A multi-state cross-sectional assessment of essential medicine availability in Sudan during armed conflict

Abstract

The armed conflict that erupted in Sudan in April 2023 has severely disrupted the country’s healthcare system, affecting hospitals, community pharmacies, and essential health services, including pharmaceutical supply chains. This study aimed to evaluate the influence of the persistent armed conflict in Sudan on the accessibility of essential medications in community pharmacies within designated states. It aims to pinpoint critical factors influencing medicine supply, assess availability across regions, and investigate the strategies employed by pharmacists to ensure access to essential medications. This study examines geographic variation, pharmacy type, and barriers to medicine access to enhance humanitarian planning, national policy responses, and pharmaceutical resilience strategies in prolonged crisis contexts. A cross-sectional survey was conducted between December 2024 and May 2025 using the WHO/HAI methodology. The WHO/HAI methodology is a standardized, international survey method developed by the World Health Organization (WHO) and Health Action International (HAI) to measure the price, availability, and affordability of essential medicines in both public and private sectors. Data were collected from 118 public and private community pharmacies across Aljazeera, Northern, White Nile, and Red Sea states. Availability of 50 essential medicines was recorded through a structured questionnaire. Descriptive statistics, t-tests, and ANOVA were used to analyze differences by pharmacy type and location. Overall, 95.8% of pharmacies reported disrupted access to medicines, and 98.3% reported significant price increases. Chronic disease medications such as insulin (11.0%), diazepam (15.3%), and captopril (26.3%) were among the most unavailable. Public pharmacies showed significantly higher average availability than private ones (p = .04), while Northern State reported higher availability than Aljazeera and Red Sea states (p < .001). Essential medicine availability in Sudan has been critically undermined by the conflict, with chronic disease treatments disproportionately affected. These findings highlight the urgent need for secure pharmaceutical supply corridors, support for local production, and coordinated humanitarian efforts to restore medicine access in conflict-affected areas.