The partners of the Palestinian Diabetes National Program tell the story of two decades of resilience, innovation, and collaboration in fighting diabetes in a protracted refugee crisis.
21 June 2023 Andreea Enea
75 years ago, more than 700,000 Palestinians became refugees almost overnight [1].
Today, the number reaches almost 5.9 million Palestinian refugees registered with the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), across the Middle East [2]. Jordan hosts nearly 40% of refugees, followed by Gaza (25%), West Bank (15%), Syria (10%) and Lebanon (10%), with one-third living in 58 UNRWA refugee camps.
This protracted refugee crisis, amplified by the recent COVID-19 pandemic, has brought the Palestinian healthcare system into a state of emergency.
The prevalence of diabetes in Palestine is estimated at 9.2%, close to the global prevalence of 10.5% [3]. However, the percentage could be double in reality [4]. For the refugee and displaced populations in need of care, the situation is more critical. Prevention and management of non-communicable diseases (NCDs) are significantly challenged and require coordination, given the complexity of the healthcare system, with parallel governance structures – including the Ministry of Health, UNRWA, civil society, the private sector – posing challenges to the delivery of services in an integrated manner
In this context, international support is essential. But humanitarian responses cannot be separated from the NCD responses of national health systems.
This is what ignited a promising partnership in 2003 when DanChurchAid (DCA) and the Augusta Victoria Hospital (AVH) in East Jerusalem opened a diabetes care clinic in Palestine – the first WDF-supported project in the area. Over the years, with continuous support from WDF (13 grants between 2003-2021), other strategic partners – such as UNRWA, Juzoor for Health and Social Development, and the Palestinian Ministry of Health (PMoH) – have joined the fight against diabetes across the West Bank and Gaza.
In 2017, these collective efforts culminated with the successful launch of the Palestinian National Diabetes Program (PNDP) led by PMoH.
For the first time, healthcare providers, civil society, and the private sector united in a single platform to place diabetes on the national health agenda and improve and integrate diabetes care and prevention.
In time for marking World Refugee Week 2023 (19-25 June), the partners launched the PNDP booklet The Power of Partnerships: Reflection on the 20 year-journey fighting diabetes in Palestine, which documents the story of a unique model of multi-sector cooperation elevating local projects into a successful national diabetes program in a protracted humanitarian crisis.
Read more about the PNDP booklet launch in the press release.
The PNDP provides equitable access to high-quality diabetes prevention and care services for marginalized communities by equipping centres, building capacity, unifying care policies and guidelines, and raising community awareness of NCDs through an integrated approach.
These efforts save countless lives in areas affected by protracted crises.
The West Bank is an example of an area with a health system struggling to respond to the needs of the population. Lack of access to resources, the protracted crisis, high tobacco use, and limited environments promoting physical activity or healthy nutrition – all pose challenges for the healthcare system. The COVID pandemic added to the disruptions of services and medication, and made diabetes diagnosis and management even more challenging, with some dispersed communities of Palestinians depending solely on mobile health clinics operated by partners.
The PNDP promotes an integrated approach to diabetic care and allowed several model centres and referral clinics to be opened across Palestine, serving more than 23,500 people and training more than 500 healthcare professionals in diabetes care.
Tens of thousands of Palestinians have been screened and registered in the health system and thousands of people have been diagnosed with diabetes-related issues such as foot problems, retinopathy, and hyperglycaemia in pregnancy (HIP) – which only reflects the growing need for more equitable and accessible health services and education.
The first phase of the PNDP (2017-2020) has improved access to diabetes care and prevention across the Northern region of the West Bank and had a strong outreach to refugee women and children. Education on prevention in UNRWA camps, rural communities, and schools has been a priority, with more than 30,000 refugees as part of the program. The valuable impact of the program is also reflected in fewer referrals, increased accessibility to care and the fact that no diabetes-related amputations were registered during the program.
As a result, the program has made a difference for almost 1.5 million people. But more work is needed.
Considering these positive results, the program entered a second phase (2020-2023) supported by WDF. The ambition is to strengthen and refine the program, institutionalize a comprehensive approach to care, assist vulnerable communities and increase focus on HIP and nutrition and scale-up of eye and foot care.
There are 108.4 million people forcibly displaced worldwide, 76% being hosted in low- and middle-income countries [5].
As a result, multi-stakeholder partnerships (such as the PNDP platform) that build integrated NCD-humanitarian responses are needed more than ever. The purpose of these collaborations has always been to serve the underserved and empower communities to become active participants in their health and well-being.
Since 2011, WDF and UNRWA have been partners for several projects developed to respond to the health needs of Palestinian refugees across the Middle East.
The continuous engagements in Jordan, Lebanon, Syria, the West Bank and Gaza sought to improve diabetes management in UNRWA health centres and scale up diabetes care at a regional level. The partnership succeeded by developing capacity and training medical personnel, building diabetic foot units, conducting community awareness and screening campaigns in refugee camps. The strong collaboration also built on past projects to expand the accomplishments in diabetes care in all UNRWA clinics, with the use of innovative tools and strategic approaches.
Since 2019, WDF has received additional support from the Novo Nordisk Foundation (NNF) to develop multiple large-scale projects to specifically respond to other humanitarian settings in the region, namely the Syrian refugee crisis in Jordan and Lebanon.
One example is a four-year project in Jordan, the second largest refugee host per capita worldwide with more than 1.3 million Syrian refugees and 2 million Palestinians [6]. The goal is to develop an integrated NCD-humanitarian national response to improve access to care within the Jordanian healthcare system and promote healthy lifestyles for refugees and host communities.
Another four-year project started in 2021 in Lebanon in partnership with the Danish Red Cross (DRC) to institutionalise a similar response. In addition to high prevalence rates of NCDs, hosting 1.5 million Syrian refugees [7] has significantly disrupted the healthcare system and its ability to provide basic services to people in need of care. To meet these needs, the intervention is focused on building primary healthcare capacity within the national healthcare system of Lebanon, with DRC leading community-level interventions.
As Jakob Sloth Madsen, Senior Humanitarian Programme Manager at WDF, explains, these are special opportunities to integrate national NCD prevention and control programmes, with an emphasis on diabetes and hypertension, into the humanitarian response frameworks in Jordan and Lebanon.
In addition to these large-scale projects, WDF has been working with UNHCR to support refugees in other parts of the world.
An ambitious project is being implemented in Burundi, Sudan, and Tanzania – critical UNHCR country operations with a strong need for NCD care and prevention. The partnership assists up to one million refugees, returnees, and internally displaced people (IDPs), and more than 500,000 people from the host populations. The project also aims to institutionalise NCD care and prevention into the UNHCR’s global approach (details here). The project is also supported by a grant from NNF.
Furthermore, WDF has been collaborating with the Danish Red Cross since 2013, building a resilient long-term partnership focused on community-based NCD prevention and care in humanitarian settings.
The most recent WDF-DRC collaborative project aims to improve NCD care for displaced populations in Kenya and Somalia. The economy and health systems of both countries are impacted by the substantial influx of refugees, IDPs and returnees who are highly vulnerable and in need of essential health services.
These key collaborations reflect the strong commitment of the WDF to the NCD-humanitarian agenda – with the two decades of work in Palestine and the newly launched booklet as a testament to this commitment.
From adopting the Diabetes Comprehensive Care Model (DCCM) as a holistic approach and efficiently reaching people with NCDs, to empowering refugee communities for better self-care and disease management outcomes, the PNDP project has numerous insights to offer.
The PNDP platform has attracted more partners believing in a shared social responsibility, advocating for policy change, and making diabetes a political priority in Palestine. Thanks to the partners’ high sense of local ownership, clear roles and responsibilities and international support, the results and benefits of this collaborative work are tangible.
The road ahead might be long.
But the positive impact that the PNDP has had on so many lives already only proves the vital importance of integrating NCD care and prevention in humanitarian response frameworks.