Food or medicine? The impossible choices facing Sudan’s chronically ill

Sudanese are facing growing costs of medicine caused by the country’s civil war.

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Hasanat al-Rashid has struggled to find the medicine to treat her diabetes during Sudan’s civil war [Fatima Edam/Al Jazeera]

The rising cost of treatment

Fatima Adam, 75, is among the patients at Port Sudan Hospital struggling to afford the medicines she needs to manage her hypertension and a thyroid condition.

She was admitted to the hospital with complications caused by high blood pressure, which has started to impact her heart. Too unwell to speak to Al Jazeera herself, her daughter, Aisha, described how the rising cost of treatment has affected her whole family.

Before the war, Fatima received medicine through the National Health Insurance Fund. She paid a quarter of the cost while the fund covered the rest. But when the war started and the economy collapsed, the medicines she needed were no longer covered by the scheme.

“My mother takes six different medicines because hypertension has affected her heart in addition to her thyroid medication. The war has made things harder because the prices of these medicines have gone up,” Aisha told Al Jazeera.

The responsibility for paying for Fatima’s treatment and supporting her and her daughter falls on her son, who works as a casual worker. With no fixed income, he goes to the market every day in search of work but sometimes returns home empty without any luck.

“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 bought a month’s supply of her mother’s medication a few days ago for 160,000 Sudanese pounds ($17.80), a substantial expense for a family whose income depends on day labour but essential to treating Fatima’s condition.

War damage

The war has caused an estimated $500m in losses to medicine stocks, infrastructure and transport fleets, dealing a major blow to Sudan’s pharmaceutical supply system, the National Medical Supplies Fund told Al Jazeera.

The National Medicines and Poisons Board estimated that only eight of the 30 pharmaceutical factories in Khartoum that shut down during the conflict have resumed operations despite the security situation in the capital recently improving.

This has increased Sudan’s reliance on imported medicines, but the subsequent depreciation of the Sudanese pound has driven up the costs of pharmaceutical procurement and production.

Hossam al-Naeem struggles to stock some medicines in his pharmacy due to the collapse of the Sudanese pound [Fatima Edam/Al Jazeera]

Hossam al-Naeem, who works as a pharmacist in Port Sudan, said customers with diabetes and hypertension require regular painkillers and vitamins to help their overall condition.

“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 added challenges for pharmacists. Before the war, a dollar traded for roughly 600 Sudanese pounds. Now black-market currency traders are quoting rates of 9,300 pounds to the dollar, meaning higher costs for most goods in Sudan.

Sometimes Hossam incurs losses himself when he finds that the prices of drugs have risen sharply, and keeping essential medicines stocked is becoming difficult.

“I used to sell a strip of cold and flu tablets for 6,000 Sudanese pounds [70 cents]. But when I went to buy new stock, I found that the supplier’s price was also 6,000 pounds per strip. That means I made no profit, not even enough to cover the pharmacy’s operating costs,” he said.

The struggle to afford heart medication

Huda Mahmoud, 58, lives in el-Obeid, the capital of North Kordofan state in south-central Sudan, where drone attacks and other violence remain a problem while the military is making advances towards the city.

Huda has lived with heart problems for more than 12 years and described the impacts of the war as being physical, financial and emotional.

“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 told Al Jazeera. “The medicines were extremely expensive, costing me 300,000 Sudanese pounds [$33.30] a month.”

Taking medication has become a carefully managed routine with each pill tied to a specific time of day.

“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.

In March, Huda was forced to travel from el-Obeid to Omdurman. Following her strict treatment regimen has become increasingly difficult during repeated periods of upheaval.

She has now returned home to el-Obeid, where her regular medicine is priced at 151,000 Sudanese pounds ($16.80) a month, something she can barely afford.

Her greatest fear is running out of medicine or being unable to afford her next supply, which would 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. I feel like I’ve become a burden on my family,” she said.