Sri Lanka: Doctors scramble for basic medicines as economic crisis engulfs nation

Doctors, nurses, and healthcare workers from Sri Lanka’s public health services took to the streets of Colombo on 6 April to protest the growing shortage of basic drugs and medical supplies amid the country’s worst economic crisis in decades.

The protests came a day after the president, Gotabaya Rajapaksa, elected in 2019 by a large margin, was forced to revoke a state of emergency that took effect on 1 April after his coalition government collapsed.

The order was meant to “ensure public security and order” but has failed to do so. Sri Lanka is battling huge debts and a severe dearth of foreign currency reserves which has left the government unable to pay for imports, triggering food and fuel shortages.

Despite calls for the president and his older brother Prime Minister Mahinda Rajapaksa to resign, they have refused to step down. They hail from a political dynasty that has ruled Sri Lanka for decades.

On 5 April, the Government Medical Officers Association, the country’s influential medical union, declared a national health emergency as doctors across the country expressed anger and frustration over the situation.

“We’ve been facing crisis after crisis since covid,” Rashmira Balasuriya, a trainee doctor in family medicine, set to work in Colombo’s private sector, told The BMJ. “At least during covid, we had support in securing ventilators and essential drugs. Currently, there’s a severe shortage of lifesaving drugs, following a ban on importing drugs imposed by the government after the economic crisis. We’re running out of paracetamol and antibiotics. Basic medical equipment is unavailable and even gloves are in short supply.”

According to the Sri Lanka Chamber of Pharmaceutical Industry, a consortium of importers, manufacturers, distributors, and wholesalers, 85% of pharmaceutical products in Sri Lanka are imported and paid for in US dollars.

On 17 March, the State Bank of India extended a $1bn credit line to the government to purchase food, drugs, and other essential items. The government has also appealed to the International Monetary Fund for assistance to repay its burgeoning debt.

About half of Sri Lanka’s 20 million people are cared for by public health services, which have ranked highly on development indices compared with other Asian countries. Over the past six months, however, a steep rise in the cost of private health services in the country have led to government hospitals being overwhelmed.

A lack of oil to power generators and rains to run hydroelectric power stations have led to 10-13 hour power cuts, which have disrupted surgery, according to Mahesh Gunasekara, medical administrator and director general of the Sri Lanka Red Cross Society. “There’s no fuel to run generators. Without electricity powering lights and medical equipment in hospitals, it’s impossible to conduct surgeries,” he said.

Anaesthesia is also in short supply. Most elective operations have been indefinitely postponed, said Gunasekara. “The situation looks grim.”

Appeals to the government from medical associations and doctors’ unions have gone unheeded.

Gobith Ratnam, a family physician, told The BMJ, “Paediatric suspensions, drugs for chronic diseases, even some emergency and life saving drugs are in short supply, some completely out-of-stock in the past couple of weeks. Currently, there’s a respiratory illness that’s circulating alongside covid, but I’m struggling to prescribe from available drugs. We are helpless.”

Reports indicate that paracetamol syrup and intravenous infusions are in short supply, as are surgical relaxants. Prices for drugs for type 2 diabetes have increased by 20-30%. Cardiac catheters, surgical equipment, snake antivenom, and cancer drugs are also in short supply, said Ratnam.