Tunisia’s financial crisis leaves the sick struggling to find medicine

Tunisia’s financial crisis leaves the sick struggling to find medicine
A view shows boxes of medicine at retired soldier Nabil Boukhili’s unofficial medicine exchange room at the roof of his house, in Tunis on May 29, 2023. (Reuters)
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Updated 01 June 2023
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Tunisia’s financial crisis leaves the sick struggling to find medicine

Tunisia’s financial crisis leaves the sick struggling to find medicine
  • Hundreds of medicines have been missing for months, pharmacies say, including important treatments for heart disease, cancer and diabetes
  • "The issue of missing medicine has become very hard for patients," said Douha Maaoui Faourati, a Tunis doctor

TUNIS: Sick Tunisians face a frantic struggle to find some medicines because the cash-strapped state has reduced imports, leaving doctors unable to control debilitating health problems and patients turning to informal markets for their medication.
Hundreds of medicines have been missing for months, pharmacies say, including important treatments for heart disease, cancer and diabetes as well as more basic products such as medicated eye drops whose absence worsens chronic conditions.
“The issue of missing medicine has become very hard for patients. We have a real problem with some medicines for which there are no generics available,” said Douha Maaoui Faourati, a Tunis doctor specializing in kidney and blood pressure disease.
Faourati has had to ask patients to try to get drugs from Europe, including ones used to control dangerously irregular heartbeat, swelling and clotting, and for which she says no good alternative is available in Tunisia.
Her difficulties show how Tunisia’s worsening fiscal problems are hitting ordinary people and adding to public anger at a state barely able to maintain even basic services.
Since last year Tunisia has struggled to pay for other goods that are sold at subsidised rates, causing periodic shortages of bread, dairy products and cooking oil as foreign currency reserves dropped from 130 days of imports to 93 days.
Tunisia wants a $1.9 billion International Monetary Fund bailout, without which ratings agencies have warned it may default on sovereign debt, but President Kais Saied has rejected key terms of the deal and donors say talks have stalled.
Tunisia imports all medicine through the state-owned Central Pharmacy, which provides drugs to hospitals and pharmacies around the country which offer them to patients at a subsidised rate.
The head of Tunisia’s Syndicate of Pharmacies, Naoufel Amira, said hundreds of medicines are no longer available, including for diabetes, anaesthesia and cancer treatment.
Amira and two officials at the Central Pharmacy who spoke anonymously because they were not authorized to talk to media, said the body owed large sums to foreign suppliers, which had restricted their sales to Tunisia in response.
“The problem is primarily financial,” Amira said.
Amira said the Central Pharmacy owed about 1 billion dinars ($325 million) to suppliers. The officials there said it owed about 800 million dinars, adding that public insurance companies and hospitals were delaying paying their bills by up to a year.
Tunisia’s Health Ministry and Central Pharmacy did not respond to requests for comment.

MEDICINE EXCHANGE
From the roof of his Tunis house, retired soldier Nabil Boukhili has opened an unofficial medicine exchange for his neighborhood in coordination with local doctors. “We have dozens of people coming here daily to get medication,” he said.
He sources medicine from people traveling overseas as well as leftover pills from people who have finished their own treatment, dispensing it free of charge to people who can show a prescription.
While Reuters was interviewing Boukhili, a woman arrived needing medicine for a thyroid problem. “I’ve been without this medicine for over a week,” said Najia Guadri, adding that she felt unable to function without it.
Sitting at his parents’ home in Tunis, Abdessalem Maraouni described how a lack of medicated eye drops has left him at risk of blindness and unable to go outside, forcing him to abandon his law studies at the university.
“This country can no longer provide even a box of medicine,” he lamented, sitting in the modest family home decorated with posters of his favorite football club but unable to see objects more than a few meters away.
The 25 year-old has not been able to find the medicine, or an alternative, for six months and has had to seek supplies from people traveling abroad, paying far more than he would from Tunisian pharmacies and rationing his use.
Maraouni’s father Kamal wept as he described how the state’s inability to import medicines had hit his son’s prospects.
“We don’t ask the state for money or grand places to live. We only ask for medicine. Is that too much?” he said.


Iraq wants to overcome dispute with Kuwait over maritime waterway, PM says

Iraq wants to overcome dispute with Kuwait over maritime waterway, PM says
Updated 4 min 14 sec ago
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Iraq wants to overcome dispute with Kuwait over maritime waterway, PM says

Iraq wants to overcome dispute with Kuwait over maritime waterway, PM says
  • Kuwait’s prime minister has described the Iraqi court ruling on the waterway as containing “historical fallacies,” calling on Iraq to take “concrete, decisive and urgent measures” to address it

Iraq is keen to overcome a dispute with Kuwait on maritime navigation in the Khor Abdullah waterway between the two countries, Iraq’s prime minister said on Tuesday.
In comments carried by Iraq’s state news agency, Prime Minister Mohammed Shia Al-Sudani said the country wants a solution that does not conflict with its constitution or with international law.
Iraq respects the sovereignty and territorial integrity of Kuwait and is committed to all its bilateral agreements with countries and to the resolutions of the United Nations Security Council, a statement from the prime minister’s media office said on Tuesday after Al-Sudani’s meeting with the state’s administration coalition.
“Such crises are resolved through understanding and reliance on rationality, away from the language of emotion and convulsive populist statements that only produce more crises and tension,” Al-Sudani was quoted as telling his cabinet.
Iraq’s Federal Supreme Court ruled this month that a bilateral agreement regulating navigation in the waterway was unconstitutional. The court said the law ratifying the accord should have been approved by two-thirds of parliament.
The countries’ shared land border was demarcated by the United Nations in 1993 after Iraq’s invasion of Kuwait, but it did not cover the length of their maritime boundaries. This was left for the two oil producers to resolve.
A maritime border agreement between the two nations was reached in 2012 and ratified by each of their legislative bodies in 2013.
Kuwait’s prime minister has described the Iraqi court ruling on the waterway as containing “historical fallacies,” calling on Iraq to take “concrete, decisive and urgent measures” to address it.


At least 100 killed in fire at Iraq wedding celebration

At least 100 killed in fire at Iraq wedding celebration
Updated 12 sec ago
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At least 100 killed in fire at Iraq wedding celebration

At least 100 killed in fire at Iraq wedding celebration

At least 100 people were killed and 150 people were injured in a fire at a wedding celebration in the district of Hamdaniya in Iraq’s Nineveh province, Iraqi state media said early on Wednesday.

-More to follow.


Morocco calls for resumption of Western Sahara talks

Morocco calls for resumption of Western Sahara talks
Updated 27 September 2023
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Morocco calls for resumption of Western Sahara talks

Morocco calls for resumption of Western Sahara talks
  • Permanent representative to UN calls for solution to ‘fabricated regional conflict’
  • ‘Climate change continues to represent the biggest challenge to humanity in the globe’

NEW YORK: Morocco’s permanent representative to the UN on Tuesday called for a resumption of negotiations over the situation in Western Sahara.

Speaking on the final day of the 78th session of the UN General Assembly, Omar Hilale said Morocco is resolute in finding a solution to the “fabricated regional conflict” as an aid to promoting peace and stability in the region and Africa more widely. 

“Morocco continues to support the efforts of the UN to relaunch roundtables with the same format and the same participants, especially Algeria, the main party to this conflict, in line with its Security Council resolution 2654,” he added.

“We reaffirm, the solution can only be politically realistic and practical, based on consensus. The initiative for autonomy as part of the toolkit of Morocco’s territorial integrity and national sovereignty remains the solution to this regional conflict. There’s no alternative.”

The Western Sahara conflict dates back to 1975, after the withdrawal of colonial occupier Spain, sparking a 15-year war between the Algeria-backed Polisario Front and Morocco for control over the territory.

A 1991 ceasefire deal brought fighting to an end, with Morocco in control of 80 percent of the resource-rich desert region and the Polisario Front clinging to hopes of a UN-supervised referendum on independence provided for in the deal.

Alongside calling for further work on bringing an end to the near half-century conflict, Hilale provided an update on efforts being undertaken by Moroccan authorities to respond to the devastating earthquake that struck at the start of the month.

“We’ve faced the repercussions of this earthquake, which led to the death of 3,000 people and injured 5,700 others, alongside grave material losses, but we face these repercussions with determination, seriousness and solidarity,” he said.

“We established an inter-ministerial committee to develop an urgent program for the reconstruction and rehabilitation of affected areas, and located about $12 billion for this program from our budget for the next five years.

“This shows climate change continues to represent the biggest challenge to humanity in the globe. This is why today, more than ever, there’s a need to promote prevention, resilience, and international cooperation as part of the international community’s priorities.”


25 dead in fierce new fighting in Deir Ezzor

25 dead in fierce new fighting in Deir Ezzor
Updated 27 September 2023
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25 dead in fierce new fighting in Deir Ezzor

25 dead in fierce new fighting in Deir Ezzor
  • Forces loyal to Assad regime clash with Kurdish-led troops in eastern Syria

JEDDAH: At least 25 people have died in two days of fierce clashes between fighters loyal to the Assad regime and Kurdish-led forces in the Dheiban area of Deir Ezzor province in eastern Syria.
The Kurdish-led Syrian Democratic Forces said they had “driven out the regime gunmen who had infiltrated the area” after gun battles erupted on Monday.
At least 90 people were killed in the same area this month in 10 days of fighting between the SDF and armed Arab tribesmen.
Britain-based monitor the Syrian Observatory for Human Rights said the latest clashes erupted when pro-regime fighters crossed the Euphrates river, which separates their positions in southwestern Deir Ezzor from the SDF in the northeast. It said 21 of the dead were regime loyalists and three were SDF fighters. A woman was also killed.
The SDF said the loyalist fighters had crossed the Euphrates “under cover of an indiscriminate bombardment”of its positions. The SDF responded by bombarding the right bank of the river, which is controlled by regimetroops with support from Iran-backed militias.
The Kurds form a majority in the core areas of SDF control in northeastern and northern Syria. But in several areas that they captured in their campaign against Daesh, Arabs form the majority.
According to the Observatory, which has a wide network of sources inside Syria, some of the Arab fighters who fled to government-held territory after the previous clashes took part in this week’s assault.
The SDF was Washington’s main Syrian ally in its fightback against Daesh, which culminated in the militants’defeat in their last Syrian foothold on the left bank of the Euphrates in 2019.


Sudan’s displaced millions struggle to survive as economy seizes up

Sudan’s displaced millions struggle to survive as economy seizes up
Updated 26 September 2023
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Sudan’s displaced millions struggle to survive as economy seizes up

Sudan’s displaced millions struggle to survive as economy seizes up
  • More than 5.25 million of Sudan’s 49 million people have been uprooted since the fighting erupted

PORT SUDAN: About two months after heavy clashes around his home in Sudan’s capital drove Sherif Abdelmoneim to flee, soaring rent and food costs forced the 36-year-old and his family of six to return to a city where fighting still rages.

Most of those who fled Khartoum after war between the army and the paramilitary Rapid Support Forces broke out in mid-April have not returned. They face malnutrition, floods and scorpions as they depend for survival on handouts and meager aid relief, the generosity of host communities stretched increasingly thin.

More than 5.25 million of Sudan’s 49 million people have been uprooted since the fighting erupted, according to UN figures. Over 1 million of those have crossed into neighboring countries, but more than 4.1 million have stayed in Sudan, where they have come under increasing financial pressure.

“The states (outside Khartoum) are safe but the prices are expensive and rents are high, and we cannot continue with that,” Abdelmoneim said by phone from Omdurman, a city adjoining Khartoum where he has rented a house in an area where he can still hear artillery fire but is no longer in the midst of clashes.

The conflict has brought Sudan’s stagnant economy to its knees, blocking much trade and transport, hampering farming, halting many salary payments, and causing vast damage to infrastructure.

The country now has to draw on what meager resources are left to support an internally displaced population which, when those made homeless by previous conflict are included, reaches nearly 7.1 million, more than any other in the world.

Aid workers expect that more of those who had paid rent or lodged for free when they fled the capital will end up in collective shelters as their funds dry up.

“We are hospitable but people are handling more than they can,” said Omar Othman, a government official in Kassala, where he said rents had risen sharply. “If the war continues, these people came with small savings so they will need shelter.”

Host communities in areas little affected by fighting have been reeling from the knock-on effects of the war.

In Rabak, about 275km (170 miles) south of Khartoum, many young people had been trying to make a living in factories or as day laborers in the capital before the war broke out.

“For the locals the labor market is paralyzed. Khartoum is the engine for the rest of the country,” said resident Fadeel Omer.

Displaced people in the city unable to afford rent were lodged in shelters with crumbling walls and scorpions, and several malnourished children had been dying daily in the city hospital, he said. Large groups had headed back to Khartoum.

In Merowe, 340km north of Khartoum, salaried workers and farmers have seen their income dry up, and local volunteers are struggling to provide basic meals to the displaced, some of whom were sleeping on sofas or tables, said lawyer and local volunteer Izdihar Jumaa.

Damage to infrastructure in the three regions worst affected by the war – Khartoum, Darfur and Kordofan – could be $60 billion, or 10 percent of its total value, said Ibrahim Al-Badawi, Sudan’s former finance minister and an economics researcher. He estimated that the gross domestic product could plunge 20 percent this year.

“If the war stops, Sudan would need emergency economic support of $5-10 billion to revive the economy,” he told Reuters in an interview in Dubai.

“The continuation of the war will lead to the destruction of the Sudanese economy and the state.”

Since the start of the war, prices for many products soared. The currency has fallen as low as 900 Sudanese pounds to the dollar on the black market in the Red Sea city of Port Sudan, a hub for government officials and aid workers, from about 560 pounds in April.

A continuing lifeline for many is remittances sent by Sudanese living abroad, said Omar Khalil, who fled to Port Sudan from Omdurman in June with his wife and three children.

“They are the ones bearing this burden on their shoulders,” he said. “This cannot last forever.” Khalil and his wife, both former art teachers, now make ice cream at home to sell to supermarkets.

International aid efforts for Sudan are severely underfunded, with less than 25 percent of the $2.6 billion required for this year received by mid-August, according to the United Nations. Aid workers say relief operations have also been hindered by government red tape and the breakdown of services and logistics based in the capital.

Authorities are nervous about relief operations by local volunteers and want the displaced to be housed in camps, but there are no funds to run them on the scale that would be needed, said Will Carter of the Norwegian Refugee Council.

Across Sudan, some displaced people who had been renting were being evicted, though most were still lodging with extended families or strangers, he said. “We’re going to have an impasse – people squatting will be destitute within these cities,” he added.