LONDON, U.K.: The war in the Middle East is forcing pharmaceutical companies to reroute shipments of critical medicines to the region, raising concerns about potential disruptions to supplies of cancer drugs and other temperature-sensitive treatments, industry executives said.

The conflict, triggered by U.S. and Israeli attacks on Iran two weeks ago and expanded by Iranian strikes across the region, has disrupted major transportation routes, shutting key air hubs and shipping lanes used to move goods ranging from medicines to food and oil.

Although there are currently few signs of major drug shortages, industry executives warned that the risks could grow if the conflict persists. Many countries in the Middle East rely heavily on imported medicines, some of which have short shelf lives and must be transported through tightly controlled refrigerated supply chains.

Executives at Western pharmaceutical companies said they were searching for alternative routes into the Middle East, including trucking medicines overland from airports in Saudi Arabia such as Jeddah and Riyadh. Other potential entry points include Istanbul and Oman.

Major regional hubs, including Dubai, Abu Dhabi, and Doha, have been closed after Iranian strikes responding to the U.S. and Israeli attacks. Dubai and Doha normally serve as key cargo hubs linking Europe with Asia and Africa.

Airlines such as Emirates and Etihad, along with logistics companies including DHL, typically handle temperature-controlled pharmaceutical shipments that must remain within narrow temperature ranges to ensure their safety and effectiveness.

Wouter Dewulf, a professor at Antwerp Management School, cited industry data showing that more than one-fifth of global air cargo, the primary transport method for many critical medicines and vaccines, could be exposed to disruption from the Middle East conflict.

Executives said creating new temperature-controlled logistics routes, known as "cold-chain corridors," is complex and cannot be done quickly.

One pharmaceutical executive said the company had formed internal teams to prioritize shipments of patient-critical medicines such as cancer treatments, warning that temperature-controlled cargo could miss connecting flights unless appropriate storage facilities were available.

A medical device company executive said companies were first mapping shipments already in transit or preparing to depart before deciding whether pallets needed to be diverted or entirely new transport plans created.

The executive, who, like others, spoke on condition of anonymity to discuss internal logistics operations, said cargo that normally moves between Europe and Asia through Dubai or Doha was now being rerouted through hubs such as China or Singapore.

Sea transport has been ruled out for many products due to longer transit times and Iran's closure of the Strait of Hormuz.

"If you have an urgent surgery with a patient waiting for treatment, you have to choose the faster mode of transport," the executive said.

Hospitals Could Face Shortages

Prashant Yadav, a senior fellow for global health at the Council on Foreign Relations, said supplies of medicines with short shelf lives, particularly temperature-sensitive treatments such as monoclonal antibody cancer drugs, are often maintained at roughly a three-month inventory.

Delays in delivering oncology medicines can be especially serious, he said, because patients may need to restart treatment cycles or risk their cancer worsening.

Some companies are already warning customers that supplies could run low within four to six weeks if disruptions continue.

More than 100 participants from the pharmaceutical and logistics industries recently joined a webinar organized by the life sciences logistics group Pharma.Aero to discuss the crisis and its impact on supply chains.

Industry Managing for Now

Some logistics providers say the industry is coping for the moment.

Dorothee Becher, who leads healthcare air logistics at freight company Kuehne+Nagel, said cargo carriers were using flights to Jeddah, Riyadh, and Oman, then transporting medicines overland to their final destinations.

"I do not see any risk yet that the inventory would go dramatically down," she said, adding that healthcare shipments were being prioritised.

Still, keeping medicines moving has become increasingly complex.

Doaa Fathallah, chief operating officer at biopharma logistics firm Marken, said temperature-controlled shipments were still moving, but only with constant rerouting as airspace restrictions shift.

The longer routes are increasing transit times and fuel costs, she said, and require more dry ice to keep medicines at safe temperatures.

Even if the medicines themselves remain available, supply disruptions could affect related materials such as vial stoppers, IV bag plastics, and other packaging components.

"It's not always a shortage of the medicine itself," said David Weeks, who tracks supply chains for ratings agency Moody's. "In some cases, it's the little stopper on the vial where the dosage is extracted."