As the date of her monthly dose approaches, the family of Manal Abdel Azim, a pseudonym, begins searching Cairo pharmacies for an Invega injection. They reserve it by telephone before travelling kilometres from their home in Alexandria. Manal, 57, lives with schizophrenia that her family describes as severe.
The family has repeated this search since the previous year. Rising prices have compounded shortages, which they say became particularly acute over the four months before the interview.
Mariam Hassan, another pseudonym used at her request, says the injection cost EGP 3,500 when Manal was diagnosed three years earlier, then rose to EGP 5,500. For around a year, the family could not find it in Alexandria, forcing monthly travel to Cairo because the pharmacy would not ship it.
They now set aside nearly EGP 7,000 each month for a single-dose ampoule and the journey. Recent shortages have stretched the interval to six weeks rather than a month. “When we cannot find it, she relapses,” a relative says. This describes a family’s difficulty obtaining prescribed treatment, not a recommended dosing schedule.
A close relative says Manal refused tablets after leaving hospital and discarded them without the family’s knowledge. Her treating doctor changed to injections because she was not taking oral medication. The relative describes this as the workable option for Manal’s individual circumstances.
Schizophrenia can involve persistent delusions, hallucinations, disorganised thought and behaviour and difficulties with attention, affecting daily functioning. Effective treatment and support are available; a diagnosis does not in itself imply that someone is dangerous.
The Arabic report cites an earlier global estimate of around 23 million people, or one in 345, and a reported Egyptian estimate of roughly one million. The national figure is not presented as a recent comprehensive census. A study cited in the report estimates global cases rose from 13.62 million in 1990 to 23.18 million in 2021.
Doctors interviewed by Zawia3 describe shortages of long-acting injectable antipsychotics in the retail market. Some say supplies remain available in hospitals run by the General Secretariat of Mental Health, but quantities there have also begun to decline.
They say interrupted treatment has led some patients, particularly those who struggle with oral medication, to relapse and require admission to public or private hospitals, increasing families’ costs.
Doctors also describe a large price gap between certain older products historically costing EGP 20–30 and available alternatives costing thousands. Different medicines and formulations are not automatically interchangeable; the comparison reflects the access problem they report rather than equivalent doses or treatment. They call for urgent intervention to maintain supply.
Long-acting antipsychotics and continuity of treatment
Invega’s injectable formulations belong to the long-acting antipsychotic category. These medicines release an active substance over an extended period, helping sustain treatment without daily tablets. Indications and administration intervals differ by product and diagnosis.
Some long-acting products are used for schizophrenia or schizoaffective disorder and some antipsychotic formulations for bipolar disorder, but that does not mean every injection is approved for every condition. Their use is a clinical decision for the individual patient.
The Arabic text dates the appearance of long-acting antipsychotics to 2018, which is not the beginning of this drug class. For example, the manufacturer records US approval of monthly Invega Sustenna in 2009. Different formulations may be given monthly or at longer intervals under their specific prescribing requirements.
Psychiatrist Mostafa Shehata, former director of Abbasiya Hospital, says shortages are substantial and particularly affect people with schizophrenia who struggle to take regular medication or do not recognise that they are unwell. Access to prescribed long-acting treatment is not a luxury, he says.
A single injection can exceed EGP 5,000 and nevertheless be unavailable for prolonged periods, he says. Relapses and hospital admission then add to household burdens. “There were only two options: treatment at home or admission to a facility,” he says of cases he managed.
For patients who had relied on injections for years, relatives’ inability to obtain them left admission as the available way to stabilise recurrent episodes, Shehata explains.
A burden on doctors and families
Psychiatry specialist Nihal Zein distinguishes tablets from injections, and emergency injections from long-acting formulations. She uses prescribed monthly regimens for selected patients to support stability; the formulation and dose depend on the case.
She says interrupted treatment can allow intense persecutory beliefs and other symptoms to return. Regular injections can help patients and families maintain a calmer daily life, but prolonged disappearance of several products burdens both.
The shortage extends beyond imported brands to locally available alternatives, Zein says, citing haloperidol injections and Haloniz tablets, as well as Clopixol injections that become available briefly before disappearing again.
When injections are unavailable, she may have to prescribe tablets, but limited insight or difficulty maintaining treatment can create obstacles. She describes some patients appearing to take tablets while actually concealing them, unlike an administered long-acting dose.
Hager Ali, a pseudonym, is a woman in her twenties living with schizophrenia in Qena. After months of unsuccessful searches for haloperidol injections, her family lost hope of finding them and she stopped taking the tablets prescribed as an alternative.
Her sister says the psychiatrist increased the prescribed tablet strength amid the shortage, but Hager declined them and stopped attending appointments.
During a hospital stay the previous year, Hager received medication consistently because injections were available there. After discharge, the family repeatedly heard that they were out of stock. Her sister says interrupted treatment and refusal of the alternative tablets were followed by deterioration and the return of symptoms that had improved in hospital.
Considering long-acting treatment earlier
A review cited in the report discusses long-acting antipsychotics as a means of improving continuity in schizophrenia treatment. Across relevant studies, they can reduce relapse and hospital readmission and some healthcare costs compared with oral treatment in particular settings; effects vary across studies and patients.
The US National Council for Mental Wellbeing’s guide to long-acting medications encourages community mental-health and substance-use services to discuss them early as a treatment option rather than reserve them only for later stages. It promotes safe, effective use and shared treatment decisions.
The guide discusses research linking poor continuity of medication with relapse and better adherence among some people using long-acting formulations. Early consideration may help prevent recurrent episodes and subsequent disability, while reducing direct hospital and outpatient costs and indirect burdens.
Despite potential benefits for symptoms, quality of life and costs, the report says long-acting medicines remain underused and are often offered only after relapse. That argument supports broader access and discussion, not a rule that tablets are inappropriate for all patients.
At a January 2026 meeting chaired by Prime Minister Mostafa Madbouly, Egyptian Drug Authority head Ali Al Ghamrawy said there was no medicine shortage, according to the statement cited in the Arabic report. That broad assessment contrasts with the specific access problems reported by families and doctors.
In another interview, he put the Egyptian medicine market at more than EGP 422 billion, with the private sector accounting for roughly 70 percent by value and the public sector 30 percent. He also cited growth from approximately USD 1.07 billion in 2024 to USD 1.3 billion in 2025, a separate dollar-denominated indicator that the Arabic text does not clearly distinguish from total domestic market value; those figures should not be treated as currency conversions of EGP 422 billion.
He emphasised localisation, saying 91 of every 100 medicine packs are manufactured locally. Aggregate production figures, however, do not demonstrate that every particular long-acting injection is consistently stocked.
Import dependence and local manufacturing
Mohy Hafez, a member of the Medical Industries Export Council, tells Zawia3 that long-acting medicines for psychiatric and neurological conditions are still imported rather than produced locally, citing specialised technology and inputs. His comments concern these formulations, not every psychiatric medicine.
He attributes limited manufacturing interest partly to low domestic consumption despite clinical importance. Reliance on imports can periodically create gaps. Earlier remarks by psychiatry professor Tarek Saad likewise described difficult preparation methods.
Hafez says exchange-rate and import pressures have affected injection prices, while pricing in Egyptian pounds remains difficult to reconcile with foreign-currency costs. He recognises the importance of dependable supplies for people unable to maintain daily tablets.
The medicine market experienced major price increases in 2024, with the report citing around 25 percent, alongside shortages linked to hard-currency access and imported raw materials. The government says it contained a crisis affecting around 1,000 products and restored approximately 80 percent of missing supplies while seeking the remaining imports.
At a 2024 press conference, the authority said Egypt required about USD 100 million monthly for pharmaceutical raw materials, importing roughly 85 percent from India and China. Foreign-currency shortages reduced factory stocks.
Before the 2024 exchange-rate liberalisation, manufacturers obtained bank dollars at the official rate of EGP 30.85. A subsequent rate around EGP 48 raised the local-currency cost of imported materials and production inputs. These are historical figures explaining that period’s pressures, not current exchange rates.
Industry and government responses
Mohamed Al Bahi, an industrial federation representative, argues that the disappearance of some products does not amount to a general medicine shortage. He attributes gaps to difficulties obtaining foreign currency, delayed active ingredients from East Asia and China and disruptions in Red Sea trade, while saying the state is working to provide chronic-disease medicines.
He says Egypt has around 180 factories seeking to provide products and alternatives. He also attributes some difficulties to doctors preferring particular brands, arguing that domestic output covers about 94 percent of medicine use and imports six percent. These aggregate estimates differ in scope from Al Ghamrawy’s pack-based figure and do not establish equivalence between specific formulations.
Al Bahi says the drug authority reviews missing products and encourages production, including at state-owned factories, to meet gaps.
Al Ghamrawy also announced a pharmaceutical track-and-trace system intended to follow packs from production to the consumer and curb illegal stockpiling and smuggling. The Arabic report says implementation began for some essential treatment groups in February 2026 under a three- to five-year rollout.
Hafez says localisation is part of the authority’s strategy and Egyptian firms are being encouraged to develop equivalent products, reducing import dependence. He considers reliable domestic manufacture an important and legitimate demand for patients and says Egypt has research and development capacity to pursue it.
For people unable to locate prescribed long-acting medicines, Hafez recommends contacting Al Esaaf Pharmacy or the Egyptian Drug Authority’s shortages department and hotline for locations where supplies may be available. Availability can vary by governorate, he says, making it important to establish whether a particular product is missing nationally or only locally.
