Cancer patients in Syria are being pushed out of overstretched public hospitals and into charity queues and an unregulated black market for life-saving drugs, according to an investigation documenting severe shortages, opaque referral practices, and the sale of potentially counterfeit treatments through pharmacies and social media.
The investigation found that patients seeking care at Al-Biruni University Hospital — Syria’s only fully integrated public cancer center — are frequently told essential medicines are unavailable. Many are then directed to charities that offer only partial financial support, often tied to designated pharmacies whose prices may exceed those charged elsewhere.
Patients unable to secure treatment through either route increasingly turn to smuggled drugs sold by private pharmacies or anonymous dealers on Facebook.
Treatment That Is Free in Name Only
Al-Biruni Hospital is officially expected to provide cancer diagnosis and treatment free of charge. In reality, patients often arrive carrying their own medicines and basic supplies.
Wafaa Hassan, a pseudonym used for her protection, has been receiving breast-cancer treatment for five years. Before traveling to the hospital, she packs the dose her husband purchased, along with cotton, a catheter, and a test injection she says may not be available at the facility.
“If someone dies in the hospital, they have nothing to give them,” she said.
The trip to Damascus with her husband and daughter costs around 100,000 Syrian pounds — roughly $10 at the exchange rate used during the investigation — about twice her husband’s daily income from a street stall.
The financial burden escalates when treatment is unavailable. Wafaa is prescribed Kadcyla, a drug she should receive free at Al-Biruni. Instead, she has been forced to buy it privately because the hospital has lacked the medicine for roughly 18 months.
Her latest dose cost 8.8 million Syrian pounds — about $900 — and smuggled doses have reached $1,200. Each dose lasts only 21 days.
“Every pharmacy sells it at a different price,” she said.
When her doctor increased the concentration after the previous dose stopped working, Wafaa could not afford the new treatment. She was offered a cheaper alternative and advised to seek help from charities. Even that option remained beyond the family’s means.
She has sold furniture from her home to pay for treatment.
Responsibility Divided Between Ministries
Administrative responsibility for Al-Biruni is split between government bodies.
The Health Ministry told the investigation that the Ministry of Higher Education and Scientific Research has direct responsibility for health services inside the hospital. The arrangement dates to May 2025, when teaching hospitals were transferred from the Health Ministry to Higher Education, with coordination left to a joint committee.
Neither ministry responded to detailed questions about the shortage of cancer medicines, procurement responsibility, the role of charities inside the hospital, or the criteria used to refer patients to particular pharmacies.
The most significant official acknowledgment of the crisis came in 2025, when Jamil al-Dabl, head of Syria’s National Advisory Committee for Blood and Oncology, said only about 20 percent of the cancer medicines required nationwide were available.
The Global Cancer Observatory recorded more than 27,000 new cancer cases in Syria in 2024. The latest publicly announced national figures list more than 15,000 cancer patients, including 8,281 women and 953 children.
Patients Sent from Hospitals to Charities
For many families, a medical prescription stamped “medicine unavailable at the hospital” becomes the only way to seek charitable assistance.
Walaa Rami, another pseudonym, traveled to a charity office in Damascus seeking help for her husband, Aziz Mahmoud, 49, who has brain cancer.
The charity does not provide medicine directly. Instead, it issues a contribution document specifying how much it will pay toward treatment purchased by the patient from an outside pharmacy.
Seven charities contacted during the investigation identified one organization — referred to as Charity S — as the most prominent source of financial support for cancer patients.
The Al-Afiya Fund, another charity assisting patients with treatment and medical services, said it distributed 680.5 million Syrian pounds — about $68,000 — in 2025. The assistance reached 640 patients, 70 percent of whom were treated at Al-Biruni.
The support, however, often covers only a small fraction of the cost.
Aziz had to pay around 600,000 Syrian pounds — about $60 — for an MRI at a private center because the hospital’s machine was out of service. Charity S contributed only 200,000 pounds toward the total cost of 800,000.
“I run in every direction to give him a chance to recover,” Walaa said. “We have no one to help us but God.”
Questions Over Pharmacy Referrals
The investigation also documented repeated referrals by Charity S to a pharmacy identified as Pharmacy A in Damascus’s Mezzeh district.
Several patients said the pharmacy charged more than alternative outlets, at times making the charity’s contribution effectively worthless.
Souad Akram and her husband, Ahmad al-Salem, who has leukemia, were referred twice to the same pharmacy. Souad said she complained that its prices were higher, only to be told the charity dealt exclusively with that outlet.
She later discovered that buying the medicine from pharmacies near Al-Biruni cost less, even without charitable support.
Walaa reported a similar experience.
Another patient, Hanan Mohammed, who has sarcoma, received a contribution worth 215,000 Syrian pounds. She abandoned the support after finding the same medicine at another pharmacy for about $60 less than what she would have paid at Pharmacy A after the charity’s contribution was deducted.
Ghada Sousan, director of the Health Ministry’s Cancer Diseases Directorate, denied that the ministry required charities to work with particular pharmacies.
“There is no law obliging any charity to choose one pharmacy over another,” she said.
The ministry also acknowledged it had no accurate figures for the number of patients receiving charitable medical assistance and referred the matter to the Ministry of Social Affairs and Labor. That ministry, however, said responsibility rested entirely with the Health Ministry.
Charity S, the Ministry of Social Affairs and Labor, and the Union of Charitable Associations did not answer questions about beneficiary selection, contractual arrangements with pharmacies, or oversight of the referral system.
Smuggled and Potentially Counterfeit Drugs
As hospital stocks disappear and charity support falls short, patients increasingly rely on smuggled medicines.
A Damascus pharmacist, identified under the pseudonym Mohammed Hassan, said cancer drugs are brought into Syria from licensed warehouses in Jordan, Lebanon, and Turkey by land and air.
Regulators confiscate such medicines and fine pharmacies that sell them because their origin cannot be verified. Hassan said the concern was legitimate, but added that leaving patients without treatment created a different crisis.
“They are right to worry about the source,” he said. “But leaving people without medicine is also a problem.”
He described a continuing shortage dating back to the Assad era and said some pharmacists now obtain medicines through Facebook — a practice he warned is especially dangerous.
“One hundred percent fake,” he said.
Invoices he showed during the investigation, purportedly issued by licensed Syrian warehouses, lacked official stamps and signatures.
The Health Ministry and the Syrian Pharmacists Syndicate did not respond to questions about shortages, price disparities, or measures against the online sale of cancer drugs.
Cancer Drugs for Sale on Facebook
The Facebook group Friends of Al-Biruni Hospital has become an informal exchange where patients and relatives search for missing medicines, donors, and information about hospital stocks.
Nurses and hospital employees also participate, sometimes confirming whether a particular dose is available before patients make expensive trips to Damascus.
During the investigation, a Facebook account claimed it could supply missing cancer drugs. Its profile photo showed a person in a white coat with a stethoscope, though the face appeared obscured in what resembled a stock image.
The account holder described himself as a distributor and initially offered a 160mg dose of Kadcyla for $425, claiming it was produced by Roche. He refused to identify the company he worked for.
When contacted again from another account, he offered the same drug for $625 and claimed a cheaper version sold for $400 was counterfeit.
A Syrian medicine warehouse responsible for supplying Kadcyla said the drug was unavailable. Roche’s scientific office in Syria declined to answer questions, citing company policy.
A field survey of 18 pharmacies in Damascus found that smuggled doses of Kadcyla generally sold for between $800 and $1,000. The Facebook seller’s significantly lower prices raised further concern that the products might be counterfeit.
“We Are Dying”
The crisis gained wider attention after Hiba Nasser, a 27-year-old cinematography student with breast cancer, posted a video describing conditions at Al-Biruni.
“We are dying right now,” she said.
Her treatment stopped in February 2026. Although she had purchased the doses herself, hardened veins prevented the medicine from being administered. She then waited two months for the hospital to obtain a device needed to continue treatment.
Hiba pays around $160 for some cancer medicines and receives immunotherapy drugs from the hospital. She said the administration usually tells patients medicines are unavailable, gives no indication of when they might return, and instructs them to buy treatment privately.
“Patients are dying these days,” she said. “No one hears them.”
The investigation concluded that Syria’s cancer patients are trapped in a system where public hospitals document the absence of treatment, charities provide partial assistance, ministries trade responsibility, and a largely unregulated market supplies medicines at unpredictable prices and uncertain quality.
For many patients, the black market has become the final route to treatment — even when the medicine itself may pose another danger.
This article was translated and edited by The Syrian Observer. The Syrian Observer has not verified the content of this story. Responsibility for the information and views set out in this article lies entirely with the author.
