“We’re Dying” of Cancer

Patients in Syria forced to use the black market for medicines!

Nermin Abbas 00 September 2026
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This investigation reveals how cancer patients in Syria are forced down a particular path, starting at the specialist oncology hospital. Driven away by the lack of treatment to charitable aids. We document how medicines are siphoned off into a booming black market of pharmacies and social media accounts, which has become the last lifeline for patients.

Early in the morning, Wafa Hassan (not her real name) packs her bag. She puts in the dose of medication her husband has bought for her, along with some cotton wool and a catheter, something she says is not always available at the Al-Bairuni government hospital. And, of course, she does not forget, of course, to take along the needle for her allergy test.

Wafa has been having breast cancer treatment for five years, and she knows full well that a shortage of even the most basic supplies can directly impact her chances of receiving the treatment and care she needs. “If someone dies in hospital, they’ve got nothing to give them.”

Al-Bairuni University Hospital is the only integrated cancer treatment center in Syria. It is supposed to provide its diagnostic and therapeutic services to people entirely free of charge.

The cost of Wafa’s journey to find treatment begins long before she reaches the hospital. Her trip to Damascus with her husband and daughter costs 100,000 Syrian pounds (around US$10 at the current exchange rate), which is twice what her husband earns in a day from working at his street stall.

In the crowded hospital corridors, Wafa knows she is not alone. She can see the pain etched on the faces of other patients too. She remembers her initial shock at seeing women older than her, worn down by illness. She consoles herself with the thought that, at the age of “forty”, her body is still holding up, whilst others are on stretchers.

Wafa wept once when she saw an old lady on a drip in the hospital waiting area all alone, with no one to hold her hand. Wafa describes the emotional burden of it all: “When I go to get treated, I feel sick before I even get there… when I get back I feel emotionally drained from all the suffering I’ve seen around me.”

As soon as the hospital visit is over, Wafa faces another trek to find her next dose of medicine from the black market that patients are pushed towards. She has been forced to sell her furniture to pay for treatment, which the hospital has been unable to provide for months.

‏900$
the cost in pharmacies outside the hospital for a single dose of Kadcyla - enough for just 21 days.
‏1200$
what one “smuggled” dose of the drug sometimes costs – “Every pharmacy charges a different price.”

Wafa is on Kadcyla, which she is supposed to receive free from Al-Bairuni Hospital. But instead she is forced to buy it from outside pharmacies, at prices that change by the month. For her latest dose she paid 8.8 million Syrian pounds (US$ 900).

She says a “smuggled” dose of the drug sometimes costs up to 12 million Syrian pounds (US$ 1,200) amid wildly inconsistent pricing. “Every pharmacy charges something different,” she says. “The problem is we’re forced to buy it, because it’s been out of stock at the hospital for about a year and a half.”

Wafa goes on to say that her doctor increased her dosage of the drug when she stopped responding. But, with it being unavailable at the hospital, the cost of a single dose – enough for just 21 days – is $900.

“I couldn’t raise the money, so the doctor said ‘I’ll switch you to a cheaper alternative, and you’ll have to go and see the charities,’” says Wafa. But even the so-called cheap alternative was beyond the family’s means. Once again, the cost stopped her from continuing her treatment.

The scale of the crisis

official figures show how severe shortages are

% 0 Only
of the required cancer medication is available in the country
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new cancer cases in 2024, according to the Global Cancer Observatory
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cancer patients in Syria, according to the latest official statistics
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of these are women and 953 children

Joint Responsibility

When I asked the health ministry press office who was responsible for overseeing health services at Al-Bairuni University Hospital, they told me the Ministry of Higher Education and Scientific Research was “the government body directly responsible for the full supervision of health services within the hospital”.

This overlap in ministerial responsibility stems from an official ruling on 22 May 2025 that transferred the hospital from the health ministry to that of higher education. The ruling stated that the academic, administrative and financial oversight of teaching hospitals be transferred in full to the Ministry of Higher Education, with the extent of coordination with the health ministry set out by mechanisms determined by a joint committee.

We asked both the Ministry of Health and the Ministry of Higher Education and Scientific Research why there was a shortage of cancer medication at Al-Bairuni University Hospital; what the role of each ministry was in ensuring treatment services were available for patients; and what the hospital’s requirements were for cancer medicines and which body was responsible for meeting them. We also asked for clarification over the list of charitable organisations displayed in the hospital, and what criteria were used in choosing the pharmacies to which patients were referred. To date we have received no response from either ministry.

In the absence of any official response, the most significant official acknowledgement of the problem came from Dr Jamil al-Dabl, Chairman of the National Advisory Committee for Haematology and Oncology. He acknowledged in 2025 how acute the shortage of cancer treatments was in Syria, saying that only around 20 per cent of the required medicines were available. The Global Cancer Observatory meanwhile reports that there were over 27,000 new cases in Syria in 2024. The latest official statistics show more than 15,000 cancer patients in Syria (including 8,281 women and 953 children).

The path patients are forced down

Click on each station to track the journey a cancer patient is driven down — from the hospital door to the black market.

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A Gruelling Road to Treatment

“Walaa Rami” (not her real name) zips up her coat and adjusts her woollen scarf as she waits her turn outside the headquarters of the charity “S”. She is hoping for some financial help, even though she knows full well that this will probably cover only a tiny fraction of the cost of her treatment. She waits in silence, broken only by the laboured breathing of people weighed down by sickness.

Walaa has come here looking for financial assistance to buy medicine for her 49-year-old husband, Aziz Mahmoud (not his real name), who is battling brain cancer and remains at home.

The charity “S” – affiliated with the Union of Charitable Associations –provides medical assistance to the most disadvantaged in Syria; this includes financial support for surgery, medicines and procedures such as scans and tests. Cancer patients are not given medicines directly. The charity instead gives them a “contribution voucher” specifying the amount it will cover, which patients can put towards the cost of the medicines they are forced to buy themselves from pharmacies.

Although there are other charitable organisations giving medical help to the underprivileged in Syria, seven such organisations we contacted in the capital, Damascus, told us that “S” is the leading body helping cancer patients with the cost of their medication.

Haitham Saltji, treasurer of the Al-Afiya Fund – one of the organisations supporting cancer patients to access treatment and medical services – explains that the total value of financial help given to patients during 2025 was 680.5 million Syrian pounds (approximately US$68,000 at current rates). This money went to support 640 patients, the majority of whom (70 per cent) were at Al-Bairuni Hospital.

Walaa is not alone in shouldering her burden: a long queue of patients and their companions has formed since the early hours of the morning. All the faces look alike, pale and exhausted. Each reminds her of her husband, as if prolonged suffering moulds every face into the same features.

All the while Walaa clutches her most important document: a prescription from Al-Bairuni Hospital, with an official stamp stating what the hospital has failed to provide: “Medicine not available at hospital”. Just a few brief words, but ones that represent her only means of obtaining help from the charity.

‘Aziz’s’ story sums up the gruelling process all cancer patients must go through to obtain treatment. Every official document conceals a long story of agonizing waits and treatment postponed indefinitely.

The family’s ordeal began as soon as Aziz was diagnosed, when he was forced to withdraw 600,000 Syrian pounds (around US$60 at current rates) from his savings to pay for an MRI scan at another center, as the hospital’s machine was out of order.

In the window of the pharmacy at Al-Bairuni Hospital there is a notice giving the names of the charities providing help to patients. Aziz and his wife had no option but to seek help from charity “S”, but it could only offer them 200,000 Syrian pounds (US$20 approx.) towards the 800,000 pounds (US$80) the scan cost.

Walaa describes their ongoing struggle: “I’m running from pillar to post trying to give him a chance to get cured; but in the end our only hope is from God.”

Given their lack of funds, the couple were forced to turn to another charity for help to cover the remaining costs of Aziz’s treatment.

The Black Market

Before the streets of Al-Qalamoun have got busy, Souad Akram and her husband Ahmad Al-Salem (not their real names) have already booked their seats in the first shared taxi to Damascus. Squeezed inside, Ahmad – who has leukaemia – winces with pain at every pothole in the road. Souad, next to him, watches the first rays of the sun while keeping an eye on her husband, who is struggling with an illness that never lets up.

When they reach the outskirts of the capital, each of them knows what to do. At Al-Bairuni Hospital Ahmad hauls himself, frail as he is, out of the taxi, while Souad continues on to the headquarters of charity S. She queues for hours, hoping to secure at least a small contribution to the cost of treatment. But the journey is often wasted, if she arrives after consultations have finished for the day.

If she does manage to arrive on time, a scramble over queue numbers begins. The charity refers patients to pre-selected pharmacies, giving them a “financial support certificate” specifying how much it will pay towards the cost of medication.

Souad and her husband were twice referred to pharmacy A, in the Mezzeh district, despite her pointing out that a number of patients had objected to being sent there because of the high prices it charged for medicines. While working on this report, we documented the couple being referred repeatedly to this same pharmacy.

Souad says she informed the management of the charity that pharmacy A sold medicines at higher prices than others, and asked to be referred to an alternative one. But the charity told her it dealt only with this pharmacy. Although the couple were subsequently sent to another pharmacy, the charity sent them back to pharmacy A.

Souad found out she could save money by purchasing the medicine from pharmacies in the Dahiyat al-Sham neighbourhood, close to Al-Bairuni Hospital. In the end, she decided to pay the full cost at those pharmacies, rather than accept help from charity S, which was conditional on her using pharmacy A, where the drug was more expensive, even after taking into account the financial subsidy from the charity.

Souad was not alone; the same pattern was repeated, in the case of Walaa (the wife of patient Aziz). She too was given a small amount of financial assistance from charity S, based on the medicine being certified out of stock at Al-Bairuni Hospital. The charity referred the couple, as usual, to pharmacy A.

“Hanan Muhammad” (not her real name) who has a sarcoma - cancer of the connective tissue - was also referred to the same pharmacy after the charity S offered her support worth 215,000 Syrian pounds (approximately US$21). In the end, Hanan forwent Ironically, Hanan ended up forgoing this assistance altogether, when she found out she could buy the medicine from another pharmacy for around US$60 less than the price charged by pharmacy A – even after factoring in the financial support provided by the charity.

Responding to these findings, the Director of the Health Ministry’s Cancer Diseases Directorate Ghada Sousan denies there is any official directive: “The Ministry of Health does not oblige any association to deal with a specific pharmacy,” but stipulates only that medicines must be subject to ministerial supervision if supplied directly to an association.

“If medicines have been purchased from any pharmacy, however, then to the best of my knowledge, there is no law forcing any association to choose one particular pharmacy over another,” she adds.

Sousan acknowledges that the health ministry does not keep accurate statistics on the number of patients who have received medical support from charities, saying the Ministry of Social Affairs and Labour was responsible for this. Each ministry, it turned out, passed responsibility to the other. When we contacted the press office at the social affairs ministry, they said the matter was “entirely one for the Ministry of Health!”

We contacted charity S to ask on what basis they decided which cancer patients were eligible for support. We also asked about their criteria for accrediting pharmacies to contract with, and whether there were any exclusive contracts with specific pharmacies. But we have so far received no response.

We also asked the Ministry of Social Affairs and Labour and the Union of Charitable Associations about their involvement in selecting and overseeing organisations that provide financial assistance to cancer patients, and about the criteria they used to decide which pharmacies would benefit from the scheme. But again we have yet to receive any response.

“It’s not your problem… God can take care of them”

Patients cram into the pharmacy of “Mohammed Hassan” (not his real name) in one of the neighbourhoods of Damascus, where he sells smuggled medicines. Hassan says they are flown in or come by land from licensed warehouses in Jordan, Lebanon and Turkey.

He explains that pharmaceutical inspection teams take a hard line on these medicines. They come armed with a warrant, confiscate the drugs, and fine the offending establishment. “They’re right; they’re worried about where they come from,” he says, but adds: “Leaving everyone without medicine is also a problem.”

This pharmacist says there has been a severe and ongoing shortage of cancer drugs since the days of the Assad regime, adding: “And even today, the state has no money, or no contracts… I don’t know.”

"
They used to say the same thing under the previous regime, and they’re telling me the exact same thing now: “It’s not your problem… leave them to it, don’t give them any medicine, tell him there isn’t any – let God take care of the sick!’”
— “Mohammed Hassan”, pharmacist

Hassan says they look out for specific things to detect counterfeit drugs, like the type of packaging, the physical appearance of the medicine itself, and other characteristics that vary from one type to another. He points out, however, that some “genuine” medicines are sold without a hologram security sticker, while such stickers can also be forged and printed in cities outside Syria.

During our interview, the pharmacist showed us invoices from licensed pharmaceutical warehouses in Syria for the medicines he had purchased for his pharmacy. But when we examined these invoices they turned out to have no official warehouse stamp or signature.

Hassan openly admitted that some pharmacists source pharmaceuticals on Facebook, but warns against this: “They’re a hundred percent fake.”

We questioned the Ministry of Health and the Syrian Pharmacists’ Union as to why there was a shortage of cancer medicines in pharmacies and why the price varied so much, and what they were doing about people selling cancer medicines on Facebook. We have so far received no response, however.

None in hospital… but available on Facebook

Facebook is full of images of cancer treatments and pleas for help to get hold of them.

The “Friends of Al-Bairuni Hospital” Facebook group lays bare this daily struggle. It has become a space where patients and their families appeal for help in tracking down a certain medicine, someone prepared to offer it, or a drug that is no longer on the market. The group’s members include not only patients and their families but also nurses and administrative staff working at Al-Bairuni Hospital. It offers a rare glimpse of what cancer patients face both inside and outside the hospital.

There are many posts asking whether cancer drugs are available in the hospital, since patients want a definitive answer before setting out on a debilitating journey to Damascus from distant parts of the country, only to find they travelled for nothing. It is often nurses who respond, saying whether the drug is available in the right dosage, or is out of stock.

Posts on the Friends of Al-Bairuni University Hospital Facebook group enquiring about the availability of medicines:

While monitoring posts within the group, we spotted a striking comment from an account claiming to be able to source missing cancer drugs, which had replied directly to the post.

I personally contacted the account holder, using a pseudonym, to find out how scarce medication can be promoted and procured on social media platforms. The profile picture showed a person wearing a white coat, with a stethoscope round his neck and, facial features obscured an image that appeared to have been copied from an online “stock photo” website.

In the course of the conversation, the account holder introduced himself as a pharmaceutical “distributor”, and offered to help in obtaining required medicines.

In our first exchange, this “distributor” offered to supply me with a dose of Kadcyla (160 mg) – used in treating breast cancer – for $425, saying it was manufactured by the Swiss company “Roche”. When I asked what company he worked for, however, he refused to disclose its name.

When I messaged him again through Facebook, he suddenly adopted a harsher tone, describing me as “indecisive”, perhaps to pressure me into concluding the sale, before then backtracking and assuring me he was able to obtain the medicine at the same price.

To verify the claims of this “distributor”, I then contacted Al-Inaya, the company responsible for supplying Kadcyla in Syria. One of the employees dispelled any doubt, confirming that the company did not have the drug in stock and referring me to the local representative office - known as the “scientific office” - of the Swiss company Roche (the drug’s manufacturer).

However, our investigation hit a dead end once again, as the Roche office manager, Farid al-Haddawi, refused to answer any questions, citing “company policy”.

I decided to look further into this and contacted the same seller on Facebook, using an account under another pseudonym, to check whether he was still promoting the drug. The “distributor” said doses of Kadcyla were available and this was “guaranteed”. But the price had somehow now jumped to $625. He even warned me against “counterfeit” Kadcyla on the market for $400, backing up his claim by sending photos via Messenger of the package he claimed was genuine.

The price alone raises suspicions about the authenticity of these “treatments”. A field study of 18 pharmacies in Damascus showed that the price of smuggled Kadcyla is between $800 and $1,000 per dose. This clearly does not match the prices charged by this seller and makes it even more likely he is peddling counterfeit medicines.

“We’re dying”

“We’re dying right now,” says 27-year-old Heba Nasser, a student of cinematography, capturing the reality for cancer patients in Al-Bairuni Hospital.

Heba appeared in one of the most widely shared videos on social media in Syria. She showed how the hospital was unable to provide even the most basic medical necessities - from particular medicines to intravenous catheters, which patients are forced to buy outside and bring in with them.

Heba’s treatment for her breast cancer has been on hold since February 2026. Even though she went to great lengths to purchase the drug she needed at her own expense, she says that because of hardening of her veins she was unable receive the injections. This meant she needed a special device, which took the hospital two months to procure.

Heba pays US$160 per dose of her cancer medication, but she does receive immunosuppressant medication from the hospital. Heba says: “The hospital management simply tells us the medicine is out of stock and they don’t know when it’ll be available…... and they ask us to buy it from abroad.”

Heba concludes: “Patients are simply dying these days… and nobody is paying any attention.”

*This investigation was made in conjunction with “Women who won the war”.

This investigation was published in Arabic on the following:
Daraj Almostathmir Mada News Raseef 22 Aaber Tanwer Women who won the war Muwatin Al-aalem Al-Jadeed Sharika walaken
AR
Syria Health Public Safety Human Rights Social Justice
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