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One of us (IV) lives in Ukraine, has type 1 diabetes, and is vice president of the International Diabetes Federation (IDF), a global advocacy umbrella organisation that represents national diabetes associations. She founded a collaboration between the Ukrainian Ministry of Health and international organisations, including the IDF and Direct Relief, a humanitarian aid organisation that provides medical supplies including insulin. To understand how day to day challenges varied by region, IV convened a nationwide group of people with diabetes and healthcare professionals. The collaboration is concerned with immediate and future needs for people with diabetes. It assessed domestic insulin supplies and secured donations from local and foreign companies to create a buffer. But people with diabetes in Ukraine lacked awareness of these efforts, which led to panic buying. Regular and timely updates on the Ministry of Health’s website and Facebook about which pharmacies had insulin stocks helped to reduce public anxiety and may have helped save lives.2 Telephone and online consultation kept patients in touch with healthcare providers,7 8 but electricity and internet are often disrupted in humanitarian crises. Communication through local patient organisations and volunteers is therefore essential to ensure that no one who needs it is left without insulin, especially elderly people.

online consultation kept patients in touch with healthcare providers,7 8 but electricity and internet are often disrupted in humanitarian crises. Communication through local patient organisations and volunteers is therefore essential to ensure that no one who needs it is left without insulin, especially elderly people. The collaboration among patients, healthcare providers, and decision makers is far from tokenistic; it includes direct, honest, two way communication with the government. Such engagement with people with lived experience is crucial. The collaboration has had several benefits. These include, firstly, patients reporting needing more short acting insulin because of stress, and the government taking this into account when distributing supplies. Secondly, mass migration to western regions led to a shortage of glucose meters and test strips, and this quickly informed distribution. Thirdly, in response to patient concern about provision of electricity for insulin storage, the government bought generators and organised warehouse space for pharmacies and hospitals experiencing temporary power cuts. Finally, some patients could not obtain their usual type of insulin so the collaboration adapted international guidance on switching products to guide patients and healthcare professionals in this specific conflict setting.9

People with diabetes themselves have been crucial in looking after each other, by sharing insulin and test strips that they received from abroad and delivering supplies to villages and areas with active fighting. Volunteers distribute leaflets explaining how to get insulin, particularly in areas to which internally displaced people have fled. The conflict prompted diabetes associations and people with diabetes worldwide to send financial and material support to Ukraine. The international community in neighbouring countries helped refugees from Ukraine, and IDF Europe provided online information and contact details in Ukrainian. It is vital, therefore, that governments and healthcare systems actively engage with people with NCDs to encourage peer-to-peer support in humanitarian crises—for example, by including them in ministry working groups on legislation. National and local collaboration should be based on partnership and open communication. We created a direct channel to the Ministry of Health for urgent exchange of information between the ministry and patient groups to solve urgent problems. Training people with NCDs in emergency preparedness and how to mitigate risk during treatment interruptions before humanitarian crises begin would be useful. Doctors, nurses, pharmacists, and others providing education on self-management of diabetes could deliver this training.

It is vital, therefore, that governments and healthcare systems actively engage with people with NCDs to encourage peer-to-peer support in humanitarian crises—for example, by including them in ministry working groups on legislation. National and local collaboration should be based on partnership and open communication. We created a direct channel to the Ministry of Health for urgent exchange of information between the ministry and patient groups to solve urgent problems. Training people with NCDs in emergency preparedness and how to mitigate risk during treatment interruptions before humanitarian crises begin would be useful. Doctors, nurses, pharmacists, and others providing education on self-management of diabetes could deliver this training. NCDs must be prioritised in every humanitarian response and access to insulin, a WHO essential medicine, be maintained. People with lived experience have an invaluable role during humanitarian crises, whether working independently or in partnership with government, healthcare, or civil society agencies, and every level of decision making in humanitarian response should be informed by people with lived experience. All healthcare responses in crises should be co-designed and co-delivered with people with lived experience, to reach practical solutions that are based on real and rapidly changing needs. Such collaboration among patients, decision makers, stakeholders, and industry brings resilience and strength.