Sudan’s health system on brink of collapse as war fuels illicit drug trade
Civil conflict between the Sudanese Armed Forces and Rapid Support Forces has crippled pharmaceutical production, forcing patients to rely on unregulated ‘Boko’ medicines that lack temperature controls and pose severe health risks.
The protracted civil war in Sudan has effectively dismantled the nation’s healthcare infrastructure, creating a public health emergency that the World Health Organization (WHO) has described as the world’s largest humanitarian crisis. More than three years of fighting between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) has destroyed pharmaceutical factories, paralysed domestic production, and collapsed vital medical supply chains. The conflict has killed over 50,000 people and displaced 14 million, leaving 21 million individuals without access to basic healthcare services.
In the vacuum left by the closure of local manufacturing, smuggling networks have flourished, flooding the market with unregulated medicines known locally as “Boko” drugs. Patients, particularly those requiring insulin and malaria treatments, are forced to purchase these expensive, illicit supplies. Because these medicines bypass strict temperature controls and quality checks during transit, they are frequently spoiled or lethally toxic. Insulin, which requires precise refrigeration, is often rendered ineffective or dangerous, while intravenous malaria injections lack the sterility required for safe administration.
The scale of infrastructure destruction is stark. According to a Health Resources and Services Availability Monitoring System (HeRAMS) report cited in a WHO Public Health Situation Analysis from January 2026, 40 percent of health facilities nationwide are entirely non-operational. The situation is even more severe in conflict zones, with 87 percent of facilities shut down in Khartoum and 85 percent closed in North Kordofan. In active regions such as Gezira, Darfur, and the Kordofan areas, shortages are particularly dire, with patients facing both exorbitant costs and life-threatening quality issues.
International aid deliveries face enormous logistical hurdles, further exacerbating the crisis. The WHO’s January 6 situation analysis noted that cross-border transit times for medical commodities can take up to 90 days to reach remote regions like Darfur from the Cameroonian city of Douala via Chad. Compounding these delays, armed groups have repeatedly targeted medical infrastructure, looting pharmacies and stripping hospitals of vital supplies. Recent drone attacks and looting incidents in East Darfur, White Nile, Blue Nile, and Kurmuk have resulted in significant casualties among medical personnel and the expulsion of patients.
Despite the widespread devastation, government-funded entities claim to be managing essential supplies. The National Medical Supplies Fund stated it has achieved 75 percent availability for cancer medications and fully secured supplies for kidney patients. However, officials admit that the overarching infrastructure is in ruins, with main warehouses at the headquarters severely impacted. WHO Director-General Tedros Adhanom Ghebreyesus warned on April 4 that Sudan is confronting one of the gravest public health emergencies in history, urging renewed international solidarity and decisive political action to prevent the total collapse of the health system.
