The escalating war in Iran and the Middle East has disrupted two of the world's most critical logistics corridors—the Strait of Hormuz and major Gulf air hubs—triggering delays across global supply chains. Commercial activity through the Strait of Hormuz remains 90% below pre-war levels as of March 16, and global air-cargo capacity dropped 79% in the Gulf region between February 28 and March 3, driving a 22% reduction worldwide.

The cascading fallout applies to the transport of critical medicines as well, and the consequences underscore a need for acute remedies and long-term structural reform. Immediate responses should focus on visibility of supply-chain gaps across the region and cargo reroutes through non-Gulf hubs. Although imminent medicine shortages are unlikely in the United States given extensive inventory buffers and largely uninterrupted Suez Canal shipping flows, pharmaceutical supply-chain vulnerabilities exposed by the conflict—a dependence on specific transport hubs, fragile cold chains, and emergency supply systems—highlight the need for a longer-term investment in the diversification and streamlining of pharmaceutical supply chains.

Consumers could see drug costs affected within four to six weeks because of increased Indian air-cargo rates

Pharmaceutical company executives are responding to the immediate pharmaceutical supply-chain threats by actively targeting unconventional routes to ensure that the delivery of products to their final destinations is uninterrupted. These new journeys include using land routes to truck cargo between airports in the Gulf Cooperation Council (GCC) region or diverting air cargo to China or Singapore to avoid the conflict zone entirely.

Rerouting costs will burden pharmaceutical export-dependent economies, as well as consumers. A strategist at a supply-chain execution firm warned that consumers could see drug costs affected within four to six weeks because of increased Indian air-cargo rates.

GCC Roles in the Global Pharma Supply Chain

The GCC region, including Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE), serves as a critical pharmaceutical transit hub connecting Africa, Asia, Europe, India, and the United States. The GCC's growing pharmaceutical industry is worth $23.7 billion, around 80% of which relies on imports through the GCC airspace and the Strait of Hormuz. This valuation is projected to more than double by 2033. 

Dubai is central in this network. Its primary air-cargo airport—the world's eleventh largest as of 2024—functions as a major pharmaceutical re-export hub, where medicines arrive, are warehoused, and then are shipped globally. CEVA Logistics, DHL, and DP World—Dubai's pharmaceutical supply-chain logistics giants—have significantly grown the emirate's pharmaceutical and health-care distribution footprint by expanding re-export and cold-chain capacities. They also capitalize on proximity to the Jebel Ali Free Zone, whose container port is the ninth largest in the world.

Dubai's air-cargo capacity is almost 4 million tons annually. Considering the conflict-driven drop in the region's cargo capacity, and that pharmaceuticals account for 4% of global air freight, the emirate could lose out on processing more than 10,000 tons of pharmaceutical air freight this March. These airspace disruptions are also spilling over into global-health emergency supply-chain response, and the World Health Organization's (WHO) Dubai hub operations are currently on hold.

What's Most at Risk and Why?

Given inventory buffers for many generic medicines, the first shortages will likely occur where supply chains are already fragile: cold chains and emergency shipments.

Cold-chain products—vaccines, insulin, biologics, and cancer therapies—have short shelf lives for their quality and integrity, making their supply chains fragile and thin. Most vaccines, for example, must be stored in transit between 2°C and 8°C. Cargo carriers could need a week and a half to catch up for every week that air shipments are suspended, increasing the risk of spoiled cold-chain products and shortages. These temperature-sensitive shipments contain specialized equipment that, if held up in the Middle East due to routing delays, may cause equipment shortages in subsequent shipments.

The WHO's emergency system that relies on the GCC airspace has already reported unmet needs in vulnerable countries stemming from the Iran conflict. WHO Regional Director Hanan Balkhy stated March 5 that its operations face a 70% funding gap as the war disrupts $18 million in humanitarian health supplies. Another $8 million in shipments cannot reach the hub, and more than 50 emergency supply requests from 25 countries are affected, including $6 million in medicines for Gaza.

GCC countries, in particular Qatar, Saudi Arabia, and UAE, are emerging as a global presence in clinical trials, a development vulnerable to disruptions from halted critical medicine imports. Although it accounts for a small portion of global clinical trials, Middle East's contribution is projected to nearly double by 2033.

The region is attracting clinical trials from pharmaceutical giants such as Abbott and Pfizer because of the area's high chronic-disease prevalence and its lenient regulations allowing for fast-tracked trials. The UAE has recently taken strides in stem cell research, and Qatar is growing its precision medicine and genomics research. Saudi Arabia—where clinical trials already account for two-thirds of the region's total—is prioritizing future growth in this sector to realize its "Vision 2030," an effort to diversify its economy through research and development.

Supply-chain disruptions could jeopardize this objective, especially for ongoing clinical trials that depend on imported treatments such as insulin.

Will the Conflict With Iran Lead to Drug Shortages?

Despite these vulnerabilities, short-term risks of drug shortages are low in most countries because of inventory buffers built into the supply chain. On March 4, for example, the UAE announced confidence in its emergency drug stockpiles.

Across the European Union, countries mandate [PDF] essential-medicines stockpiles ranging from two to six months. These inventory regulations should cushion the continent from sharp shipment price increases resulting from the Iran conflict. The Washington Post reports that the cost of air cargo from Asia to Europe has risen 45% since the war began, more than twice the increase from Asia to the United States.

Supplementing country-level buffers, pharmaceutical companies also hold on average 180 days of finished-goods inventory, both at production sites and additional downstream locations in the supply chain. In addition to inventory buffers held by the manufacturers, large pharmaceutical distributors such as Cardinal, McKesson, and Cencora hold approximately 25 to 30 days of stock.

Despite a low risk of overall shortages, U.S. medicine imports routed through the Middle East could still be affected, per 2025 Zauba data. India, the largest generic medicine exporter to the United States, shipped 4,922 tons of finished pharmaceuticals through Middle East sea routes in 2025. A year earlier, 32% of U.S. API came from India, but these shipment routes run predominantly through the Red Sea, a route also disrupted by security concerns following Houthi attacks that escalated in 2024.  

Pakistan, notably, relied on Salalah—an Oman port that suffered a March 11 attack by Iran—to re-export more than 80% of its medicine cargo weight to the United States in 2025.

Countries in Africa, however, are less equipped to absorb acute pharmaceutical-supply shocks due to limited inventories for high-value medicines. These weaker buffers stem from constraints on working capital.