For nearly two months, Amira Abdel-Radi, who was diagnosed with kidney failure in 2021, has been struggling with a severe shortage of anemia treatment injections, especially Erythropoietin (EPO)—a glycoprotein hormone naturally produced by the kidneys to stimulate bone marrow to generate red blood cells, thus supplying oxygen to body tissues. The drug is used to treat anemia caused by chronic kidney disease, chemotherapy, or HIV. The shortage often forces her to undergo blood transfusions, which expose her to serious health complications.
She recalls that more than twenty years ago, she had to undergo a blood transfusion because of the unavailability of anemia injections. However, the blood she received carried an inactive hepatitis B virus, which became active once inside her body, causing a life-threatening health crisis. Suddenly, she found herself expelled from the dialysis unit where she used to receive treatment, beginning a long and exhausting journey to another, more distant hospital that she had to visit three times a week for two full years, until she recovered from the virus.
Later, Amira launched the Save Kidney Failure Patients Campaign. She remembers a mother whose daughter suffers from kidney failure and whose hemoglobin level dropped to 4 in recent days. The mother rushed to find blood bags for her child at any cost. When she went to the hospital, she was told that she could not obtain blood unless she brought two donors. When she failed to find any, she offered to buy a bag for over 1,000 pounds ($20), but still could not get it easily.
Until recently, Amira used to receive 12 “Epotin” injections per month, but the number gradually decreased until it stopped completely four months ago, both for patients under public health insurance and those receiving treatment at the state’s expense. Like most patients, she now relies on donated medications among patients themselves, a temporary solution that does not meet their needs. She adds that other essential drugs, such as B-Com and L-Carnitine, have also disappeared, even though they are crucial to compensate for what the body loses during dialysis sessions.
“The Epotin injections that were regularly provided to kidney failure patients receiving treatment at the state’s expense have been reduced and then disappeared,” says the founder of the Save Kidney Failure Patients Campaign to Zawia3. “Now, we share whatever donated medicines we can get, but is that a permanent solution?”
She adds, “The crisis is not only about the shortage of medicines. It also includes the high costs of medical tests, scans, and surgical examinations, which patients are still required to pay for even when treated at the state’s expense. Most of us cannot work because of our health conditions, as employers refuse to hire anyone who must attend dialysis sessions three times a week, while there are no supportive policies to provide suitable jobs.”
The problems faced by patients extend beyond medicines to dialysis filters themselves. After the introduction of the ‘automated dialysis system’, patients are now required to register their data electronically under the pretext of providing filters that suit their body weights. However, Amira believes the result has been the opposite, claiming that locally manufactured filters, often unsuitable for patients, are now frequently used during dialysis sessions, for both adults and children. “Has supporting local industry come at the expense of our health?” she asks.
In March 2025, the Ministry of Health and Population announced new procedures for receiving dialysis sessions under the automated system (Nephro-Misr) across all governorates, as part of the state’s digital transformation strategy. The new system allows patients to book sessions via a hotline, which then directs them to the nearest available dialysis center—whether public, private, or NGO-run—and schedules their sessions electronically, informing them of the days and times.
Since the launch of the automated dialysis system in April 2024, around 2 million dialysis sessions have been conducted, averaging 11 sessions per patient per month for a total of 50,000 patients. According to a previous statement by Dr. Hossam Abdel-Ghaffar, the ministry’s spokesperson, the system has helped save 20% of state expenditures and monitor the performance of 12,000 registered nurses.
Transportation costs to dialysis units three times a week represent another layer of suffering. Although the law grants patients this financial support from the moment the dialysis decision is issued, they are often forced to file lengthy lawsuits to obtain it, paying about 35% of their dues to lawyers, while some are coerced into signing waivers that prevent them from claiming it at all. “We once won a court ruling granting us 200 pounds ($4) per session, but years later, the amount was reduced to 30 pounds ($0.6)—which covers nothing. Why must we fight legal battles to get our rights?” Amira asks.
Amira believes the problem goes far beyond the shortage of medicines or high costs—the entire healthcare system exhausts patients and their families. She stresses that kidney failure patients face multiple burdens: the lack of drugs and supplies, rising blood costs, the absence of real support for transportation or employment, and a system that forces them to rely on donations and court orders. “The solution,” she insists, “lies in urgent state action to ensure the regular supply of essential medicines and injections, and in enshrining patients’ rights fairly, without the need for legal struggles or individual charity.”
Meanwhile, Hadir Alaa, a kidney failure patient living in Marsa Matrouh Governorate, says she received her September and October medication, including L-Carnitine and B-Com injections given after dialysis sessions, but she has been unable to obtain EPO injections for the past two months due to their unavailability. Her hemoglobin levels have been dropping rapidly, forcing her to undergo blood transfusions she wishes to avoid because of their health risks. She says she recently had to buy a blood bag of type (O+) at her own expense for 350 pounds ($7) because it was not available in hospitals.
Hadir confirms that the suffering of kidney failure patients does not stop at the shortage of medicine; it extends to their daily physical and psychological hardships. She had to quit her job after the “fistula” surgery affected her left hand, rendering it useless for any activity. “This hand is like my second heart,” she says.
She tells Zawia3: “Post-dialysis medications like L-Carnitine and B-Com are distributed unevenly among patients. For me, treatment at the state’s expense is provided every one or two months, while some insured patients struggle to obtain it. The main shared problem is the irregular availability of anemia injections, which differs from one area to another.”
Hadir calls on the state to recognize kidney failure as a disability, granting patients access to the Comprehensive Services Card and the Takaful and Karama social protection pension. The disease, she says, deprives patients of the ability to work and imposes additional financial burdens, including transportation costs of about 100 pounds ($2) per hospital visit, as she attends three sessions weekly. She notes that the transportation allowance patients previously obtained retroactively through court rulings is no longer disbursed, depriving them of a legally guaranteed right.
In 2020, Egypt’s Supreme Administrative Court ordered the health insurance authority to pay 600 pounds ($12) per month in transportation allowance to five kidney failure patients from villages in Beheira Governorate, after the authority refused to provide the compensation voluntarily. The court rejected the authority’s appeal and upheld the earlier ruling by the Alexandria Administrative Court, which stated that transportation costs between home and dialysis centers are part of the essential treatment expenses that the healthcare provider is legally obliged to cover.
In December 2024, the Supreme Administrative Court of the State Council established a judicial principle ruling that an insured pensioner cannot simultaneously receive both a transportation allowance and health insurance benefits for dialysis sessions. The court determined that the law limits the entitlement of pensioners or their dependents under the health insurance system solely to medical treatment and care benefits.
Financial Burdens and Deteriorating Living Conditions
The shortage of medicines and the reduction in prescribed doses represent a serious crisis for dialysis patients, including Mohamed Mahmoud, who lives in Beheira Governorate and receives an Epotin or Recormon injection during each dialysis session, as prescribed by his doctors. Recently, however, he has not been receiving the full number of injections. He explains that the situation varies from month to month: in June, he received all six prescribed doses, but in subsequent months, the number decreased or stopped altogether.
He tells Zawia3, “Last month, I didn’t get any injections because the hospital had none available. When I came back this month to ask, they told me the injections from last month were no longer available for me and gave me only two instead of four, even though I’m supposed to get one every week.” He adds that treatment authorization decisions for kidney failure patients can take months to be issued, forcing them to buy the injections themselves, even though they are vital for their health.
Mohamed adds that L-Carnitine and B-Com injections are not distributed regularly. His doctor told him that his treatment authorization covers only six B-Com doses, compelling him to purchase the rest at his own expense, despite the continuous increase in drug prices. He stresses that the lack of injections often forces patients to undergo blood transfusions, which adds another financial burden due to the high cost of a blood bag and the difficulty of finding donors.
He calls on the government to grant dialysis patients the Comprehensive Services Card, noting that kidney failure is a chronic illness that prevents patients from leading normal lives. Mohamed also emphasizes that the transportation allowance issue remains unresolved, as the amounts ruled by courts are extremely small and do not meet patients’ needs. He concludes: “Very few of us can work while undergoing dialysis, so we need a special pension to help us survive, especially with prices constantly rising.”
While Enas Farouk, who began dialysis treatment in September 2024, suffers like many others from the shortage of Erythropoietin, an essential drug for anemia, and from the lack of suitable dialysis filters for her body weight, she recalls facing great difficulties finding an available spot in public hospitals under the health insurance system. Most were already at full capacity or charged high fees for dialysis sessions, forcing her to receive treatment at the Al-Wafaa wal Amal Center in Nasr City, Cairo, under the insurance system, while paying the cost difference of 115 pounds ($2.3) per session. She now fears an expected price increase that would exceed her financial capacity.
She tells Zawia3: “The total cost of a session is 900 pounds ($18), of which the Health Insurance Authority covers 785 pounds ($15.7), and I pay the difference. But we were informed that the center plans to raise the session price to 1,200 or 1,300 pounds ($24–$26), which means I’ll have to pay 400 to 500 pounds ($8–$10) per session. That’s completely beyond my ability.” She adds that this is not the first time the center has attempted to raise prices.
Hanan Hamada, a member of the General Assembly of the Egyptian Kidney Association, explains that the biggest challenges facing kidney failure patients in Egypt are the shortage of vital medicines and the rising cost of treatment. She confirms that state-funded treatment authorizations are insufficient to cover patients’ needs, often not exceeding 4,000 pounds ($80) for six months, while patients require multiple medications for bones, calcium, blood pressure, thyroid disorders, and anemia injections—which have been completely unavailable for months—forcing them to undergo repeated blood transfusions.
She tells Zawia3: “The suffering extends to the financial burdens. Patients pay for tests, analyses, and medicines out of their own pockets, even during dialysis sessions at private centers. On top of that, the transportation allowance has been stopped or reduced to 30 pounds ($0.6) per session, even though many patients travel long distances to reach the centers.” She notes that dialysis patients are denied access to the Comprehensive Services Card, despite their inability to work and their near-total dependence on treatment.
Hanan, who was diagnosed with kidney failure eight years ago, adds that the number of dialysis centers in Egypt is insufficient to accommodate all patients, leading to long waiting lists and the closure of some private centers. Although the new automated system offers advantages, such as allowing patients to undergo dialysis in any governorate through a centralized platform, it still suffers from issues such as standardized filter sizes, which pose a danger to underweight patients.
The number of kidney failure patients requiring dialysis in Egypt is estimated at around 60,000, with each patient needing at least three sessions per week. The actual cost of one session is about 685 pounds ($13.7). The state subsidizes most patients, many of whom receive treatment in public hospitals, while their families bear a large part of the expenses, especially those not covered by health insurance. According to the Ministry of Health and Population, in a 2017 statement, 49% of kidney failure cases in Egypt are caused by high blood pressure or diabetes.
In October 2025, the Ministry of Health announced the issuance of 776,379 treatment authorizations at a total cost of 6.364 billion pounds ($127.28 million) between July and August 2025, as part of the “100 Days of Health” initiative. These authorizations covered specialties including oncology, liver, kidney, cardiac, orthopedic, neurology, and bone marrow transplantation, benefiting a total of 736,543 patients.
Drug Shortages Threaten Patients
The shortage of medicines for kidney failure patients in Egypt has not yet reached catastrophic levels, but the most severe problem they face is the recurring scarcity of Erythropoietin, the essential drug used to treat anemia. Its absence forces patients to undergo blood transfusions, a physically and financially exhausting alternative, given the limited availability of blood bags, the difficulty of finding compatible types, and the high costs involved. According to Dr. Hamed Ezzat El-Iraqi, consultant of nephrology and internal medicine, speaking to Zawia3, Erythropoietin is only available under a few brand names such as Epotin, Epiao, and Recormon, yet “the issue lies not in the brand names but in the imported raw material, which faces periodic shortages.”
He explains: “There are other drugs that are also in short supply, including post-dialysis supplements like Vitamin B-Complex and L-Carnitine. These have some available alternatives and do not pose as serious a risk. However, Sevelamer, used to lower phosphorus levels in the blood, is also in shortage, especially after being removed from the list of medications covered by public health insurance. This has doubled the burden on patients due to its high price.”
El-Iraqi adds that the foreign currency crisis has pushed the government to replace several imported products with locally manufactured ones, raising concerns among kidney transplant patients who fear the negative effects of any change in their treatment protocols. He notes that the concern is not only medical but also psychological, as patients feel uneasy about local alternatives, and some have reported poor response to these substitutes.
He also addresses complaints from patients regarding mismatched dialysis filter sizes, confirming that a large proportion of the filters supplied through the Unified Procurement Authority are imported and of high quality. However, some locally made filters may not be suitable for all cases, since filter selection must be based on the patient’s body weight, which has not always been achieved after the suspension of certain supplier contracts.
“The patient used to receive a transportation allowance determined by a court ruling, based on the distance between their home and the dialysis center,” he says. “Now, some are coerced into signing unclear documents that effectively strip them of this right, forcing them once again to go to court to reclaim it.”
El-Iraqi points out that the number of dialysis patients is rising steadily due to the growing prevalence of diabetes and hypertension, which are the leading causes of kidney failure globally. He adds that machine occupancy rates in Egypt range between 60% and 70%, emphasizing that the real problem lies not in the shortage of machines but in the unequal distribution of medical equipment and staff across governorates.
For his part, Dr. Mohamed Gamal, director of Sonaa Al-Hayat Dialysis Centers, confirms that kidney failure patients in Egypt endure extreme daily suffering. Their ordeal begins with traveling to dialysis units three times a week for sessions lasting about four hours each, meaning that every visit keeps the patient away from home for at least five to six hours. This exhausts them both physically and financially, especially since most need a companion and must pay high transportation costs.
Gamal explains that patients rely on state-funded treatment authorizations for medications such as L-Carnitine and B-Com injections administered after dialysis, as well as Epotin injections for anemia. However, these drugs are currently in severe shortage—patients often receive only five or six injections instead of the 13 required per month, forcing them to buy expensive alternatives from private pharmacies, where the price of a single injection ranges between 200 and 300 pounds ($4–$6).
He tells Zawia3: “When patients do not receive these injections regularly, their blood levels drop, leading to anemia and forcing doctors to resort to blood transfusions. But transfusion is not the ideal solution—it physically weakens patients and increases their suffering, even though modern procedures have become safer, as blood bags are now thoroughly tested in central blood banks and major hospitals to prevent infections.”
He adds: “The current crisis is limited to the shortage of certain anemia medications and post-dialysis injections, while there are no major shortages in supplies like dialysis fluids, which the state provides widely. However, drug availability still varies from one hospital to another, forcing some patients to purchase them privately at much higher prices.”
The director of the dialysis centers notes that most kidney failure patients have long demanded that their condition be officially recognized under the Comprehensive Services Card and the Takaful and Karama social protection program, as it is a chronic, irreversible illness equivalent in severity to permanent disabilities. Yet this demand has not been legislatively approved so far, even though such recognition would grant patients vital social and service benefits. He adds that the transportation allowance, though reaffirmed by court rulings, is now paid only after lengthy procedures and in small amounts that do not cover actual costs. He suggests that the most effective solution would be to redistribute patients geographically to centers closer to their residences, thereby reducing both financial and physical strain.
According to official data, there are 813 dialysis centers operating under Egypt’s national dialysis system, comprising 18,623 dialysis machines, at an average of 2.7 patients per machine. This ratio, as Dr. Hossam Abdel-Ghaffar, the spokesperson for the Ministry of Health, previously stated, is better than the global average of four patients per machine. Government spending on dialysis treatment exceeded 4.5 billion pounds ($90 million) in 2023, serving approximately 59,000 patients annually, each of whom requires around 13 dialysis sessions per month, according to Dr. Ahmed Saafan, head of the Ministry’s Therapeutic Medicine Department at the time.
New Burdens on Patients’ Shoulders
Dr. Ahmed Mabrouk El-Sheikh, consultant of internal medicine and kidney transplantation, and member of the Media and Publications Committee of the Egyptian Medical Syndicate, confirms that the shortage of medicines poses the greatest challenge for kidney failure patients. He explains that there are two types of shortages: the first concerns drugs for which alternatives exist, such as post-dialysis supplements (known among patients as “finishing” or “closing” injections), while the second—and far more dangerous—concerns the anemia treatment injections that contain Erythropoietin.f
He tells Zawia3: “These injections have no substitute except for blood transfusions, which carry multiple risks and complications for kidney failure patients. Transfusions may quickly raise hemoglobin levels, but their effect is short-lived. They can also increase potassium levels in the blood and cause fluid retention, leading to what is known as pulmonary edema, a potentially fatal condition.” He adds that blood transfusions are often performed during dialysis sessions, but some private centers refuse to allow transfusions on-site, leaving patients in a dire predicament.
El-Sheikh highlights the financial burden the crisis places on patients: a locally produced anemia injection costs about 200 pounds ($4), while the imported version costs 600 pounds ($12). Since a typical patient requires three injections per week, the monthly cost reaches about 2,400 pounds ($48)—a sum far beyond what most can afford, particularly elderly patients who rely solely on their pensions.
The syndicate member also confirms reports that some dialysis centers force patients to sign declarations waiving their right to claim the transportation allowance, after a court ruling in December 2024 excluded health insurance beneficiaries from receiving it. As for the cost of dialysis sessions for those not covered by health insurance or state-funded treatment, he explains that the price of a single session in private dialysis centers is around 1,000 pounds ($20). Private centers, he adds, are compelled to charge patients under public or state-funded programs the cost difference to sustain their operations and avoid closure.
El-Sheikh points out that kidney failure patients undergo three dialysis sessions per week, which prevents them from working regularly and deepens their suffering. He stresses the urgent need to grant kidney failure patients the Comprehensive Services Card, recognizing them as persons with disabilities entitled to financial and social support.
Meanwhile, Mahmoud Fouad, director of the Right to Medicine Association, attributes the shortage of Erythropoietin drugs—crucial for treating severe anemia in kidney failure patients—to import suspensions and delays in supplying the Unified Procurement Authority, which has exacerbated patients’ suffering and poses a direct threat to their health.
He tells Zawia3: “The problems go beyond drug shortages. They also include the maintenance of dialysis machines and filters. A few years ago, a well-known incident occurred at a hospital in Kafr El-Sheikh, where eight patients were infected with Hepatitis C due to the reuse of dialysis filters from one patient to another. That tragedy led to the introduction of separate machines for Hepatitis C patients, yet the fear of infection transmission during dialysis still exists today.”
Fouad explains that dialysis sessions themselves are extremely exhausting, as patients must attend three times per week, with each session lasting two to three hours, turning every visit into a physically and emotionally draining journey for both patients and their families. The drug shortages only worsen the situation, especially for patients in rural and remote Upper Egypt areas, who must travel long distances to reach dialysis centers.
He adds that about ten years ago, a court ruling obligated the Ministry of Health to provide a transportation allowance for kidney failure patients, yet the amounts currently disbursed are far below the actual costs, creating yet another burden. Fouad notes that he contacted the Egyptian Drug Authority, which confirmed a severe shortage of anemia medications, urging an immediate government intervention to prevent the crisis from escalating further.
Parliamentary Action
Member of Parliament Dr. Freddy El-Bayadi submitted an urgent inquiry to the Prime Minister and the Ministers of Health, Finance, and Planning regarding Egypt’s ongoing drug shortage crisis, criticizing recent remarks by the Prime Minister that blamed doctors for the problem, alleging that they prescribe brand names instead of generic names.
El-Bayadi questioned the government about its concrete plan to address the crisis and tackle its root causes instead of “looking for scapegoats,” warning that the continuing shortage poses a threat to national health security and must be confronted through clear and transparent strategies.
Speaking to Zawia3, El-Bayadi confirmed that there is a severe shortage of medicines across Egyptian markets, citing a previous statement by the Pharmaceutical Industry Chamber, which announced that nearly 3,000 drug types were missing from circulation.
He attributes the crisis to a combination of interrelated factors, foremost among them poor economic management, difficulty in securing foreign currency needed for imports, and unfair price control policies that force some pharmaceutical companies to halt production of certain drugs because continuing to produce them is no longer economically viable.
Meanwhile, the Pharmaceutical Industry Chamber within the Federation of Egyptian Industries attributes the shortage of several drug types to the dollar crisis, which has disrupted the import of raw materials required for manufacturing, forcing factories to reduce production capacity.
El-Bayadi adds that the shortage may stem either from the inability to import fully manufactured drugs or from the lack of active ingredients needed for local production, leading to the disappearance of certain drugs and the reappearance of others intermittently. He criticized the government’s attempt to shift the blame to doctors for using specific brand names, emphasizing that this “is not the real cause of the crisis.”
The MP also notes that the Unified Procurement Authority’s debt to pharmaceutical companies might be one reason for the government sector’s difficulty in importing medicines. However, he stresses that the crisis extends beyond the public sector to private pharmacies, which rely on independent import companies unrelated to the authority. “The government,” he says, “bears full responsibility for managing the pharmaceutical sector and ensuring the sustainable availability of medicine.”
A few days ago, Finance Minister Ahmed Kouchouk announced plans to disburse 7.4 billion pounds ($148 million) in cash payments over the coming days to settle dues owed to pharmaceutical suppliers, in addition to 7.3 billion pounds ($146 million) in letters of credit in coordination with the banking sector. He further announced 14.7 billion pounds ($294 million) in total credit facilities for suppliers, with regular monthly cash flows secured under the 2025–2026 state budget.
In an official statement, the minister explained that the current budget has already disbursed 14 billion pounds ($280 million) to the Unified Procurement Authority since the beginning of July 2025, while the total amount disbursed to the Authority during the previous fiscal year reached 73.4 billion pounds ($1.47 billion).
Despite these official efforts and repeated government announcements about improving the dialysis system and ensuring regular treatment sessions for thousands of patients, firsthand accounts reveal a far harsher reality dominated by drug shortages, rising treatment and transportation costs, and deprivation of basic social rights.
While Egypt’s kidney failure patients continue to fight a daily battle for survival, the solution remains tied to swift and systemic government action that guarantees fair and consistent access to essential medicines and medical supplies—along with the introduction of adequate financial and social support that reflects the severity of a chronic illness consuming both their lives and their livelihoods.
