A year into Sri Lanka’s sharp economic decline, the country’s public health institutions are on their knees, with shortages of medicine, delayed surgeries, and an exodus of medical professionals. “Our hospital system is in a shambles,” Peter Almeida, deputy general secretary of the Ceylon Mercantile, Industrial and General Workers’ Union, told The New Humanitarian. At least 1,000 medical specialists have reportedly left the country in recent months. The World Health Organization says stocks of 150 essential medications – blood thinners, antibiotics, vaccines, anaesthesia, and cancer chemotherapy drugs – have run out at certain points over the last year. Several public hospitals have also had to suspend laboratory tests due to delays in machine maintenance, a lack of personnel, or a limited supply of chemical reagents. “Accessibility of healthcare is a problem,” said Dr. Mahesh Gunasekara, director-general of the Sri Lanka Red Cross Society. “Then, once you access healthcare, you can’t get medicine because the availability of medicine is not there and the availability of services has been compromised… this has clearly affected the people.” While there may not yet be proof that the mounting issues are directly contributing to patient deaths, Gunasekara believes it’s undeniable that patients are suffering. “I don’t have hard evidence to say people have been dying, but suffering is there because of the lack of medicines and [due to] routine surgeries being postponed,” he told The New Humanitarian. Almeida shared the story of one colleague who has been waiting for more than six months for surgery even though he could die at any moment because of a 90% blockage in his heart. “He went to the clinic and he was [prescribed] eight drugs; none of which are available in the government hospital. How on Earth is he going to pay and get the drugs?” Even if the drugs were available, Almeida’s colleague may not be able to afford them due to Sri Lanka’s economic crisis. As of 2022, the prevalence of poverty among the Sri Lankan population was 25.6%, nearly double the 2019 rate of 13.1%.

Read more: How Sri Lanka went from topping Lonely Planet’s list to almost 30% hunger levels

In May 2022, amid plunging foreign currency reserves, Sri Lanka defaulted on its international debt for the first time. Empty supermarket shelves and lengthy queues at gas stations became clear signs of a stark new reality: The government no longer had the money to import the basics, such as fuel and food. According to a Save the Children survey, the average household expenditure increased by 18% between June and December last year and there was a 23% increase in households unable to meet most or all of their general basic needs, causing half of all families to reduce the amount they feed their children. Aside from food, medicines – of which 80% are imported – are among the items most affected. “There are a large number of all different types of medicines out of stock or in short supply,” said Gunasekara. And those medicines that are still being imported can cost up to four times what they did previously, impacting the ability of both public and private hospitals to function.

‘Huge brain drain’

Over the past year, authorities have been grappling with creditors to find a financial solution. A bailout was agreed with the International Monetary Fund in March, but so far it has done little to lower the costs of essential goods. To address the pharmaceutical shortfalls, Colombo has turned to its old friend, New Delhi, to purchase Indian-made medicine on credit. But the quality of Indian drugs is under the microscope after complications arose in a number of Sri Lankan patients. “He went to the clinic and he was prescribed eight drugs; none of which are available in the government hospital. How on Earth is he going to pay and get the drugs?”

“We’re losing our doctors in large numbers, so we don't have the resources to rebuild the country.”

A WHO probe into a supply of contaminated Indian-made cough syrups that have led to deaths of children in other countries is casting even more doubts over the reliance on Indian-produced drugs. Shortages of laboratory tests in public hospitals are also forcing people to turn to private facilities and pay for tests that would have been free, explained Dr. Manoj Fernando, a doctor and senior lecturer in health promotion at Rajarata University. “People have to get it done from the private laboratories so the out-of-pocket expenditure for laboratories has gone up,” Fernando said. But for those unable to pay, it means delayed diagnosis and treatment for potentially life-threatening conditions. Against this backdrop of economic struggles and shortages of basic essentials, many people, including highly skilled professionals, are leaving in search of better-paid work and more affordable living conditions overseas. “There’s a huge brain drain at the moment… from Sri Lanka to other developed countries,” Fernando said. According to the Central Bank of Sri Lanka, 1.1 million people left Sri Lanka in 2022 – nurses, doctors, lab technicians, and pharmacists among them. Whilst the majority went to study abroad, 27.6% left seeking foreign employment. “Being a nurse, you are not paid well. Most of the nurses are trying to leave the country,” said Sudath Warnakulasuriya, dean of the faculty of nursing at the University of Colombo. The average monthly wage of a nurse is around 74,500 rupees ($242). That’s not enough to cover the current costs of living, Warnakulasuriya added. Substantial income tax and energy tariff increases being imposed by the government in order to qualify for IMF support are making things even more difficult. In March, many public sector workers took to the streets to protest the untenable costs of living. “We’re losing the professionals because they increased taxes arbitrability,” Almeida said. “They say that’s not sustainable. We’re losing our doctors in large numbers, so we don't have the resources to rebuild the country.”

Impact on care

No healthcare workers means no health delivery. In March, the paediatric ward at the main hospital in the northern city of Anuradhapura was forced to temporarily close due to staffing issues, while emergency treatment and surgeries had to be halted in April at a hospital in Ratnapura district in the south of the country because of a lack of anaesthetists. “People suffer, delay their operations, some die without proper treatment; that’s happening here and there,” Warnakulasuriya said.

 “It’s not war, it’s not a big natural disaster, but it’s a chronic type of disaster where you see day by day the situation in the country deteriorating.”

At the same time, the health of the Sri Lankan people is taking a hit as the high food prices increase rates of malnutrition. “There are early warning signs of a full-blown hunger crisis,” said Dr. Pramod Gunawardena, senior health and nutrition manager at Save the Children. This predisposes individuals to other illnesses and puts a further strain on a health system that had challenges prior to both the pandemic and economic crisis, he added. Save the Children told The New Humanitarian about Aisha, a 20-year-old student whose family has struggled to afford food for the last year. “Our reality is that we don’t get to eat three meals every day,” Aisha told Save the Children. As a result, she said she has developed gastritis – an irritation of the stomach lining. She also has a pre-existing spinal problem that needs treatment. As both the transport to the hospital and the medicine are too costly, Aisha is having to forgo that treatment. The WHO has warned that “hard-earned public health gains… are at stake with the economic crisis.” “One worry is that some of these health indicators were lagging behind, even before the crisis – such as underweight children and malnutrition of children in certain parts of the country – but if you don't act fast these indicators might deteriorate further and lead to many problems,” Fernando warned. Gunasekara agreed: “It’s not war, it’s not a big natural disaster, but it’s a chronic type of disaster where you see day by day the situation in the country deteriorating,”

Finding solutions

The government has started taking some steps to try and bolster the failing health system. To address the lack of medical personnel, it has increased the number of medical students it typically admits to its programmes, and it has installed some economic recovery initiatives with an emphasis on supporting lower-income families, Fernando said. NGOs such as Save the Children and the Red Cross, as well as UN agencies, have also been stepping up their programming, providing various forms of assistance.

“Sri Lanka's children will bear the burden of the polycrisis as the ripple effects will impact their futures.”

To tackle the medicine shortages, the Ministry of Health is engaged in a Sri Lanka Red Cross platform called Elixir, which coordinates the needs of various hospitals to then coordinate potential bulk price discounts from suppliers. The WHO says $8 million is required to help the country purchase raw materials to locally produce essential medicines through the State Pharmaceutical Manufacturing Corporation. Pramod said the situation is improving, but shortages remain, most notably in rural areas. There’s more that needs to be done, agreed Fernando. “We have to help communities to look after themselves to a certain degree, and the government ministries need to take action, especially to look after the vulnerable people.” He called on private philanthropies to step in – alongside the likes of the WHO – to support the healthcare system. “Without funding from the international community and donors, Sri Lanka's children will bear the burden of the polycrisis as the ripple effects will impact their futures,” Gunawardena said. Edited by Ali M. Latifi.