As a wave of pharmaceutical shortages has swept across Egypt, exacerbated by a steep drop in the pound, the family has had to rely on the good will of friends for a sporadic supply of black-market Silymarin tablets to treat their daughter. Her condition, meanwhile, has worsened, and access to the medicine is becoming more difficult.

“All I can do is pray to God because I cannot do anything else,” said her father, Abdel Maksoud Khalil. “I am helpless.”

Egypt has the highest prevalence of hepatitis C in the world, according to the World Health Organization, which estimates the level of infection at 15 percent of the population, with 165,000 new cases every year. Most commonly caused by coming into contact with contaminated blood, untreated hepatitis C can develop into liver cancer.

Mr. Khalil lost another daughter, Rodiana, seven months ago to acute bronchitis after he could not find the right medicine to treat her.

“We have dropped from the thoughts and care of everybody,” he said.

It is a story that is all too familiar throughout Egypt, where the poor struggle within a system that gives them little access to affordable public health care while the well-off can pay for generous private medical services.

In the aftermath of the 2011 revolution, a steep devaluation in the Egyptian pound, and the lack of hard currency, makes it more difficult to import expensive drugs because the law requires them to be resold at a fixed price.

Egypt’s total pharmaceutical market has been worth about $3.4 billion, but more than 40 percent of that was reliant on imports, making a currency devaluation a financial hurdle for companies.

There is a shortage of an estimated 400 different drugs, some of which are considered lifesaving, said Alaa Ghannam, the director of the health care program at the Egyptian Initiative for Personal Rights in Cairo.

These include treatments for cancer, diabetes and hepatitis C, but also nonprescription items like Zantac for stomach ulcers.

“Up until now, we have managed to find some alternative but not with the same quality,” he said, referring to generic products.

Egypt’s fixed drug-price system has made it increasingly difficult for pharmaceutical companies to cope with a sharp fall of the local currency against the dollar this year, and executives say most companies are losing money.

The situation is exacerbated by the fact that the country’s pharmaceutical market is dominated by the private sector, which supplies most of these medicines. But as the Egyptian pound has depreciated, so has the ability of these companies to meet demand. But large multinational pharmaceutical companies say they have long-term commitments to supply the retail market.

In a country where the government’s allocation to health care is less than 5 percent of the budget — lower than in most Middle Eastern countries — shortages are an additional strain on Egyptians who are already struggling with fuel and food shortages, rising unemployment and a deteriorating security situation.

Doctors and executives in the industry say it is a policy problem that requires immediate government intervention and increased government funding.

While the government is allocating 27.4 billion Egyptian pounds, or $4 billion, to health care in the 2012-13 budget, an increase of 18 percent from the previous financial year, underinvestment in the sector has left many hospitals understaffed and without enough beds and equipment to treat patients.

Shops selling medical equipment, like wheelchairs and surgical knives, exist predominantly for patients to purchase supplies that a nearby public-sector hospital may not have. It is not unheard of for poorer Egyptians to bring their own bedsheets to the hospital.

“We are lacking so many simple medicines, for example Zantac, which is supposed to be used in the emergency room,” said Mohammed Saad, a doctor at a hospital in Damanhur, a city in Lower Egypt.

Medicines that are not subsidized by the government are often too expensive for the poor to purchase. Subsidized insulin, for instance, costs as little as 6.5 Egyptian pounds but would normally cost 50 to 60 pounds — beyond the reach of the poorest patients — if it were not part of the welfare program.

Pharmaceutical companies operating in Egypt say they have not stopped importing drugs or manufacturing them in the country but are trying to negotiate price increases of some drugs to counteract losses.

Article source: http://www.nytimes.com/2013/04/04/world/middleeast/fall-in-egyptian-pound-weighs-heavily-on-the-ill.html?partner=rss&emc=rss