Sudan war: Chronically ill patients forced to choose between food and medicine

Hasanat al-Rashid, 48, has lived with diabetes for 15 years. Three and a half years of conflict between the Sudanese army and the paramilitary Rapid Support Forces (RSF) have turned finding treatment into a daily struggle for her.

When war broke out in April 2023, she had to leave her home in Haj Yousif, north of the capital Khartoum, and flee south to Umm Daw Ban in Khartoum state. During those days of displacement she repeatedly went without medicine and had to eat food unsuitable for her condition, such as the traditional porridge asida.

Diabetic complications led to two foot operations after severe infections. She sought treatment at hospitals in Rufaa, Wad Madani and Al-Hasahisa in Gezira state, south of Khartoum. When fighting reached that area in December 2023, she fled again to Port Sudan, the Red Sea city largely spared by the war.

Her condition is now severe enough that she must inject insulin every day, adding to her costs. The dose varies depending on whether her blood sugar is high or low, she says.

The war has pushed incomes in Sudan back to 1990s levels, according to the United Nations Development Programme, making it hard for Hasanat and other diabetics to afford the drugs they need.

Doctors advised her to use insulin pens, which cost one or two per month. But the price of 70,000 Sudanese pounds (about $8) is beyond her if she has to pay it all at once, so she opts for a cheaper vial of insulin at 17,000 pounds (about $1.80). Even so, she must buy ice every day to keep the insulin cool, spending 180,000 pounds (about $20) a month. Spreading the cost over the month makes the vial her only feasible choice, even though the total is higher than the pen.

"The medicine can last a month or less, but the difficulty is that I have no refrigerator, so keeping the insulin properly is very hard," she says. She also needs painkillers and vitamins regularly to manage her complications.

Climbing treatment costs

At Port Sudan hospital, Fatima Adam, 75, is also struggling to find money for drugs for high blood pressure and a thyroid condition. She was admitted after hypertension complications began affecting her heart. Too weak to talk, she let her daughter Aisha describe how rising drug prices have hit the family.

Before the war, Fatima received medicine through the National Health Insurance Fund, paying only a quarter of the cost, with the fund covering the rest. When war broke out and the economy collapsed, the drugs she needs were no longer covered.

"My mother takes six different medicines because high blood pressure has affected her heart, plus thyroid medication. The war has made everything harder because the prices of all these drugs have gone up," Aisha says.

The burden of paying for Fatima's treatment falls on her son, a casual labourer. With no steady income, he goes to the market looking for work each day, but some days he returns empty-handed. "Sometimes my brother finds work and we buy enough medicine for a month. Sometimes we have to buy smaller amounts and use the drugs intermittently," Aisha says. Recently she bought a month's supply for her mother for 160,000 pounds (about $17.80), a large sum for a family living on day labour.

A devastated health system

The war has caused an estimated $500 million in damage to medicine stocks, infrastructure and transport fleets, dealing a heavy blow to Sudan's pharmaceutical supply system, according to the National Medical Supply Fund. The National Council for Medicines and Poisons estimates that only 8 of the 30 drug factories in Khartoum that closed during the conflict have resumed operations, even as security in the capital has improved recently.

That has increased Sudan's reliance on imported medicine, while the depreciating Sudanese pound has sent the cost of buying and producing drugs soaring. Before the war, one US dollar bought about 600 Sudanese pounds; on the black market it now trades at up to 9,300 pounds.

Pharmacist Hossam al-Naeem in Port Sudan says diabetics and hypertension patients need painkillers and vitamins regularly. "It saddens me to see patients' faces when they ask about prices and realise how much they have risen because the Sudanese pound has lost its value," he says.

He himself sometimes takes a loss when prices jump sharply. "I used to sell a strip of cold and flu tablets for 6,000 Sudanese pounds (about 70 cents). But when I restocked, the supplier's price was also 6,000 pounds a strip. That leaves me no profit, not even enough to cover the pharmacy's running costs," he says.

Fears of running out of heart medicine

Huda Mahmoud, 58, lives in el-Obeid, capital of North Kordofan state in central Sudan, where drone attacks and violence continue as the army advances on the city. She has had a heart condition for more than 12 years and describes the war's impact as physical, financial and psychological.

"I take five different medicines. At times they were unavailable and I suffered terribly. Sometimes I had to ask people in Wad Madani, Sennar or Port Sudan to send me the drugs," she says. "The medicine is terribly expensive, costing 300,000 Sudanese pounds (about $33.30) a month."

Taking her medication is a tightly managed routine, each pill tied to a time of day. "I am bound to my pills: this one before eating, that one after eating. If I miss one, my heart races," she says.

In March she had to leave el-Obeid for Omdurman, and keeping to the strict regimen became even harder amid repeated upheaval. She has now returned to el-Obeid, where her usual medicine costs 151,000 pounds (about $16.80) a month, a sum she can barely afford.

Her greatest fear is running out of medicine or being unable to pay for the next batch, putting her at risk of a blood clot. "I am afraid of losing my ability to work. I used to look after the whole family; now I need help. I feel like a burden on my family," she says.