Hasanat al-Rashid, 48, has lived with diabetes for 15 years, and she says the civil war between Sudan’s military and the Rapid Support Forces paramilitary group, now in its third and a half year, has made getting her treatment a daily struggle. Her case reflects a wider pattern in which people with long-term illnesses are forced to decide between buying medicine and buying food.
Patients with chronic conditions across the country describe rising prices, unreliable supplies and shrinking incomes. Pharmacists and officials also point to damage to the country’s drug supply system, which they say has been hit hard by the fighting and by the sharp fall in the value of the Sudanese pound.
Diabetes patient weighs insulin pens against cheaper vials
Hasanat was forced to flee her home in Haj Yousif in Khartoum North when the war broke out in April 2023. She moved to Umm Daw Ban in Khartoum State, and during her displacement she went for days without medication. She was also forced to eat foods unsuitable for her condition, such as asida, a traditional Sudanese porridge.
After complications of diabetes, including a severe infection, she underwent foot operations twice. She later moved between hospitals in Gezira State, in Rufaa, Wad Madani and Al-Hasahisa, before fighting reached those areas in December 2023. She then fled to Port Sudan, a Red Sea city that she said was less affected by the war.
Her condition has worsened, and she now needs insulin every day. Her doctor recommended an insulin pen, which she would need one or two of each month. At 70,000 Sudanese pounds ($8), however, the pen costs more than she can pay up front, so she buys vials instead.
The vials cost 17,000 Sudanese pounds ($1.80), but she must also buy ice every day to keep the insulin cool, which adds 180,000 pounds ($20) a month. She said the vials are still her only workable option because she can spread the payments through the month. “It may last a month or less, but the challenge is that I don’t have a refrigerator, so I struggle to store the insulin properly,” she said. She also needs painkillers and vitamins regularly to manage complications.
Heart and thyroid patient struggles with uncovered medicines
Fatima Adam, 75, is one of the patients at Port Sudan Hospital who are struggling to afford medicines for hypertension and a thyroid condition. She was admitted with complications from high blood pressure that have begun to affect her heart. Too unwell to speak to a reporter herself, she was represented by her daughter, Aisha.
Before the war, Fatima received her medicine through the National Health Insurance Fund, paying a quarter of the cost while the fund covered the rest. Once the war began and the economy collapsed, the scheme no longer covered the medicines she needed. “My mother takes six different medicines because hypertension has affected her heart in addition to her thyroid medication,” Aisha said. “The war has made things harder because the prices of these medicines have gone up.”
The family depends on Fatima’s son, who works as a casual labourer and has no fixed income. He searches the market every day for work, and some days he returns with nothing. “Sometimes, when my brother finds work, we buy enough medicine to last a month,” Aisha said. “Other times, we have to buy smaller quantities and take the medicines intermittently.”
Aisha said she recently bought a month’s supply of her mother’s medication for 160,000 Sudanese pounds ($17.80). She described the sum as a heavy cost for a household that relies on day labour, but one that is essential to Fatima’s treatment.
Shortages and currency slide squeeze pharmacies and supply
The National Medical Supplies Fund said the war has caused estimated losses of $500m to medicine stocks, infrastructure and transport fleets. It described the damage as a major blow to Sudan’s pharmaceutical supply system. The National Medicines and Poisons Board estimated that only eight of the 30 pharmaceutical factories in Khartoum that shut during the conflict have resumed operations, even though security in the capital has recently improved.
Officials said this has increased Sudan’s reliance on imported medicines. However, the depreciation of the Sudanese pound has raised the cost of buying and producing medicines. Before the war, a dollar traded for roughly 600 pounds. Black-market currency traders are now quoting 9,300 pounds to the dollar, which pushes up the cost of most goods.
Hossam al-Naeem, a pharmacist in Port Sudan, said customers with diabetes and hypertension need regular painkillers and vitamins to support their general health. He said it distresses him to see patients react when they learn how much medicine prices have risen. “I feel deeply saddened when I see the expressions on some patients’ faces as they ask about the prices of medicines,” he said.
Hossam also said he sometimes takes losses himself. He recalled that he used to sell a strip of cold and flu tablets for 6,000 pounds (70 cents). When he restocked, the supplier’s price was also 6,000 pounds per strip, leaving him no profit and not enough to cover the pharmacy’s operating costs.
Heart patient in el-Obeid fears running out of pills
Huda Mahmoud, 58, lives in el-Obeid, the capital of North Kordofan state in south-central Sudan. Drone attacks and other violence remain a problem there, while the military is making advances towards the city. Huda has lived with heart problems for more than 12 years and describes the impact of the war as physical, financial and emotional.
She takes five medicines and said there was a time when they were unavailable, forcing her to ask people in Wad Madani, Sennar or Port Sudan to send them to her. “The medicines were extremely expensive, costing me 300,000 Sudanese pounds [$33.30] a month,” she said. Each of her pills is tied to a specific time of day, which she described as a carefully managed routine. “If I forget one, my heart starts beating very fast,” she said.
In March, Huda was forced to travel from el-Obeid to Omdurman, and keeping to her treatment schedule has become harder during repeated periods of upheaval. She has since returned to el-Obeid, where her regular medicine now costs 151,000 Sudanese pounds ($16.80) a month, which she said she can barely afford.
Her greatest fear is running out of medicine or being unable to pay for her next supply, which she said could put her at risk of a blood clot. “I’m afraid of becoming incapacitated. I used to be responsible for the whole household, but now I need help,” she said. “I feel like I’ve become a burden on my family.”
