Type 1 diabetes (T1D) is an autoimmune disease. It causes the cells that produce insulin in the pancreas to be destroyed, which affects the body’s ability to produce enough insulin. Without insulin, T1D is deadly, so an insulin replacement is required. However, this is not always available – or accessible.

In Northern Bahr el Ghazal (NBeG) state, South Sudan, where MSF runs the paediatric department at Aweil State Hospital, children regularly go into DKA and our ICU treats an average of 30 children with DKA every month. We have a cohort of 185 children with T1D, some of whom are hospitalised in our ICU up to three times every month because it is so difficult for them to keep their diabetes under control. The reasons for this are both medical and social. The MSF clinic in Aweil State Hospital is the only facility providing specialist diabetes care in NBeG. For the children in our care, we are currently able to provide them only with vials of insulin that they need to store in clay pots to keep the insulin cool enough in such a hot climate where refrigeration is not possible. They need to come to the hospital on a monthly basis to collect their supply of insulin and for their monthly check-ups. However, many live in rural areas up to 100km away and cannot afford the cost of transport, so they miss their appointments – and they also often run out of insulin.