Al-Shifa pharmaceutical factory

Al-Shifa pharmaceutical factory was a major source of affordable medicines and veterinary products in Sudan until U.S. missiles destroyed it on August 20, 1998. The book treats the factory’s loss not as a contained military episode but as a prolonged human and political disaster: a medicine supply vanished, relief work was interrupted, a possible peace process faltered, and Sudanese offers of cooperation against Osama bin Laden’s network were rejected. The consequences make Al-Shifa a central example in the author’s case for judging state violence by its effects and applying legal standards consistently.

The factory and its place in Sudan’s health system

The accounts collected in the book describe Al-Shifa as a vital part of Sudan’s pharmaceutical infrastructure. One report says it produced 90 percent of the medicines most commonly used in the country; another gives a figure of 50 percent. Whatever the difference in those estimates, both depict a national supply with little capacity to absorb the loss. The factory made affordable medicines for a country where poverty and weak infrastructure made imported alternatives difficult to obtain.

Al-Shifa’s importance was especially stark in the treatment of malaria and tuberculosis. Its destruction left Sudan without reserves of chloroquine, the standard malaria treatment, while the factory was also described as the only domestic producer of tuberculosis medicines. Those drugs served more than 100,000 patients and cost about one British pound per patient each month. Imported versions were more expensive and beyond the reach of many patients and their families, including people who might themselves have contracted tuberculosis.

The factory also made veterinary medicines, reportedly the only facility in Sudan doing so. In a vast, predominantly pastoral country, its products treated parasites that passed from livestock to herders and were identified as a major cause of infant mortality. The loss therefore reached beyond clinics and patients: it also removed a means of protecting livelihoods and limiting disease across rural communities.

Destruction and the accumulating health toll

The attack’s consequences unfolded over time rather than ending with the missile strike. A year afterward, reporting cited in the book described increasing deaths as Sudan went without medicines the destroyed facilities had produced. Tens of thousands of people, most of them children, were said to be suffering and dying from malaria, tuberculosis, and other treatable diseases. Sanctions against Sudan prevented it from importing enough pharmaceuticals to replace the factory’s output, deepening the shortage.

The scale of the loss was intensified by Sudan’s existing conditions: endemic malaria and tuberculosis, periodic meningitis and cholera outbreaks, limited arable land, chronic shortages of clean water, high mortality, debt, few industries, AIDS, and a devastating civil war. The book presents affordable medicines in this setting as a matter of survival, not merely domestic manufacturing. It cites field assessments estimating that tens of thousands had already become ill and died within a year as a direct consequence of losing the country’s principal producer of inexpensive medicines and veterinary products, while acknowledging that the full toll could only be imagined.

The British government’s response illustrates how difficult replacement supplies were to secure. Months after the bombing, it refused Sudan’s request for an emergency supply of chloroquine until the country could restore its own pharmaceutical production. The factory’s destruction thus persisted as a health emergency: the lost capacity could not quickly be rebuilt, and outside assistance did not make good the shortfall.

Relief disruption and political consequences

The effects were not confined to medicine. According to a report from Human Rights Watch, after the bombing all United Nations agencies with offices in Khartoum evacuated their American staff, and many other relief organizations followed. Numerous aid efforts were delayed for an indefinite period, including a critical U.S.-run International Rescue Committee project in a government-held town where more than fifty people from southern Sudan were dying each day.

The United Nations estimated that 2.4 million people in parts of southern Sudan risked starvation. The interruption of aid to populations already devastated by conflict threatened to create a grave crisis. The book also describes the bombing as apparently halting a gradual movement toward compromise among Sudan’s warring parties. That process might have produced a peace treaty, ended a civil war that had killed 1.5 million people since 1981, and opened a path toward peace in Uganda and the wider Nile basin.

The reported political opening mattered in its own right. Sudan’s Islamist government was said to have been moving toward pragmatic engagement with the outside world, trying to resolve internal crises, stop supporting terrorism, and reduce the influence of radical Islamists. The attack, according to the account cited, damaged the expected gains from that shift. Al-Shifa’s destruction therefore appears in the book as an action with consequences for both immediate relief and the regional prospects of peace.

Rejected cooperation and the September 11 aftermath

The book connects the 1998 attack to a separate decision by the United States with consequences for counterterrorism. Just before the missile strike, Sudan held two men suspected of bombing U.S. embassies in East Africa and had informed Washington. U.S. officials later confirmed that Sudan had offered cooperation. After the attack, Sudan released the suspects in anger; they were subsequently identified as agents of Osama bin Laden.

Later-released Federal Bureau of Investigation reports added a further complication: the bureau reportedly wanted the suspects extradited, but the State Department refused. A senior Central Intelligence Agency source characterized the refusal, along with the rejection of other Sudanese offers, as the most serious intelligence failure in the wider September 11 story and described it as key to what followed. The same source attributed the refusals to the Clinton administration’s intense hostility toward Sudan.

Among the offers rejected was a substantial database on Osama bin Laden and more than 200 senior figures in his Al-Qaeda network. Sudan offered files containing photographs and detailed biographies, as well as information about the network’s financial interests around the world. The intelligence source assessed that access to these records would have given the United States a better chance of preventing the September 11 attacks. The book does not present that counterfactual as a certainty; it uses the reported offers to show how hostility toward a government could obstruct information and cooperation that might have been consequential.

Argument and significance

The factory’s story supports the book’s broader comparison between acts of violence commonly treated as crimes and those minimized when committed by powerful states. The author argues that the relevant measure includes people harmed by the consequences of an attack, not only those killed immediately by missiles. In Al-Shifa’s case, the damage described includes preventable disease and death, interrupted food and medical relief, and setbacks to a peace process. The book further argues that institutional causes or the absence of a personal intention to kill do not erase such consequences.

That comparison is also a demand for consistent legal and moral standards. The book contrasts the Sudanese experience with the treatment of U.S. actions elsewhere and argues that governments confronting terrorism should seek evidence, cooperation, and lawful procedures rather than use force in ways that increase suffering. In this account, Al-Shifa is both a destroyed industrial site and the point from which a wider chain of consequences becomes visible: from medicine shortages to aid delays, from political isolation to rejected intelligence, and from an immediate attack to harms that continued long after the missiles had struck.