Muslims who are suffering from diabetes in the Netherlands are putting their health at risk to take part in Ramadan.
The month-long Islamic religious festival, when observant Muslims fast during daylight hours, is just starting around the world.
But Ramadan can cause serious health problems to those suffering from diabetes -- a condition where the body releases too much sugar into the blood.
"We have 1,400 patients. Half are immigrants, of which 60 percent are Moroccan and the rest are from Turkey and Surinam", said Eelco Meesters, head doctor of the diabetes unit at Slotervaart hospital.
There is a sharp increase in the number of patients in the week leading up to the start of Ramadan, she explained.
"They come to change their course of medication or to ask for advice," added Fatima Malki, a nurse at the hospital.
Each patient receives a specific course of medication, provided that they are fit enough to participate in the Ramadan, usually doses of insulin to be taken throughout the day.
Patients are called into the clinic a few days after the start of Ramadan to evaluate the dosage.
"We advise them to take light exercise or to have a walk after eating," said Malki.
However the majority of patients are advised against fasting during Ramadan.
"Often they decide to fast anyway," said Malki. "We have to tell them it's not a good idea. We explain to them that there are verses of the Koran which allow very sick people to be excused from fasting."
The nurse, herself of Moroccan origin, has organised meetings with mosque imams to tell worshippers that the Koran allows for exceptions.
"It's up to the imams to explain it to them as well," said Malki.
Lamfeidal el-Bouazzati, a Moroccan woman in her sixties, is sat in the waiting room.
"It's been two years since I've been allowed to fast during Ramadan. This year, I hope to be able to do the Ramadan like everybody else," she said in broken Dutch.
In less than 10 years, the service has made a name for itself. "At Ramadan, there are not only more patients, but there are also more phone calls from colleagues asking us for advice," said Malki.
Eelco Meesters has also written an advisory leaflet for general practitioners in the Netherlands, who treat 80 percent of diabetics in the country and are often ill at ease with the issue.
"Medical passports" have been issued, written in both Turkish and Arabic. The passports are aimed at Muslims suffering from diabetes who often go back to their home country for several weeks of the year. They contain essential medical information as well a list of specialists they can consult back home.