Four days after her mother’s death, Salwa found the box of medicine she had been using to treat malaria. A quick glance at the expiration date shocked her (2018).

Salwa’s search for medicine for her mother was not easy amid the chaos engulfing Khartoum, where she lives in the South Belt area. But she finally managed to get it from the popular Sabreen market in Omdurman.

She did not know that what she thought was a lifeline for her mother, who was exhausted by illness and prolonged use of traditional treatments, would be the cause of her death. Salwa told Sudan Tribune with a voice choked with sorrow: “I believe in God’s will, but I will never forgive myself for not checking the expiration date of that medicine.”

Official Action and Limited Oversight

Mohamed Bashir, Secretary of the Monitoring Secretariat at the National Medicines and Poisons Board, acknowledges significant challenges. In his interview with Sudan Tribune, he confirmed the recent detection of many pharmaceutical violations and revealed legal actions taken against pharmaceutical institutions found with non-compliant medicines under the Medicines and Poisons Act.

Despite his assertion that violations have significantly decreased “due to improved drug availability and the effective supervisory role of the board’s branches in the states,” according to the semi-annual monitoring report, the reality told by stories like Salwa’s paints a different picture.

Bashir emphasized that the board is combating smuggled drugs by enhancing oversight and activating its mechanisms in safe states, conducting regular inspection campaigns, which has helped reduce the presence of unregistered medicines. He pointed to a deterrent legal framework represented by the 2009 Medicines and Poisons Act and other supporting laws such as the Consumer Protection Act.

He added that the board formed a high committee to monitor entry points including customs, economic security, and standards authorities, aiming to protect the country from the danger of smuggled drugs, while confirming that drug prices are subject to a controlled pricing schedule.

“Koko”… The Trade of Death

Pharmacist Dr. Bahaa Eldin Al-Haj told Sudan Tribune that Sudan has suffered for years from the phenomenon of counterfeit drugs of unknown origin, locally known as “Koko.”

Al-Haj confirms that the trade of these deadly drugs flourished especially after the 2021 coup and worsened catastrophically during the current war. He says: “Because of the war, most of the drugs sold and distributed now are counterfeit and of unknown origin.”

He revealed that most counterfeit drugs reach Sudan from Egypt through the Argeen border crossing, and from India via South Sudan to the city of Rabak, in addition to other quantities arriving through Kassala state.

Al-Haj warns that these fake drugs pose a deadly threat to public health, as patients consume them unaware they contain toxic substances or incorrect doses, leading to poisoning, treatment failure, and disease worsening. He adds: “These products also accelerate the spread of drug-resistant infections, especially antimalarials and antibiotics.”

Regarding the scientific debate about using expired drugs, Al-Haj explains that the matter is complex, as the expiration date (expdate) differs from shelf-life, which refers to the time during which the active ingredient’s effectiveness decreases to 90%.

However, he adds: “In post-war Sudan, due to the greed of unscrupulous individuals and lack of oversight, things have become confused. It is no longer just about the expiration date, but the spread of completely counterfeit drugs alongside expired medicines and a small amount of genuine drugs.”

He also attributed the rise in drug prices to supply chain disruptions caused by the war and the collapse of the pharmaceutical system with most local companies and factories exiting the market. He confirmed that Sudan has not witnessed drug stability for the past fifteen years.

Worsening Crisis and Heavy Losses

Amar Mohamed, a former employee at the Medicines Board, sees the crisis as not new, pointing in his interview with Sudan Tribune to previous UN reports warning about the spread of counterfeit drugs in African countries including Sudan. He confirmed that the board worked hard before the war to combat this phenomenon, adding that the ongoing fighting has exacerbated the drug crisis unprecedentedly.

Mohamed concluded by emphasizing that “losses are no longer limited to lives but extend to heavy economic losses for the state itself, whose health system is collapsing and whose patients are dying either due to lack of medicine or due to the circulation of deadly drugs.”

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The Sudanese Media Forum and member institutions publish this material prepared by Sudan Tribune to highlight the crisis of counterfeit and expired drugs in Sudan, revealing weak official oversight and the risks of exacerbation with the war, along with resulting deadly health and economic risks.