Shortage of Psychiatric Medications in Egypt: A Daily Struggle for Survival

The severe shortage of psychiatric medications in Egypt has led to a healthcare crisis, affecting mental health patients’ treatment and quality of life
Rasha Ammar

Mariam (28 years old) from Giza Governorate spent four consecutive days without sleep, deciding to commit suicide on the fifth night before her brother saved her and took her to a nearby psychiatric clinic. This was due to the unavailability of Lamictal, a drug used to treat epilepsy and bipolar disorder, which she had been taking for five years. She couldn’t find her medication due to the ongoing drug shortage crisis in Egypt.

Ibrahim, Mariam’s elder brother and caregiver after their parents passed away, told Zawia3 that she has been suffering from severe bipolar disorder for years. It’s a serious mental illness that makes the patient always feel deep sadness and intense despair, with no desire to live or interact with people. The medications alleviate the severe symptoms of the disease, enabling the patient to move calmly and reducing suicidal tendencies.

Since January, Ibrahim has faced difficulties in obtaining her medication, as it has been scarce in major pharmacies in Giza and Cairo, and there are no local or imported alternatives. Although its price has tripled (official price 150 EGP), reaching up to 500 EGP on the black market at times, he managed to secure only three packs over six months, which is half of Mariam’s prescribed dosage. This led to the deterioration of her health condition, culminating in her suicide attempt and subsequent admission to a private psychiatric clinic two weeks ago. Ibrahim is now desperately trying to secure some packs of the medication through the black market.

In recent months, Egypt has faced a severe shortage of some drug types, particularly imported ones. This has caused a significant crisis for citizens, making it extremely difficult to obtain essential medications, including those for psychiatric and neurological diseases, which are among the most dangerous chronic diseases. The primary reason for the crisis is the shortage of US dollars, which eased slightly recently. This impedes the ability of pharmaceutical companies to import raw materials needed for drug manufacturing or import ready-made drugs from abroad.

About 25% of Egyptians suffer from mental and psychological disorders, meaning that one in four individuals screened has a symptom or psychological disorder, according to official data from the Ministry of Health (the National Mental Health Survey). The most common disorders are mood disorders (sadness, depression, anxiety) at 43.7%, followed by substance abuse disorders at 30.1%.

Data from the Drug Chamber of the Egyptian Chambers of Commerce indicate that the drug trade amounted to 140 billion EGP last year. Egypt provides over 90% of the medications consumed locally through domestic production, while the rest are imported. These include drugs for cancer, hormonal therapy, and rare specialized diseases, worth about 8 billion EGP.

In February, the Egyptian government acknowledged a shortage of some drugs, and Prime Minister Mostafa Madbouly held a meeting with the Minister of Health, the Governor of the Central Bank, the head of the Drug Authority, and other officials to discuss providing the healthcare sector’s needs.

According to the official statement, Minister of Health and Population Khaled Abdel Ghaffar explained that a committee formed by a Prime Ministerial decision is working to provide medications and medical supplies, including representatives from various relevant bodies. He noted that some drugs and medical supplies, especially imported ones, had begun to run out recently, necessitating this important move to increase reserves.

The Egyptian government is constitutionally committed to providing comprehensive healthcare for citizens, including medication. Article 18 of the Constitution states, “Every citizen has the right to health and to comprehensive healthcare in accordance with quality standards. The state guarantees the preservation of public health facilities that provide services to the people, supporting and improving their efficiency and equitable geographical distribution.”

The state is committed to allocating a percentage of government spending to health that is not less than 3% of the Gross National Product, which gradually increases until it aligns with global rates. The state is also committed to establishing a comprehensive health insurance system for all Egyptians that covers all diseases. The law organizes citizens’ contributions to its subscriptions or exempts them according to their income rates. It is prohibited to refrain from providing various forms of treatment to every person in emergencies or life-threatening situations. The state is committed to improving the conditions of doctors, nursing staff, and workers in the healthcare sector.

Severe Crisis: What Are the Reasons?

According to a report issued by the Pharmaceutical Chamber of the Egyptian Federation of Industries last March, about 1,471 branded drugs are unavailable in the local market; 300 of them have no alternatives and are unavailable in any other brands. Many of these drugs are essential, life-saving medications, according to the report. In a bulletin issued in December, the Ministry of Health and Population reported that there are generic alternatives for 189 drugs currently in short supply, while the stock of 43 drugs has completely run out.

Mahmoud Fouad, executive director of the Egyptian Center for the Right to Medicine, told Zawia3 that the drug shortage crisis in Egypt is directly related to the economic crisis, the shortage of dollars, and the high exchange rate against the pound. He noted that the pharmaceutical industry in Egypt is the most important and vital due to its critical need. He added that people could temporarily do without food, but delaying a medication dose beyond its scheduled time could lead to catastrophic results.

Fouad attributes the drug crisis to several factors related to manufacturing, production, and importation. The first is the fixed pricing of drugs, which cannot be changed in any way except by an official decision from the Cabinet published in the official gazette. The second factor is that 95% of the pharmaceutical industry in Egypt relies on imports, from active ingredients to the ink used to print the drug’s name on the product. Therefore, the entire pharmaceutical industry is at the mercy of the dollar.

The fixed pricing of pharmaceutical products is an inherent responsibility of the Egyptian Drug Authority alone. A recent statement from the authority in May indicated that Law No. 151 of 2019 establishing the authority stipulated that it shall implement the laws, regulations, organizational decisions, controls, and procedures governing the registration, pricing, circulation, and control of pharmaceutical and medical supplies subject to the law, and the raw materials used in their manufacture. It follows up on the application of procedures related to them to ensure consumer protection and takes legal action against violators.

Fouad said, “The drug crisis will continue as long as the dollar crisis continues. When the pound was first floated in 2017, the government quickly decided to reprice drugs and increased the prices of 3,010 items, which can be described as ‘sacrificing the citizen instead of the drug’.”

That was, according to Fouad, the last government pricing of drugs, and at the time, the dollar was equivalent to 18 EGP. Today, the dollar has reached 70 EGP before the last exchange rate liberalization, and it is now around 48 EGP in banks, with expectations of potential increases. This directly impacted the import of raw materials for drug manufacturing, which has almost entirely stopped because companies will incur losses if they continue manufacturing.

During the current crisis, there is a significant delay in the Egyptian government’s response, reaching the point of ‘indifference’ and neglecting human lives and citizens, in addition to damaging the reputation of the industry and not maintaining job opportunities in this sector.

The roots of the problems facing the Egyptian pharmaceutical industry today date back many years. Keeping drug prices artificially low came at the expense of pursuing investments and innovations that would have allowed the industry to evolve and prosper.

Before 2009, the prices of locally manufactured drugs were determined under a somewhat arbitrary “cost-plus” framework to keep drugs affordable for everyone. However, in practice, industry insiders say prices were often determined through behind-the-scenes deals between manufacturers and officials. In 2009, Egypt shifted to an external reference pricing system to curb corruption, modernize the industry, and make it more aligned with the global market.

Under the new framework, drug prices were supposed to be linked to costs in 36 “benchmark” countries, including Canada, European countries, and Gulf Arab states. But the inconsistent implementation and protests from consumer groups ultimately resulted in many prices remaining artificially low. Meanwhile, the state did not update drug prices since 2010.

Mahmoud Fouad says: “Drugs produced in Egypt are supposed to meet the needs of 85% of the population, so Egypt does not face a drug manufacturing crisis. Instead, it is an economic crisis related to importing active ingredients used in manufacturing. The remaining 15% of the drugs are imported from abroad and are also essential.”

He points out that the Egyptian government entered into negotiations with companies and held meetings with the Central Bank to provide the necessary foreign currency for importing raw materials. However, the situation was very difficult. As a result, major companies like Sigma, owned by businessman Sayed El-Badawy, laid off around 500 workers, while some companies had to shut down, including foreign companies operating in the sector.

Fouad adds: “We have 165 companies with factories and 162 companies with factories under construction. There are eight public sector companies, 22 foreign companies, and over 1,200 companies that do not have factories but buy and sell drugs. The size of the pharmaceutical industry and market in Egypt reached about $3.2 billion in 2023, making it the largest market in the Middle East and Africa.”

The state has gradually relinquished control of the industry to the private sector. Today, only 11 of the 137 registered pharmaceutical companies are publicly owned, responsible for producing just 10% of the drugs purchased by Egyptians, according to the government statistics agency. Around 42% of drugs sold in local pharmacies are manufactured by multinational pharmaceutical companies, while another 18% are imports.

According to Fouad, the government also made an arbitrary decision to pave the way for privatizing government hospitals in front of investors, stating that any patient is entitled to receive only one type of medication. Therefore,

only one type of medication is available in hospitals and pharmacies, exacerbating the crisis. Some people have lost their lives due to the unavailability of medication.

The most common type of medication, insulin mix, is not available in pharmacies despite its price increase from 60 to 93 EGP due to the lack of active ingredients. Other medications, such as those for immunity, blood, antibiotics, and hormones for women, are also unavailable, affecting approximately 700 types. Around four million children suffering from Mediterranean fever have not received their medications for four months and are at risk of death. Meanwhile, the prices of chronic disease medications have increased by about 30%, which is a significant shock, especially since most patients are retirees and from the most needy classes, with only about 63% of Egyptians covered by health insurance.

Hell for Psychiatric and Neurological Patients

Mahmoud Abdel Salam (40 years old) from Sohag Governorate had to resort to the black market to buy “Verdebiotal” medication for chronic depression, after losing his son three years ago. He had to pay prices exceeding ten times its original cost, as he described, to survive. The drug’s listed price on the Egypt Drug Guide is around 140 EGP, up from 63 EGP, but Abdel Salam confirms that the prices on online drug sales pages have far exceeded this amount.

He describes living without treatment as living in hell: “I faced severe circumstances after losing my only son at the age of eight. I resorted to psychiatric treatment after two failed suicide attempts and was diagnosed with severe chronic depression. The doctor told me I must adhere to the treatment for a long time. I improved to some extent, but with the medication being unavailable, I feel like I’m back to square one.”

He adds: “A few days ago, a friend sent me the address of a Facebook page called ‘Medicine Shortages’ where some people provide medication, but at inflated prices. As soon as you request a drug name, someone responds in a message to confirm if it’s available and to determine its price and location.”

Dalia El-Dawy, the sister of a schizophrenia patient, says she had to bring “Fluanxol” medication (an imported drug) from one of the Arab countries after it became unavailable in Egyptian pharmacies. Her sister’s condition deteriorated a few months ago, but fortunately, Dalia is a university professor at a Gulf university where the medication is available, allowing her to secure it.

She tells Zawia3 that the lack of medication for patients, especially those with chronic diseases like psychiatric and neurological disorders, is extremely dangerous because these patients rely almost entirely on medication to feel better and avoid harming themselves. The absence of medication or even a change in the timing of taking it can lead to disasters for the patient and their family and directly threatens their life.

Ahmed Mowafy, a professor of psychiatry and addiction treatment, says that many psychiatric and neurological treatment drugs are unavailable in the market. These include the popular “Cipralex” for treating anxiety and depression, as well as dozens of drugs for epilepsy, depression, schizophrenia, and hyperactivity, among other disorders.

Mowafy explains that the lack of psychiatric and neurological treatment drugs is dangerous even if alternatives are available. Patients are usually accustomed to specific medications that they prefer and react to in a particular way. Changing or lacking these medications can lead to significant problems that may threaten the patient’s life.

He adds that stopping or lacking psychiatric medications can lead to the return of psychiatric disorder symptoms, such as anxiety, depression, bipolar disorder, and schizophrenia. These symptoms can be severe and significantly affect a person’s ability to work, study, and live daily. Some people who suffer from a lack of psychiatric medications may resort to alcohol and drugs to alleviate their symptoms, which can lead to addiction and many other health and psychological problems.

From his perspective, Mahmoud Fouad says that the essential drug types, those considered strategic for chronic diseases like psychiatric and neurological disorders, have started to disappear entirely from the market. For example, there are no medications for depression, epilepsy, or attention deficit hyperactivity disorder, a severe condition that can make patients unable to sleep for three consecutive days and students lose focus almost entirely.

Fouad, who served on the board of directors of El-Khanka Hospital in Abbassia, the largest medical facility for psychiatric and neurological diseases in Egypt, considers the lack of medications for the nervous system and psychiatric diseases a disaster threatening Egyptian society. He calls for urgent action to contain the impact on patients, especially given the significant increase in the number of psychiatric and neurological patients in recent years.

He points out that in 2015, sales of psychiatric and neurological medications increased from 13th to 9th, then to 4th place, indicating a dangerous rise in the number of patients with these diseases recently and more Egyptians turning to psychiatric treatment. Sociologists attribute the increased demand for psychiatric treatment to the social and economic repercussions between the revolutions.

Parliamentary Action and Government Contradiction

Following the crisis, the Egyptian parliament saw angry movements from members demanding solutions to the issue. Ereen Saeed, a member of the Health and Population Committee in the Egyptian Parliament, told Zawia3 that she submitted an urgent request to the government to discuss the shortage of medications in the Egyptian market, but it has not been discussed yet. She considers the drug crisis a strategic issue related to Egyptian security, requiring urgent solutions.

Saeed explains that the crisis is due to multiple factors, including some pharmaceutical companies ceasing production because they cannot cover manufacturing costs under fixed pricing while the prices of raw materials have significantly increased. Additionally, the shortage of imported drugs is due to the difficulty in obtaining foreign currency needed for import, especially after the Egyptian pound was floated. There are no alternatives for some medications, such as those for cancer and thyroid diseases, leading to a severe shortage of essential drugs, posing a significant threat to patients’ lives.

The shortage of medications directly threatens the health and lives of many patients, especially those who rely on specific drugs with no alternatives. Saeed calls on the Egyptian government to take immediate steps to resolve this crisis. She proposes conducting a dialogue with pharmaceutical companies to understand why they stopped production and finding solutions to enable them to resume manufacturing while maintaining stable drug prices for patients. She also suggests taking steps to provide the necessary foreign currency to import essential drugs that lack local alternatives and supporting local drug manufacturing by offering incentives to investors in this field and providing a suitable environment for the growth of the Egyptian pharmaceutical industry. The Egyptian Drug Authority should play a more effective role in monitoring drug availability in the market and taking necessary measures to prevent shortages.

From his perspective, Ali Aouf, head of the Pharmaceutical Division of the Chamber of Commerce, told Zawia3 that the drug crisis is primarily due to the culture of doctors and patients in Egypt, who insist on prescribing and using brand-name drugs rather than recognizing or using alternatives. Although all drugs have alternatives in Egyptian pharmacies, patients insist on obtaining specific types.

Aouf asserts that all unavailable drugs have alternatives. If a doctor prescribes medication within a hospital under health insurance, they are not allowed to write the brand name of the drug but only the scientific name, and the drug is dispensed if available, and the alternative if not. Medications in health insurance are available and not of lesser quality than those outside the insurance.

According to Aouf, changing doctors’ habits will significantly reduce the crisis. He confirms that all medications have alternatives, and those without alternatives can be obtained from the Ambulance Pharmacy (a major pharmacy affiliated with the Egyptian Ministry of Health, located in the heart of the capital), which has a hotline to receive complaints about unavailable medications. Patients can call the hotline, and the pharmacy will direct the patient to the nearest location where the medication is available and dispense it with the prescription and national ID.

Regarding other government measures to address the crisis, Aouf says that the government monitors drug stores, distribution companies, and pharmacies to ensure no manipulation or actions that could exacerbate the crisis. If there is any drug shortage, patients can contact the Egyptian Drug Authority, which will guide them to the locations where the drug is available or its available alternatives.

In May, Aouf warned of an increase in shortages in the market to about 1,000 types. He said in a statement: “The pharmaceutical sector faces significant challenges in pricing, which may lead to an unprecedented drug shortage, increasing the suffering of Egyptian patients, potentially leading to an increase in counterfeit and smuggled drugs.”

He explained that “the Egyptian market has 14,000 types of drugs, including 4,000 types that are the most common, topped by the 1,000 types facing severe shortages in the market.” He points out that the pharmaceutical sector is looking for a “lifeline” from the specter of cessation, and there will be unprecedented repercussions on this sector, given the increase in costs due to the exchange rate rise after the pound was floated.

Are There Solutions?

Mahmoud Fouad says that it will take at least three months to make medications available in the market if dollars are available to buy active ingredients. The expectations are that the crisis will extend until next December or beyond unless the medications have been stored by pharmacies and major companies in anticipation of price increases. This has happened, and there have been intense campaigns by the Ministry of Interior, the Drug Inspection Department, and the Administrative Control Authority in recent periods to combat hoarding and storage. More than 45 drug stores have been seized.

According to Fouad, 80,000 pharmacies are threatened with closure. The solution to the crisis depends on the availability of dollars. If the economic crisis continues, the drug crisis will continue, and we will return to square one. The chronic disease crisis, such as psychiatric and neurological disorders, remains the most dangerous and significant.

Fouad says that if the government wants solutions, it should generalize the comprehensive health insurance system in all governorates. So far, the system has only been implemented in four governorates, providing medications in hospitals and

ensuring the availability of medications in hospitals. Additionally, printing a custom dollar for vital industries, and there’s nothing more vital than medicine, would be necessary.

The solution also involves reviving the public sector pharmaceutical companies that were destroyed at the end of President Hosni Mubarak’s era. Decades ago, these companies produced 62% of Egypt’s drug needs. Today, their production doesn’t exceed 6%, leaving Egyptians’ treatment dependent on imports and the control of private and foreign companies.

Rasha Ammar
Egyptian journalist who has worked for several Egyptian and Arab news sites, focusing on political affairs and social issues