Hamza al-Ghazali, 20, from the Zeitoun neighborhood in southern Gaza City, set out at dawn again to hunt for an insulin pen. This was not his first time scouring pharmacies and medical centers for a dose. Since war erupted in October 2023 and Israel tightened restrictions on medical supplies entering the Gaza Strip, finding insulin has become an inescapable part of his daily life.
Hamza knows that delaying an insulin shot can be life-threatening. Type 1 diabetes requires strict daily treatment and constant monitoring. Under war and blockade, controlling the disease has become a perilous daily struggle.
Before the war, Hamza says his health was far more stable. He would buy insulin from pharmacies for 25 to 35 shekels (about $8.5–$12) per pen, sometimes cheaper. “I knew every pharmacy, and they knew me, because I always came to buy insulin pens,” he said.
Everything changed when war broke out and restrictions on medical aid tightened. The price of each insulin pen soared to 75–100 shekels ($25–$34). Needing six to seven pens a month, Hamza is forced to stretch each one as far as possible.
The shortage also hit monitoring equipment. Test strips are scarce, limiting Hamza’s ability to check his blood sugar daily and forcing him to rely on bodily symptoms. Glucose monitors cost 250–300 shekels ($85–$120), but the real problem is availability of test strips. Without them, the machine is useless, prompting many patients to buy new monitors repeatedly.
Data from the Palestinian Health Ministry in Gaza shows about 70,000–80,000 diabetes patients in the territory are at risk due to severe shortages of insulin and test strips, the collapse of medical monitoring services, and poor nutrition. Some 2,500 children with type 1 diabetes are in an extremely critical health condition.
Dr. Adli al-Ghouti, an endocrinologist and diabetes specialist, warns that deteriorating insulin quality, expired supplies, and improper storage due to power outages can reduce effectiveness, creating a false sense of security while blood sugar remains uncontrolled. This can lead to dangerous complications such as diabetic ketoacidosis, a life-threatening emergency.
Hamza also recalls a period a year ago when Israel's food blockade caused famine in northern Gaza, forcing him to eat whatever he could. But it was not just a nutrition problem—it was about balancing the insulin he had with the food he could find. Eating too much without enough insulin could dangerously spike blood sugar. Eating less for fear of running out of insulin could lead to severe hypoglycemia and death.
“I am afraid for myself during the shelling in northern Gaza,” Hamza said. “We were under siege. If the house is bombed, I might survive under the rubble but die from hypoglycemia. And if I eat without insulin, my blood sugar could spike dangerously. I live between two fears.”
