John Devlin, MD, MPH, is an endocrinologist whose practice has primarily focused on the management of diabetes.  He retired 2019 in order to work with Doctors Without Borders and continues to volunteer at Greater Portland Health. He lives in Cape Elizabeth.

As I was approaching retirement, I thought of trying to fulfill a long-term dream of working
with Doctors Without Borders, the U.S. section of Médecins Sans Frontières (MSF).

Fortunately, MSF was placing increased emphasis on non-communicable diseases, including diabetes, and my years of volunteering in Haiti with the Portland-based non-governmental organization Konbit Santé, was a key factor in my acceptance.

During my first MSF assignment, I spent six months in South Sudan, working to improve the care of type 1 diabetes in children and adolescents living in the Bahr el Ghazal region.

Children were frequently admitted to the hospital in Aweil with diabetic ketoacidosis, if they were fortunate enough to reach the hospital alive, since many had to walk for two to three days from remote villages made inaccessible during the rainy season.

This was also the time of the malaria peak, which took the lives of so many children and overwhelmed the hospital staff. Severe acute malnutrition (SAM) was a common cause of, or contributing factor to, the high mortality rates.

Food insecurity made the management of diabetes extremely challenging, due to the inability to have predictable meal schedules to match the insulin doses. In addition to frequent displacement due to intertribal conflict, ongoing following the end of civil war in 2020, climate change has caused reduced crop yields and food scarcity in Sub-Saharan Africa.

The long-term side effects of SAM in childhood can be permanent, including stunted physical growth, impaired cognitive and motor development, weakened immunity and an increased risk of chronic health issues including heart disease, diabetes and obesity later in life. There are also long-term adverse effects on mental health, leading to behavioral problems later in life.

Treatment of SAM requires expertise in gradual refeeding with specialized nutritional supplements that are only available in dedicated feeding centers.

In October 2023, I was given the opportunity to travel to Bangladesh to work in the Hospital
on the Hill (HOH), located in the middle of the world’s largest refugee camp, primarily inhabited by Rohingya refugees fleeing the ethnic violence in their home region of Myanmar.

Chronic physical and mental health problems were rife within the camps, the result of forceddisplacement, food scarcity compounded by reduced funding from the World Food Program, the ever-present violence from armed gangs and the restriction against leaving the camps to find employment.

The heinous and barbarous attack by Hamas on southern Israel had occurred two weeks prior to my arrival in Bangladesh. Along with the rest of the civilized world, I was shocked and appalled by reports of the atrocities carried out upon innocent civilians living in kibbutzim and attending the Nova music festival.

Although initially supporting the military response of the Israel Defense Forces, I became progressively disturbed by the indiscriminate killing of Palestinians as the war dragged on. Several of the expats working with me in Bangladesh had previously worked in Gaza, and were personally acquainted with some of the humanitarian health workers still there.

It soon became apparent that no one and no place was safe in Gaza, with targeted attacks on hospitals, schools and places for religious worship.

The recent report from the Integrated Food Security Phase Classification has determined that a famine is now present in Gaza, only the fourth such declaration since its creation in 2004. For the reasons discussed above, this will have dire consequences for the Palestinian people long into the future.

The fact that the U.S. government still provides military and diplomatic support to Israel in its ongoing assault on this population should galvanize every American to take action to stop this genocide.

Please join the many of us who stand on street corners, engage in acts of civil disobedience, go on a hunger strike and meet with our senators and representatives in a desperate effort to stop the bombing and allow the delivery of lifesaving supplies before it is too late.