IMF reforms, a military coup and a doctor's strike: Sudan's health system on brink of collapse
Sudanese doctors have played a central role in the coup opposition since its announcement on October 25, announcing an open strike in both teaching and governmental hospitals and declaring the withdrawal of doctors from military, police, and intelligence services hospitals. However, they have committed to continue providing emergency healthcare, intensive care, obstetric and newborn care services, and other essential medical services.
According to Sudan's Central Doctors Committee (SCDC), the strike was observed by 80 percent of members and was accompanied by dozens of protests organised in hospitals across Sudan, as doctors joined the fast-growing popular mobilisation against the coup and then the civil-military settlement signed by ex-PM Abdalla Hamdok on November 21.
Security service violations against healthcare workers
Doctors' anger has only increased as hospitals have been repeatedly stormed by security service personnel who have at times assaulted medical staff. Other grievances have been patient arrests; stopping injured protesters from getting to hospitals; and the prevention of staff at the national blood bank from performing their duties.
Prisoners have been denied healthcare and ambulances have been stopped on their way to hospitals. Moreover, road closures have hindered hospital access to the sick and tear gas has been fired inside hospitals.
"According to Sudan's Central Doctors' Committee (SCDC), the strike was observed by 80% of members, and was accompanied by dozens of protests organised in hospitals across Sudan, as doctors joined the fast growing popular mobilisation against the coup"
Added to this, the blockade of Port Sudan in September 2021 heightened an already serious crisis of a lack of medicines, as protesters demonstrated deteriorating political and economic conditions in eastern Sudan.
Economic reforms see costs rise
Some date the current medicines crisis in Sudan back to January 2020, when the Central Bank of Sudan cancelled their allocation of 10 percent of the country's non-oil exports revenue to medicines imports.
Many medicine prices in Sudan quickly rose. Since the military coup, medicines for chronic illnesses and psychiatric medicines (which had enjoyed continued governmental support) have also become scarce: the central bank had been using foreign currency auctions to subsidise the import of 60 percent of these medicines but this system halted following the coup.
The transitional government's decision to liberalise the exchange rate of the Sudanese pound, in line with IMF reforms, had previously caused an upsurge in prices, according to Anas al-Hussein, spokesman for the Steering Committee for Pharmacy Owners, although prices had also been rising prior to this when the decision was made to liberalise drug prices by removing government subsidies.
In recent days, Sudanese civilians have also faced escalating problems accessing healthcare. In Khartoum especially, the health system has reached the point of collapse.
A joint statement issued by hospital general managers said: "Since the 25 October coup, health ministry staff have been fired and elements of the former regime have replaced them. Hospital funding has halted and there has been a severe shortage of essential medical supplies, leading to hospital services plummeting. Some are headed for total closure."
Reports on the health situation in Sudan's North Darfur region testify to the abject neglect suffered by the medical sector there. Emergency care is in a particularly poor state, which has led to scores of deaths from the unchecked spread of hepatitis E, especially in the IDP and refugee camps. The Unified Doctors' Office stated: "20 deaths from hepatitis E have been recorded among pregnant women, most at the final stage of pregnancy."
A doctor from North Darfur (who preferred to remain anonymous) says that the central health authorities feeble response to attacks on the sector since the coup is to blame. He says the Federal Ministry of Health has almost completely ceased activity since the minister and other senior staff were sacked after the coup. Most ministry staff stopped working in protest, he says.
"The coup leaders appointed individuals affiliated to the former regime into ministry positions, whose priorities aren't in dealing with health emergencies, like the one in North Darfur, or handling the outbreak of epidemics like coronavirus which are affecting many areas"
"The coup leaders appointed individuals affiliated to the former regime into ministry positions, whose priorities aren't in dealing with health emergencies, like the one in North Darfur, or handling the outbreak of epidemics like coronavirus which are affecting many areas".
Covid-19: The straw that breaks the camel's back?
The doctors' strike is seen by some as controversial in light of the struggling healthcare system – the health ministry has reported a spike in Covid-19 related deaths and infections since the strike took effect, which has further exacerbated the crises in hospitals as it becomes increasingly difficult to find space for patients in the isolation centres.
Sadiq Ahmed, a 70-year old, contracted coronavirus, and his family tried to find space for him in a hospital in vain. His son says this resulted in him remaining at home with home visits from a doctor. However, the family were unable to obtain an oxygen tank for him and he died 10 days after becoming infected.
Dr Haithem Makkawi, an anesthesiologist and intensive care specialist at Soba University Hospital, explained to Al-Araby Al-Jadeed: "The health system is experiencing one of the worst periods in its history… it had inherited serious weaknesses from Bashir's regime [before the current crises], and then Abdalla Hamdok's policies damaged the health sector even further… Hospitalising one patient costs 25,000 Sudanese pounds per day ($55) but there is no funding available."
He adds: "The idea of free healthcare for needy sectors of society has become a fantasy – even people with money can't find treatment centres. We have started seeing private companies specialising in 'home medicine' appearing as a response. Although this is lessening pressure on hospitals, which is needed, there is no oversight of these activities."
The political crisis must end
He continues: "Only an end to the political crisis will end the problems in the health sector – the unions need to be incorporated into the management of healthcare institutions and a strategy for healthcare needs to be put in place, as well as monitoring of private hospitals which are profiting from the pockets of the sick without oversight due to the current collapse of the public health system."
Central Committee of Sudan Doctors (CCSD)— لجنة مقاومة جنوب كاليفورنيا (@scarcommittee) January 17, 2022
7 civilians have been #killed by the live ammunitions of security forces during today’s anti-coup peaceful protests.
The death toll among civilians since the military coup rises to 71.
#SudanCoup 🇸🇩#Jan17Massacre 💔 pic.twitter.com/2SIygKUPa9
Mohammed Naqdullah, former director of Khartoum's Health Promotion Department, who was fired following the military coup, believes the health system was starting to recover during the few months before the coup: "Signs of improvement were emerging as international funding was secured and put into updating hospital equipment, vaccine provision, and maternal and child healthcare, under the supervision of the WHO, UNICEF, EU, and the World Bank. But the donors withdrew their support immediately after the coup.
"Sudan obtained more than a million coronavirus vaccines with help from the World Bank, and received promises of more, but no one knows where these are now."
He pointed out that "the doctors' strike could be called off at any time, but more serious is the medical crisis. I also anticipate a mass exodus of doctors after the shock and frustration caused by the coup which has plunged the country into chaos."
However, economist Abdullah Al-Ramadi believes both the scarcity and the extortionate cost of medicines is primarily due to government compliance with the deregulation policies demanded by the IMF and World Bank and their condition that drug prices be liberalised.
"Economist Abdullah Al-Ramadi believes both the scarcity and extortionate cost of medicines is primarily due to government compliance with the deregulation policies demanded by the IMF and World Bank and their condition that drug prices be liberalised"
Pharmacist Ahmed Saqir believes that "experience has taught us that military coups reject accountability and transparency – this was clear during Bashir's rule, where we saw major corruption in the medical sector. This caused soaring costs and medicines scarcity, and this is what we would expect as a result of the present coup.
"The other dilemma is that the sector needs to be heavily subsidised by the state, but since coup leaders don't consider healthcare a priority, and focus on security and the military at the expense of health, education and services, the results are likely to be catastrophic."
This is an edited translation of two articles from our Arabic edition.
The first was published on 27/11/21 and you can read it here.
The second was published on 09/12/21 and you can read it here.
Translated by Rose Chacko
These articles were taken from our Arabic sister publication, Al-Araby Al Jadeed and mirror the sources' original editorial guidelines and reporting policies. Any requests for correction or comment will be forwarded to the original authors and editors.
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This article is part of a series focusing on MENA health crises: A collection of articles looking at public health-related issues across the MENA region, as ill-prepared health systems continue to struggle against the Covid-19 pandemic in a region wracked by instability and war.
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