Sudan's War Forces Chronic Illness Sufferers to Choose Between Life-Saving Medicine and Food

For individuals like pharmacist Hossam al-Naeem, the ongoing conflict in Sudan has led to significant financial losses, sometimes even forcing them to sell medicines at a loss. Hasanat al-Rashid, a 48-year-old living with diabetes for 15 years, has seen her condition drastically worsen due to the civil war between Sudan’s military and the Rapid Support Forces paramilitary group, which began in April 2023. Her daily struggle for essential treatment intensified after she was displaced from her home in Haj Yousif, Khartoum North, to Umm Daw Ban in Khartoum State. During this displacement, she endured days without medication and was compelled to consume foods unsuitable for her condition, such as asida, a traditional Sudanese porridge. Complications from diabetes led to two foot operations due to a severe infection. She sought treatment across Gezira State, moving between hospitals in Rufaa, Wad Madani, and Al-Hasahisa. When fighting reached these areas in December 2023, she was forced to flee again, eventually reaching Port Sudan, a city on the Red Sea that had been less impacted by the war. Her health has deteriorated to the point where daily insulin injections are now necessary. This increased need comes with added costs, forcing diabetes patients in Sudan into an impossible choice between affording medicine and other basic necessities like food. "The doses vary depending on whether my blood sugar is high or low," she told Al Jazeera. The United Nations Development Programme reports that the war has regressed Sudan's income levels to those seen in the 1990s, exacerbating the financial strain on Hasanat and other diabetes sufferers trying to afford their treatment. Hasanat’s doctor recommended an insulin pen, which would require one to two devices monthly at a cost of 70,000 Sudanese pounds ($8). However, this upfront cost is prohibitive, leading her to opt for insulin vials, which are cheaper at 17,000 Sudanese pounds ($1.80). The challenge with vials is the daily expense of buying ice to keep the insulin cool, amounting to 180,000 pounds ($20) per month. Despite the higher overall cost, vials are her only viable option as she lacks a refrigerator to store insulin properly. She also requires regular painkillers and vitamins to manage diabetes-related complications. Fatima Adam, 75, is another patient at Port Sudan Hospital facing difficulties affording medications for hypertension and a thyroid condition. Her daughter, Aisha, explained that Fatima was admitted with high blood pressure complications affecting her heart. Before the war, Fatima received subsidized medication through the National Health Insurance Fund, paying only a quarter of the cost. However, the war's economic collapse meant these medicines were no longer covered by the scheme. Fatima requires six different medications due to hypertension impacting her heart, in addition to thyroid medication. Aisha noted that the war has significantly increased the prices of these essential drugs. The financial burden of Fatima’s treatment and support falls on her son, a casual worker with no fixed income, who struggles to find daily work. "Sometimes, when my brother finds work, we buy enough medicine to last a month. Other times, we have to buy smaller quantities and take the medicines intermittently," Aisha said. She recently purchased a month's supply for 160,000 Sudanese pounds ($17.80), a considerable expense for a family reliant on daily labor. The war has inflicted an estimated $500 million in losses on medicine stocks, infrastructure, and transport fleets, severely disrupting Sudan's pharmaceutical supply system, according to the National Medical Supplies Fund. The National Medicines and Poisons Board estimates that only eight of Khartoum's 30 pharmaceutical factories have resumed operations since the conflict began, despite recent security improvements. This has increased Sudan's dependence on imported medicines, with the Sudanese pound's depreciation further escalating procurement and production costs. Hossam al-Naeem, a pharmacist in Port Sudan, highlighted that patients with diabetes and hypertension often need regular painkillers and vitamins. "I feel deeply saddened when I see the expressions on some patients’ faces as they ask about the prices of medicines and discover how much they have increased because of the depreciation of the Sudanese pound," Hossam told Al Jazeera. The currency's collapse has created significant challenges for pharmacists. The exchange rate has shifted dramatically, with black-market rates reaching 9,300 pounds to the dollar, compared to roughly 600 pounds before the war. This has driven up the cost of most goods. Hossam sometimes incurs losses when drug prices surge, making it difficult to maintain essential medicine stock. He cited an instance where the supplier's price for a strip of cold and flu tablets equaled his selling price, resulting in no profit and insufficient funds to cover operating costs. Huda Mahmoud, 58, residing in el-Obeid, North Kordofan state, faces similar struggles amidst ongoing violence and military advances. Living with heart problems for over 12 years, she described the war's physical, financial, and emotional toll. "I take five different medicines. There was a time when they weren’t available, and I suffered a lot. Sometimes, I had to ask people in Wad Madani, Sennar or Port Sudan to send them to me," she said. "The medicines were extremely expensive, costing me 300,000 Sudanese pounds [$33.30] a month." Her medication regimen is precise, with each pill timed to specific meals. "I’ve become tied to my pills: this one before eating, that one afterwards. If I forget one, my heart starts beating very fast," she added. Huda was forced to travel from el-Obeid to Omdurman in March, making adherence to her strict treatment difficult due to repeated upheaval. She has since returned to el-Obeid, where her monthly medication costs 151,000 Sudanese pounds ($16.80), a sum she can barely afford. Her greatest fear is running out of medicine or being unable to purchase her next supply, which could lead to a blood clot. "I’m afraid of becoming incapacitated. I used to be responsible for the whole household, but now I need help. I feel like I’ve become a burden on my family," she said.