Fuel Crisis Devastates Patient Care in Malawi

For weeks, drivers at Abwenzi Pa Za Umoyo (APZU), as Partners In Health (PIH) is known in Malawi, have been desperate.

They have been scouring the country for fuel: the precious resource responsible for making ambulances roar to life, for powering backup generators that keep hospital lights on during outages, and for enabling vehicles to get doctors, nurses and health service providers to the hardest-to-reach patients.

Some drivers have been spending the night at gas stations, hoping they will be there when the rare shipment of petroleum and diesel arrives. They know it could mean the difference between life and death for some patients.

The impact of the United States and Israel's war with Iran has been felt worldwide since the end of February, with fuel prices soaring globally.

For Malawi, this is an acute-on-chronic crisis. The landlocked country has experienced fuel access issues for years.

Even before the war, fuel prices had already increased by over 40% in an effort to prevent shortages and preserve a limited amount of foreign exchange currency. This was, in part, due to economic reforms tied to international financing agreements, including currency devaluation and the removal of fuel subsidies.

Malawi, whose economy relies heavily on agriculture, has had a chronic foreign exchange shortage problem, especially following structural adjustment programs. Foreign exchange currency is used to purchase oil and other essential goods-including medications and fertilizers-on the international market. This issue has been exacerbated as the value of tobacco, Malawi's main export, has dropped.

Combined with the war, which has spurred "the largest supply disruption in the history of the global oil market," Malawi is facing an ongoing crisis that is rippling across the health care system.

"It's having a real impact on patients, not just in Neno-across the country," said APZU Executive Director Basimenye Nhlema.

A Health System Under Strain

Just before the most recent shortage hit, days of electricity blackouts depleted APZU's fuel reserves at Neno District Hospital.

Still, APZU has continued to keep operations running, even supporting the Ministry of Health in transporting patients 160 kilometers from Neno District Hospital to Queen Elizabeth Central Hospital in Blantyre.

Over the weeks, supplies have continued to fluctuate, and despite drivers working day and night to locate fuel across the country, difficult decisions have had to be made by APZU's leadership as the crisis persists.

Youth membership sessions and nursing education sessions scheduled for the month of May were among the first to be canceled in order to preserve fuel for APZU's emergency clinical services.

But as the shortage has dragged on, the effects have spread far beyond postponed trainings and community programs. Essential health services have increasingly been disrupted, particularly in rural areas where fuel is already harder to access.

At Lisungwi Community Hospital, some surgeries have had to be delayed because there is no fuel to transport specialist doctors between facilities-or to bring patients to the care they need.

Elsewhere, outreach services have also been affected. During the most recent shortage, an outreach clinic in Kambale specializing in maternal and child health had to be canceled entirely, leaving residents without access to antenatal care, childhood immunizations, HIV testing, family planning services, and general clinical care.

Palliative care home visits for noncommunicable diseases were also impacted.

"Usually it's pain management," APZU obstetrician and gynecologist Dr. Thokozani Kaliati said of the regular services provided to palliative patients. "For example, if they're bleeding, you help them with medication to stop the bleeding. Also, since palliative care is about mental and psychological support, you would offer that."

For many patients, these visits are not only routine check-ins; they are a lifeline. Beyond pain management and emotional support, fuel shortages have also disrupted the delivery of medications for patients living with chronic illnesses such as hypertension and diabetes.

When Ambulances Cannot Reach Patients

The situation has grown more dire as the shortage has dragged on, with even essential ambulance services compromised.

In the recent fuel shortage crisis, there were challenges to transport a baby approximately 70 kilometers from the Lisungwi Community Hospital to the Neno District Hospital, which has the only NICU in the district.

"The baby had to wait for about 6 hours and 30 minutes for an ambulance, but it didn't come soon enough," said Kaliati.

For health workers, stories like this have become devastating reminders of how quickly a fuel shortage can turn into a medical emergency.

Despite the country's recent hardship, there are glimmers of hope. The Malawian government sold $30 million worth of gold reserves in April in an attempt to increase fuel access in the country.

At the moment, gas filling stations are sporadically receiving petroleum and diesel, but will often not have both at the same time, which makes planning for health service delivery still problematic, said Nhlema.

Isaac Chikoti, a distribution officer, offloads fuel from drums transported from Mwanza District at the Neno Head Office in Neno, Malawi. Joseph Mizere / PIH

Despite all these uncertainties, people have held on to hope that things will get better.

"We don't know how long it will take for this situation to stabilize fully, but we remain resolute in our mission of accompanying patients and the Ministry of Health," Nhlema said.

Preparing for a More Uncertain Future

Fuel shortages in Malawi are not uncommon, but with a more turbulent global oil market and shortage of foreign exchange currency, they could become more frequent or prolonged.

As health care workers, it is essential to develop systems to prepare for this reality. APZU has spent years building infrastructure to reduce the impact of crises like this, including installing automatic transfer switches to maintain electricity during outages and establishing backup fuel storage.

Still, every shortage carries consequences felt most sharply by patients waiting for care. With your support, we can continue working to find solutions and create backstops to ensure patients can get the high-quality care they deserve.