In the embattled city of Goma, situated at the edge of the Virunga National Park in eastern Democratic Republic of Congo, a small diabetes treatment association is carrying on a quiet frontline mission against a deadly but treatable disease.

The Association des Diabetiques du Congo, or ADIC, a local nonprofit diabetes association, has become a lifeline for nearly 5,800 patients, many of them children and young adults. In just three years, patient numbers have jumped from 3,965 in 2021 to 5,789 in 2024 — a spike fueled in part by mass displacement, limited access to nutrition in refugee camps, and the collapse of other local healthcare options.

Non-communicable diseases, or NCDs, of which diabetes is one, are projected to become the leading cause of death in sub-Saharan Africa within the next five years, surpassing infectious diseases, according to the World Health Organization.

Speaking at the 4th Global NCD Alliance Forum in Kigali, Rwanda, in February, Katie Dain, CEO of the NCD Alliance, emphasized the urgent need to address the growing burden of non-communicable diseases, warning that people living with NCDs are increasingly vulnerable in what she called a global “polycrisis”— a convergence of challenges including pandemics, climate change, armed conflict, and humanitarian emergencies.

ADIC’s work is a prime example of those challenges.

“We operate in a very difficult environment,” said Alfred Kakisingi, ADIC’s manager.

In 2021, a series of disasters rocked the region: a volcanic eruption, severe earthquakes, and the imposition of martial law. Under the state of siege, even basic internal travel required military authorization. And when armed rebellion followed, access to rural patients became nearly impossible. Some remained trapped in rebel-occupied areas; others fled to camps where international NGOs, once providers of basic medical care, were forced to pull out.

Delivering medications, especially temperature-sensitive insulin, which was never easy, quickly became challenging.

“The risk was high on both sides: serving patients in rebel areas made us vulnerable to loyal forces, who could mistake us for collaborators, and vice versa,” Kakisingi said.

To reach patients, ADIC relied on a fragile network of motorbike couriers and merchants through perilous routes across Virunga National Park — where transporters risked encounters with wild animals, including snakes, and crocodile-infested rivers. Some medicine, like insulin, came via air shipment into Kigali, Rwanda, then traveled overland to the Goma border, where customs fees were paid— often both in Rwanda and the DRC— before the cargo reached ADIC’s center, where Direct Relief supplies most of the clinic’s donations.

Many patients live in Goma, but ADIC works hard to get medications to those in isolated areas as well. Moving products to those patients comes with a new set of obstacles, including exposure to the elements, impassable roads, long travel times, and limited portable refrigerated containers.

The lack of quality diabetes management supplies in the country has led many to turn to locally available products.

“It’s common to find patients who, due to lack of access to quality products, resort to herbal remedies, which often worsen their health,” he said. Even at ADIC’s clinic, sometimes care is given using impromptu means. Recently Kakisini shared that a boy who came into the clinic with severe hypoglycemia was treated by giving him sugar water and then some donuts, “for lack of a better option,” he said.

ADIC’s partnerships have helped close the gap in some areas. Since the 1990s, the group has collaborated with Aidevision ASBL, which provides eye care to low-income patients. Diabetic retinopathy is a major issue in the region, and the two groups coordinate to stabilize blood sugar and blood pressure before eye surgeries.

“The collaboration is built on years of friendship and brotherhood,” Kakisingi said.

Due to a separate partnership between Aidevision and the Lions Club, 19 young people have received corrective eye surgeries and prescription glasses since 2021. Another five received glasses and 235 adults were referred to Aidevision for heavily subsidized care.

ADIC’s vision is to evolve from an outpatient support center into a full diabetes clinic, capable of hospitalizing patients in crisis. Kakisingi said four solar-powered fridges from Direct Relief were a step forward towards that goal. The clinic also has a machine for testing HbA1c and microalbumin/creatinine levels— but reagents are scarce, and other key lab equipment, like a blood chemistry analyzer, is still out of reach.

Global health donors, Kakisingi emphasized, should invest not only in drugs but in helping local doctors train and serve in their own communities.

Meanwhile, the costs of limited access to care are measured in lives. Three young people died from untreated hypoglycemia in the past year. Four others died after leaving Goma without insulin.

But there are victories, too — young patients who regained their sight, others whose blood sugar is now under control, and many more who are living proof of the clinic’s ultimate mission: to help people lead full, healthy lives.

Since 2023, Direct Relief has provided $17.5 million in medical support to Association des Diabetiques du Congo, or ADIC. This support includes diabetes management supplies, including needles, test strips, insulin, and refrigerators for cold storage of temperature-sensitive medications.