Since the war between the Sudanese military and the Rapid Support Forces began in April 2023, chronically ill Sudanese have faced a daily struggle to obtain treatment. The United Nations Development Programme says the conflict has pushed income levels back to those last seen in the 1990s, while the currency's collapse has made imported medicines increasingly unaffordable.
Hasanat al-Rashid, 48, has lived with diabetes for 15 years. Forced to flee her home in Haj Yousif in Khartoum North, she has moved repeatedly, spending time in Umm Daw Ban and in the Gezira State towns of Rufaa, Wad Madani and Al-Hasahisa before reaching Port Sudan when fighting spread south in December 2023. She now needs daily insulin. Her doctor recommended an insulin pen costing 70,000 Sudanese pounds ($8), but she cannot afford the upfront cost, so she buys vials of insulin at 17,000 pounds ($1.80) and spends 180,000 pounds ($20) a month on ice to keep them cool without a refrigerator. "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 told Al Jazeera.
Fatima Adam, 75, admitted to Port Sudan Hospital with complications from hypertension that has begun to affect her heart, takes six medicines for her blood pressure and a thyroid condition. Before the war she received treatment through the National Health Insurance Fund, paying a quarter of the cost while the fund covered the rest. That coverage has ended, and the responsibility now falls on her son, a casual worker who sometimes returns from the market empty-handed. Her daughter Aisha said the family sometimes buys a full month's supply and sometimes buys smaller quantities, taking the medicines intermittently. A month's supply recently cost 160,000 Sudanese pounds ($17.80).
The war has devastated Sudan's medical supply system. The National Medical Supplies Fund told Al Jazeera the conflict has caused an estimated $500m in losses to medicine stocks, infrastructure and transport fleets. The National Medicines and Poisons Board estimates that only eight of the 30 pharmaceutical factories in Khartoum that shut down during the conflict have resumed operations, deepening dependence on imports just as the pound's depreciation raises procurement costs.
Port Sudan pharmacist Hossam al-Naeem said customers with diabetes and hypertension need regular painkillers and vitamins, and described watching patients discover how much prices had risen. Before the war a dollar traded for roughly 600 Sudanese pounds; black-market currency traders now quote about 9,300 pounds to the dollar. He said he sometimes makes no profit because supplier prices have risen so sharply. "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," he said.
In el-Obeid, the capital of North Kordofan, Huda Mahmoud, 58, has lived with heart problems for more than 12 years and takes five medicines. With drone attacks and other violence still a threat in the area, her regular medicine costs 151,000 Sudanese pounds ($16.80) a month, which she can barely afford. Earlier in the war, when supplies ran short, she sometimes had to ask people in other cities to send medicine, at one point costing her 300,000 pounds ($33.30) a month. "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.