Madiha Ibrahim (46), a breast cancer patient, faces a double ordeal between illness and the exorbitant cost of treatment, as she is forced to borrow money every month to buy the medical needles for her port-a-cath device, which is used to inject chemotherapy. Government hospitals do not provide these needles at a suitable quality, which exposes her to serious complications such as burns and inflammation of the veins, while the price of an original needle in private pharmacies ranges between EGP 350 and EGP 500, an amount beyond her means amid the rising cost of living.
Although she receives treatment at a government hospital close to her home in the Old Cairo area, the scarcity of good medicines and their high prices make her journey with the disease harsher. Madiha needs more than EGP 1,000 a month just for the needles, not counting the other medicines whose prices have risen insanely recently. Because of her husband’s limited income, she finds herself forced to borrow, either from relatives or from neighbours, to ensure that her treatment continues, at a time when medical supplies are turning into an additional burden on cancer patients who are fighting for their lives.
Recently, Egypt has been suffering from a major crisis involving the disappearance of dozens of drug items used to treat chronic diseases as a result of the rise in the price of the dollar, which exceeded about 1,000 items, most notably medicines for high blood pressure, diabetes, heart disease, the gallbladder, the thyroid, the kidneys and stomach disorders, in addition to medicines for Mediterranean fever, cancer, nasal drops for infants and adults, and cold and gynaecological medicines. Estimates by the head of the Chamber of Pharmaceutical Industry at the Federation of Egyptian Industries, Gamal El-Leithy, in media statements during February 2024, indicate that the shortage of medicines on the market ranges between 30% and 40%, including 15% of medicines for which no alternatives are available.
Commenting on the crisis, Irene Saeed, a member of the Health Committee of the House of Representatives, tells Zawia3 that providing medicine is the cornerstone of the health services system that the state provides, pointing out that diagnosis without treatment is useless, as the shortage of medicines and medical supplies is an obstacle to the completion of health services, which wastes the efforts of the entire medical system. She asks: “What is the use of an examination without treatment?”
Irene adds, speaking to us, that the recent period has seen acute crises in providing medical supplies, which has led to longer waiting lists, despite presidential efforts to tackle them, explaining that government hospitals, after making progress on this file, suffered a new setback because of the dollar crisis and the difficulty of importing medical supplies. Transferring patients between hospitals to solve the shortage of supplies has become common, which exhausts patients and their families. The MP stressed the need to reconsider the policies of the Unified Procurement Authority, as well as to develop direct purchasing mechanisms, or to provide a strategic stock of vital supplies and medicines, especially those that treat chronic diseases.
For his part, Ali Ouf, head of the Medicines Division at the Chamber of Commerce, affirms in a statement to Zawia3 that all the missing medicines were made available months ago, while government efforts continue to prevent the crisis from recurring. On the causes of the crisis, Ouf says they are mainly due to many doctors insisting on writing the brand name of a medicine instead of its scientific name, while patients also insist on obtaining specific brands, despite the availability of effective alternatives in Egyptian pharmacies. This behaviour aggravates the problem, even though most of the medicines in short supply on the market have available alternatives.
Ouf stresses, speaking to us, that all the medicines experiencing shortages have alternatives, and that recently all medicines have become available, pointing out that doctors working in government hospitals and health insurance centres are obliged to write only the scientific name when prescribing treatment, so that the available medicine, or its alternative if it is unavailable, is dispensed, and stressing that health insurance medicines are not of lower quality than others. He adds that changing the habits of doctors and patients can play a big role in reducing the severity of the crisis.
Recommended reading: How Did the Trade in Expired Medicines Turn into a Lucrative Market?
Poverty, illness and medicine shortages: a double ordeal
Zawia3 spoke with a number of citizens who face continuous suffering in obtaining medicines, particularly cancer and kidney failure patients. Noha Mahmoud (52), from Giza governorate, a leukaemia patient, says she lives in a spiral of financial helplessness because of the continuous rise in the prices of medicines and medical supplies. Noha undergoes regular chemotherapy sessions at a government hospital, but she faces an acute crisis in obtaining the necessary medicines, which have become either scarce or priced beyond her financial means, since they have recently ceased to be available under free treatment at the state’s expense.
She explains, speaking to Zawia3, that she needs special injections to prevent blood clotting during treatment, but the hospital does not provide them, forcing her to buy them from outside pharmacies at a price of up to EGP 600 per injection, an amount she is unable to raise every month. Her problem was not limited to medicines: even medical gloves, masks and sterile solutions, which are essential to prevent infection during the sessions, have become unavailable at the hospital, and she has to buy them herself. Every month, she finds herself facing two options: either debt or postponing treatment, which may put her life at risk. With the absence of any effective government support to provide these supplies at reasonable prices, Noha, like many others, feels that the illness is not the only obstacle on the road to her recovery, but also the economic crisis that has turned treatment into a luxury that only those with means can afford.
From cancer patients to kidney failure patients, the suffering does not differ much. Hassan Abdallah (52), from Sohag governorate, recounts in a conversation with Zawia3 that every three days he wakes at dawn to begin the search for a dialysis session at a government hospital where dialysis solutions are available. The matter was not this difficult before, but now he is forced to move between hospitals because the solutions have become scarce, and sometimes the doctors inform him before the session that they are unavailable, which leaves him facing two options, the sweeter of which is bitter: either postpone dialysis and put his life at risk, or buy the solutions from outside at prices beyond his means. Hassan, who was a simple labourer before the illness, has come to depend on help from his relatives, but debts are piling up on him month after month.
The last time, he was forced to pay half of his monthly salary just to secure a single dialysis session, while he was dripping with sweat in the crowded hospital, waiting for his turn, which might not come if the solutions ran out before they reached him. As he sits exhausted on one of the seats, he looks with sorrow at other patients who have just come out of the session having managed to get their share, wondering whether he too will get his chance or not.
For Souad (42, from Beheira governorate), the suffering appears greater, as she depends on certain medicines that stabilise the level of phosphorus in the blood and others that protect her immune system, but she no longer finds them in government pharmacies, and she has been forced to buy them on the black market at prices of up to five times their original price. Souad says, speaking to Zawia3, that she could not afford this luxury, so she began reducing the doses, which caused her condition to deteriorate rapidly, to the point that she is no longer able to leave the house except with difficulty.
On one of her recent visits to the hospital, she sat in the corridor waiting for her usual doctor, but she no longer had the same hope, as she had become certain that her basic treatment had become a luxury she could not afford. As she looked at her husband, who was trying hard to find a way to buy her medicines, she felt a pang in her heart, asking: “Is it conceivable that medicine is harder than the illness itself?”.
A video clip of Health Minister Khaled Abdel Ghaffar sparked wide controversy after he appeared responding to a complaint by a patient at a hospital about being delayed several hours past his scheduled time to enter the dialysis room, explaining that the delay was due to the need to sterilise the machines between cases. However, the controversy escalated because of the minister’s talk about the need for patients first to offer “thanks” to the state for developing the health system before submitting any complaint, as he said: “I am very surprised, isn’t it the state that built this beautiful place at the state’s expense? And until now I have not heard a word of thanks for the state’s implementation of this (system)”. He added: “First say thank you for the beautiful building and the available equipment, but we have some requests, and this is called good manners, and this is your right from us”. He also continued: “We provided new equipment and new medical staff, and now someone says he was delayed an hour; are you delayed an hour every time?”. The video sparked a wide wave of criticism on social media, as some considered that the minister focused on asking for gratitude instead of dealing with complaints seriously, which angered many.
Recommended reading: The Shortage of Psychiatric Medicines in Egypt: A Daily Struggle for Survival
A catastrophe facing Egypt’s medicine sector
Mahmoud Fouad, head of the Egyptian Center for the Right to Medicine, says in a conversation with Zawia3 that the crisis, which worsened from 2023 and continued in 2024 because of exchange rate instability, is still ongoing, and its impact on the medicine and medical supplies sectors has become catastrophic, because most of these products are imported from abroad, which has made the crisis worse as the price of the dollar fluctuates.
The biggest problem, according to Fouad, was in medicine, because it is subject to compulsory pricing, whereas medical supplies are sold on the free market. But after the emergence of the Unified Procurement Authority, no entity was able to purchase medical supplies directly any longer; instead, the matter became dependent on the authority. That is where the problems began, as debts owed by the authority to supplier companies accumulated, and the companies were unable to collect their dues, which left them unable to import new supplies or even to provide the minimum strategic stock.
This situation led to a major crisis, to the point that the Prime Minister held two meetings to solve the problem, and it was agreed to disburse EGP 5 billion to pay off part of the debts. After the resignation of Major General Dr Bahaa El-Din Zidan, head of the Egyptian Authority for Unified Procurement, Medical Supply and Provisioning, and the appointment of a new official, it was decided just two weeks ago to disburse an additional EGP 2 billion to the companies. Nevertheless, the crisis persists, especially with regard to the medical supplies needed for critical surgical operations.
The Egyptian medicine market comprises about 17,000 pharmaceutical products manufactured by about 170 factories. Despite the rise in the prices of about 400 drug items, by 20% to 30% for medicines intended to treat chronic diseases and by between 30% and 50% for non-essential and seasonal medicines, medicine sales in Egypt reached about EGP 215 billion in 2024, compared with EGP 154.7 billion in 2023, reflecting an increase estimated at about 40%, according to estimates by the head of the Medicines Division at the Federation of Chambers of Commerce, Ali Ouf. He also expected, in previous statements, that the Egyptian Drug Authority would raise the prices of only about 1,000 pharmaceutical products during 2025.
As for the number of pharmacists, it is estimated at about 213,000 pharmacists working in 80,000 pharmacies across the country. According to the World Health Organization, the ratio of pharmacists to population in Egypt is one pharmacist for every 438 citizens, while the global rate ranges between one pharmacist for every 1,100 and 1,600 people, the equivalent of 23 pharmacists per 10,000 citizens. As for pharmacies, there is one pharmacy for every 1,261 citizens in Egypt, compared with the global rate, which ranges between one pharmacy for every 3,500 and 5,000 people.
Recommended reading: A Deadly Injection: How Did Antibiotics Turn into a Danger Threatening Egyptians’ Lives?
Surgical operations halted and equipment in short supply
Fouad says, speaking to us: “Because of the shortage of medical supplies, some types of cardiac catheterisation stopped, stent-fitting operations were affected, and joint and bone surgeries were completely disrupted because screws and artificial joints were unavailable; even kidney and liver transplant operations were severely affected by the shortage of surgical instruments and the medicines that accompany them.”
He continues: “The crisis also hit hearing aids for children, as there is now an acute shortage of medical hearing aids and the spare parts they need, which prompted the Ministry of Education to allow children suffering from hearing loss not to attend school because of their inability to communicate. Even people with special needs who depend on wheelchairs faced great difficulty because of the shortage of spare parts, which led to a real tragedy for many and affected their lives directly.”
Fouad points out, speaking to us, that the crisis was not limited to medical supplies but extended to medicines, as there is still a crisis in some essential drug items. The government tried to confront the crisis by announcing the provision of strategic and vital medicines in 24-hour emergency pharmacies, but the problem is that these pharmacies are limited in number and exist only in some major cities, which means that a patient in Matrouh, Aswan or Fayoum may not find his medicine easily, which is unacceptable.
The head of the Egyptian Center for the Right to Medicine explains that the concept of “availability” in the medicine sector means that treatment is available in every place and at every time the patient needs it, not that he has to travel to another governorate to obtain it. He notes that this crisis reflects a deeper problem in planning and production, as the shortage of medicines is due to the pharmaceutical industry being affected by the economic crisis, especially since it is a compulsorily priced industry, which makes companies hesitant to produce in large quantities for fear of losses.
Oncology and hormone medicines on the black market
The medicine crisis has reached even cancer patients. Mahmoud Fouad points out, speaking to us, that the shortage of chemotherapy drugs has led to the halting of treatment sessions for a large number of patients, and notes that the government recently announced the import of 180,000 injections of one of the oncology drugs, but no one knows how long this quantity will last, especially since other medicines are still missing, such as the hormone medicines essential for women in cases of pregnancy or delayed childbearing, which have come to be sold at fantastical prices on the black market.
Fouad cites, as an example, the “Ginator” injection, which is officially sold for EGP 245 and is no longer available in pharmacies, but is available in private hospitals at prices ranging between EGP 800 and EGP 3,000 depending on the level of the hospital! This chaos has led to the emergence of a huge black market for medicines, as some parties exploit the shortage of medicines in pharmacies to sell them at multiplied prices, which threatens the lives of patients who cannot bear these costs.
Fouad adds: “Kidney failure patients were not spared the crisis, as the dialysis sector faced an acute shortage of filters, machines and the basic materials used in the sessions, which led many dialysis centres to stop working. The ministry tried to intervene by launching a hotline to follow up on the crisis, but the truth is that patients suffered for a long time from the halting of sessions, which put their lives at risk”, pointing out that dialysis machines need periodic maintenance and regular replacement of spare parts to prevent the spread of infection, especially hepatitis C, which made the crisis more dangerous, because a continued shortage of these supplies means increased health risks for patients.
He notes, speaking to us, that the medicine that is still available suffers from another problem, namely the insane rise in prices. The simplest example: the cheapest prescription to treat a cold now costs at least EGP 250, and some antibiotics have exceeded EGP 300! This means that the cost of treating a simple cold may reach EGP 1,000, including the doctor’s examination and the medicines, so what about chronic diseases or surgical operations? He stresses that the current situation is unbearable, patients have become unable to bear the costs of treatment, and the crisis is still worsening without radical solutions.
As the crisis of shortages of medicines and medical supplies worsens, the suffering of patients who have become trapped between rising prices and the absence of effective alternatives is growing. Despite government efforts and optimistic statements about the availability of medicines, reality confirms that thousands of patients, especially those with chronic diseases such as cancer and kidney failure, face daily challenges in obtaining the necessary treatment. While the causes remain multiple, from the dollar crisis to inflexible drug policies, the urgent solution remains the development of a comprehensive strategy that guarantees the availability of medicines at suitable prices, together with tighter oversight of the medicine market to prevent the exploitation of patients. Until that happens, the lives of many will remain hostage to the crisis, waiting for treatment that may not come in time.
Editorial correction: In one place in the first version of the report, the name of breast cancer patient Madiha Ibrahim appeared as “Mona”; the correct name is “Madiha”.
Editorial correction: The first version of the report stated that the statements on medicine shortages by the head of the Chamber of Pharmaceutical Industry, Gamal El-Leithy, were made last February; in fact, they were made in February 2024, according to the published source to which the report refers.
