drops below healthy levels, which can sometimes be life-threatening.
The injections had to be given at home, as it made some of these challenges more manageable for Moussa’s mother. But as a result, he would sometimes have to miss school in the afternoon to return home to get his injections. This curtailed his independence and affected his confidence in school.
Moussa gets his insulin from the MSF clinic in town. Since July 2022, all children and adolescents undergoing treatment at MSF’s clinic for diabetes have been receiving insulin pens from MSF to help control their disease. In the past, many of them, like Moussa, used glass vials and syringes. Adults living with type 1 diabetes also started receiving insulin pens recently.
Moussa’s mother explains how they are coping with Moussa’s illness amid these challenges:
“At first, we had to admit him into the hospital since I didn’t know a lot about diabetes, insulin, and treatment. MSF teams helped me a lot and guided me to better deal with the situation, on how to give him the injection, what his lifestyle should be, what to feed him, and what should he do. We have got used to it now, but even after more than five years, it’s still challenging.”
Using the insulin vials and syringes was problematic for other reasons too for the family. For instance, Moussa found the injections with the syringe’s needle very painful, and since he needed injections several times a day, this created stress for both mother and child, with Moussa often reluctant to take the injections.
Since switching to insulin pens last year, many of these challenges are much easier for Moussa and his family. Using pens has allowed Moussa to take control of his treatment. He is able to inject himself, and this has given him more mobility, autonomy and confidence when going to school. His mother, too, appreciates the simplicity of injections with the pens.
Dr Beverley Prater, who works in MSF’s clinic in Arsal to support people living with diabetes and other chronic non-communicable diseases, explains that children – all children – want to feel ‘normal’. This is especially important in situations that many children and their families in Arsal find themselves as refugees. Rising anti-refugee rhetoric and restrictions on freedom of movement of refugees have added to the difficulties of life in Arsal for families like Moussa's.
“Life with diabetes is a challenge at baseline for any of us. But for people who lack a safe space or proper housing, food security, refrigeration or access to electricity, insulin pens ease their daily lives and facilitate long-term health,” says Dr Prater. “In an unstable life situation, this also allows for hope, for long-term vision of growing up and growing old with diabetes.”
For both Moussa and his family, the introduction of insulin pens has made a big difference to their lives, giving reassurance to his mother that he’s less likely to experience hypoglycaemia, and giving Moussa the independence he craves to be out and about, playing with his friends, going to school, living something close to a ‘normal’ life in these challenging circumstances for himself and his family. With the pens, Moussa is also empowered to respond to his medical condition and cope without relying on someone else to help him carry on with his everyday activities.
Here’s Moussa himself on how the pens have helped him to adapt to living with type 1 diabetes:
“I have been using insulin pens for the last year. When I don't take it, my sugar level increases, and I get headaches. I take it at home or at school, and even when there’s a party. I’m used to it now.”
MSF has been working to support both the refugee and local Lebanese community in Arsal over the last decade. The medical team provides treatment for patients with a wide range of chronic diseases that require management over a long period of time, such as hypertension, epilepsy, and diabetes. Recently the decision has been taken to offer insulin pens to all patients with type 1 diabetes, not only children.