On a modest bed inside his war-battered home in the Khartoum North neighbourhood of the Sudanese capital, Khartoum, Murtada Mohieddin, a diabetic patient in his early 50s, carefully counts his remaining doses of insulin. His search for medicine has transformed into a harrowing battle – not just to find the treatment he needs to survive his diabetes, but to ensure the medicine is not expired or ruined.

“Sometimes the insulin is spoiled,” Mohieddin tells Al Jazeera, inspecting his limited supply. “You wouldn’t know if it is ruined or expired. You can check the expiration date, but it could still be damaged from poor storage.”

More than three years of civil war have crippled Sudan’s healthcare infrastructure: hospitals, health centres and pharmaceutical factories have been shut and vital medical supply chains and storage across the country have been disrupted.

The war, which erupted as a power struggle between Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF), has killed more than 50,000 people and displaced 14 million – nearly a quarter of the country’s population.

The devastating conflict has paralysed domestic pharmaceutical production and collapsed vital supply chains across the country.

According to a World Health Organization (WHO) news release dated April 14, 2026, Sudan represents the world’s largest humanitarian crisis, with 21 million people lacking basic healthcare services out of 34 million needing aid.

In the void left by the closure of pharmaceutical companies, smuggling networks have flourished, flooding the market with unregulated drugs locally known as “Boko” medicines.

These include critical intravenous malaria medications smuggled across borders. Because they completely bypass strict temperature controls and quality checks during transit, these drugs are frequently spoiled, rendering them either totally ineffective or lethally toxic to patients.

A double threat

Inside local pharmacies in Omdurman, located on the outskirts of Khartoum, the crisis is not just limited to scarcity. Patients now face the double threat of exorbitant costs and life-threatening quality issues, as these illicit medicines are often severely spoiled due to a lack of proper storage and refrigeration.

Mutawakil Hamza, a pharmacist based in Omdurman, said the reliance on unregulated channels is putting lives at immediate risk.

“Most malaria medicines are now brought in through smuggling,” Hamza said. “These are ultimately injections for intravenous use, and this is highly dangerous to a patient’s health.”

Because intravenous treatments bypass the body’s natural defences and require absolute sterility, administering improperly stored or degraded smuggled injections can rapidly cause severe bloodstream infections, systemic shock, or death.

The war has effectively dismantled local manufacturing, reversing years of medical self-reliance. Yasser Ahmed Youssef, a pharmaceutical industry expert whose factory is located in Khartoum, noted the stark contrast to the pre-war era, when local factories managed to produce “very large quantities of life-saving medicines, including drugs for blood pressure, diabetes, colds, and paediatric care”.

Now, the majority of those production lines are silent, leaving the population dependent on a shattered healthcare system. According to the October 2025 Health Resources and Services Availability Monitoring System (HeRAMS) report cited in a WHO Public Health Situation Analysis from January 6, 2026, 40 percent of health facilities nationwide are entirely nonoperational.

The situation is even more drastic regionally, with 87 percent of facilities shut down in Khartoum and 85 percent closed in North Kordofan, whose control is contested between the rival sides.

In active conflict zones such as Gezira, Khartoum, Darfur and the Kordofan regions, the shortages are particularly dire.

A United Nations Population Fund (UNFPA) emergency report from August 2025 highlighted that the only functioning maternity hospital in the besieged city of el-Fasher faces critical medicine shortages and risks imminent closure.

El-Fasher, the last SAF stronghold in the western region of Darfur, was taken over by the RSF in late October 2025, trapping approximately 700,000 civilians – mostly women and children. People have been cut off entirely from food and medicine and subjected to attacks.

Collapsed warehouses and supply lines

In the government-funded public sector, the National Medical Supplies Fund maintains that it is working to secure essential medicines despite the fighting, claiming to have achieved 75 percent availability for cancer medications and fully secured supplies for kidney patients.

However, officials admit the overarching infrastructure is in ruins, with the local health ecosystem almost destroyed.

“We have been massively affected by the ongoing war inside Sudan,” said Abubakar Salouha, a department director at the fund. “The medical supplies have been severely impacted; there has been a collapse at the level of the main warehouses at the headquarters.”

International aid deliveries from neighbouring countries also face enormous logistical hurdles.

The WHO’s January 6 situation analysis detailed 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 suffocating delays, armed groups have repeatedly targeted medical infrastructure, looting pharmacies and stripping remaining hospitals of their vital medical supplies.

Recent attacks highlight this systematic destruction by rival sides. On March 20, 2026, a drone attack on Al-Daein Teaching Hospital in East Darfur state killed at least 64 people, including medical personnel, and injured 89 others. Sudanese rights group the Emergency Lawyers reported that the army was behind the attack.

On April 2, another drone attack struck Al-Jabalain Hospital in White Nile state, killing 10 staff members, including the hospital’s director while he was performing surgery. That same day, the Family Hospital in el-Daein was looted, and patients and health workers were assaulted and expelled. Similarly, a hospital in Kurmuk, Blue Nile state, was looted on March 25, its equipment destroyed, and patients forced out. The RSF was blamed for these attacks.

“Sudan is confronting one of the gravest humanitarian and public health emergencies in the world today. The ongoing conflict has pushed the health system to the edge of complete collapse,” warned WHO Director-General Tedros Adhanom Ghebreyesus on April 4.

“These incidents are stark reminders of the urgent need for renewed international solidarity and decisive political and humanitarian action. Sudan cannot endure this crisis alone.”