Sudan’s latest coup is crippling its frail health sector
Last October’s military coup has had a ripple effect on the country’s healthcare sector.
Khartoum, Sudan – At Ibrahim Malek hospital in Sudan’s capital Khartoum, anaesthetics are in such short supply that patients sometimes wake up while still on the operating table.
Staff say they have stopped receiving medical supplies from the Ministry of Health since Sudan’s October 25 military coup.
“When people are about to wake up, we give them more anaesthesia,” said Dr Ali Shaker, general manager of Ibrahim Malek, one of the busiest public hospitals in the country. “These supplies should be given to us for free from the Ministry of Health, but they’re not coming…it’s a catastrophe.”
Like all other hospitals, Ibrahim Malik has resorted to purchasing drugs and equipment from the unregulated black market, but doctors cannot know whether those supplies are safe or effective.
Anaesthetics, in particular, wear off much sooner than they should, pushing doctors to administer double and sometimes triple the dose to knock patients back to sleep during an operation.
An already reeling sector
Sudan, and its healthcare sector, has been through a lot in the past three years. In April 2019, former dictator Omar al-Bashir was overthrown by a wave of popular protests and a civilian-military partnership formed to administer the country. Four months ago, the military overthrew the civilian administration and took power alone.
Even before the military coup, Sudan’s healthcare sector was already reeling from decades of privatisation under al-Bashir. Officials of his administration were notorious for eroding public medical services and pocketing funds for the sector, while wealthy Sudanese sought treatment abroad.
Medical workers and former health officials say that during the country’s brief democratic transition, then-Prime Minister Abdallah Hamdok improved the situation somewhat. But he also imposed IMF-advised austerity measures that made medications unaffordable for many.
Under the military’s control, things have worsened. The sector is on the verge of collapse as protests persist nationwide against the coup. Hospital directors and health officials have been replaced with Bashir-era cronies – many of whom have been accused or implicated in corruption scandals – after international aid to the tune of billions of dollars was paused because of the coup.
This has led to shortages of drugs and equipment as well as a spike in medical costs across the public sector, say doctors and former health workers.
Potential for corruption
Asil Sidahmed, a former adviser to the health ministry under Hamdok’s government, says the coup opened the door for high-level corruption in the sector.
She said most of the Ministry of Health’s funding was supposed to come from the World Bank Global Fund and Gavi, a public-private partnership providing vaccines to the global south.
But Sidahmed cautioned against the restoration of aid to the ministry because it would finance the military, not help patients.
“I think what we need to do is find a model where healthcare centres get money directly,” she told Al Jazeera over the phone. “It should go to directors of primary healthcare clinics and some selective hospitals that meet the requirements of fiscal responsibility. Those are the places where money should go.”
Despite already leaning heavily on international and local aid groups, Dr Shaker said his hospital barely has the materials needed to perform most basic operations safely. In the hospital’s storage room, he points at a few boxes of surgical gloves; they were the only ones available to conduct an estimated 60 surgeries a day for at least the next month.
“We ask our patients to buy gloves and syringes before their operation,” Dr Shaker told Al Jazeera. “We try to save the ones we have for emergency procedures.”
A number of medical workers and healthcare officials have also been fired since the coup; Al Jazeera was unable to verify the exact number.
Dr Khaled Badr, the former director of primary healthcare at the health ministry, said he was one of three people kicked out just one week after the coup. “We were the ones fired at the federal level, but at the state level many people were fired,” he said.
Dr Shaker was also supposed to be fired along with his deputies, but the heads of all 27 departments in Ibrahim Malik threatened to strike if their manager was let go.
The indiscriminate sacking of healthcare professionals was because doctors and medical workers like Dr Badr played a major role in protests that overthrew al-Bashir in 2019, explained Samahir Mubarak, spokesperson for Sudan’s Professional Pharmacists Association. At the time, the Sudanese Professionals Association – which was mostly doctors – spearheaded protests that called for the fall of the regime.
With members from al-Bashir’s National Congress Party (NCP) now back in government, she expects them to settle scores. “The return of the NCP (officials) will definitely be vengeful,” she said. “They are coming back with power and with the army behind them.”
Since April 2021 when Dr Shaker took over the reins at Ibrahim Malik Hospital, he has waived medical fees for patients unable to pay, a welcome gesture in a country where even public healthcare costs are unaffordable for many.
But on February 19, the government hiked healthcare fees across the board without first informing the public, according to the pharmacists’ union and several doctors.
Patients now have to pay at least 2,000 Sudanese pounds ($4.49) to spend a night in the hospital and pay at least four times as much for X-rays and malaria tests. Even admitting a patient to the hospital rose from 220 Sudanese pounds ($0.45) to at least 7,000 ($16) – an increase of 3,000 to 5,000 percent.
Sudan’s health minister, Dr Haythem Mohamad Ibrahim, told Al Jazeera the cost of services is related to the lack of international funding. He added that the ministry is considering ways to help poor citizens, such as expanding national health coverage so insurance companies can foot a portion of the bill.
“There is not enough money going to hospitals from the Ministry of Finance,” he told Al Jazeera via WhatsApp voice notes. “That’s why medical prices are expected to be at least five times more expensive this year.”
People like Ahmed Baqar will not be able to afford such high costs. Baqar, a day labourer who makes a meagre 5,000 pounds ($11.22) a month, brought his baby son to Ibrahim Malik just before the price hikes took effect.
“I brought [my son] here because he was having trouble breathing…but I didn’t expect each service to suddenly cost 4,000 or 5,000 Sudanese pounds,” he said, with his wife and baby next to him. “I thought I would have to take my son home.”
Luckily for him, Ibrahim Malik refused to apply the new prices, unlike most other hospitals.
Dr Shaker had pleaded with the authorities to roll back the hikes until a transparent review was conducted. The next day, the government approved his request, but he fears that prices will not stay frozen for long and hopes to see the administration increase support for the sector.
“If the [military] wants to govern this country, then they should pay for people’s healthcare as much as they pay the security forces… and as much as they pay for the tear gas they use to fire at protesters,” he told Al Jazeera.
“We know the government has money, but it’s not going towards healthcare.”