CAIRO — A woman carried her son as she pleaded with the doctor in charge of Nasser Institute Hospital's blood bank for a few bags of blood to save his life after a serious car accident. The doctor turned her away, saying that the boy's rare blood type was not available.

Salma Khattab, whose father was undergoing heart surgery at the same hospital witnessed the incident, and watched the grieving mother leave the hospital in despair. Khattab's father was also in a need of the same rare blood type. "We donated a lot of blood so that we could exchange them for the blood type that my father needs," she said. After a few phone calls to well-connected people, the same doctor was ordered to give Khattab's father the blood he needs.

The situation of blood banks in Egypt's public hospitals continues to deteriorate, as blood is turning into an expensive commodity not everybody can afford.

According to World Health Organization's (WHO) 2011 report on the Global Database for Blood Safety (GDBS), the blood donation rate in Egypt ranges between 10-19.9 donations for every 1,000 people, which is a relatively low rate. Egypt has consistently suffered from blood supply shortage, a result of this absence of a blood donation culture. The crisis also reflects structural failure in the policies organizing blood donation and transfusion.

In 1999, the Health Ministry issued a decree banning the collection of blood from paid donors nationwide to control a growing blood donation market. The decree was part of a government initiative to restructure blood transfusion services that started in 1997. According to the national blood policy presented by the Egyptian government to the WHO, a regulatory body called the National Blood Transfusion Service (NBTS) was launched in 1997 to act as "the sole provider of blood and blood products within the Health Ministry and defines the organizational, financial and legal measures to ensure adequate supplies of safe blood and blood products over a specified period of time."

The new government policy prevented public hospitals from providing blood transfusion services, limiting the procedure to university hospitals through their blood banks. Blood banks at public hospitals were turned into storage blood banks. NBTS sells subsidized blood bags to citizens for LE130 and to hospitals for LE95.

Ahmed Zaghloul, founder of one of Egypt's biggest voluntary blood donation initiatives "The Egyptian Blood Bank," explained to Mada Masr that this policy ultimately further worsened the crisis of blood transfusion in Egypt. He accused NBTS of selling blood bags allocated to public hospitals to private hospitals as part of corrupt deals. An average blood bag of a rare type in a private hospital can cost LE300, and can go as high as LE700, he claims.

For every blood bag needed by a patient in any Egyptian hospital, the patient's family is required to donate at least one bag of blood themselves. If the patient has a rare blood type, the family is required to donate more blood for every blood bag needed. In some cases, family members have to donate five bags of blood in exchange for one bag of a rare blood type.

"This level of scarcity created a black market for blood, which is mostly dominated by certain hospitals that have developed a reputation in blood dealing," Zaghloul explained.

The head of the NBTS was not available to comment on these accusations.

Writer Omar Taher published an article on June 2011 claiming that most of the blood donated by Egyptians to the revolution's casualties through NBTS was sold to private hospitals. According to Taher, NBTS declined to provide public hospitals with the necessary blood supply.

Zaghloul asserted that Taher's article, which went viral back then, pushed regular Egyptian donors to question where their blood goes. "People have become more reluctant to donate their blood. They don't want their blood to be sold for money as part of a corrupt business deal," he explained.

Currently, people commonly donate blood to their relatives who undergo serious surgeries, or through online blood donation campaigns. He cited one case where a blood donor was told that he has hepatitis C after donating one bag of blood to a private hospital. Later on, his blood tests showed that he was not a Hepatitis C patient, and that the hospital lied to him so they would not have to provide him with blood in exchange for the bag he donated.

"Those hospitals literally suck people's blood," Zaghloul said.

Ahmed Atteya recounts his ordeal with a friend who needed an urgent blood transfusion last year to Mada Masr. "After going to VACSERA, one of the main blood banks, and six hospitals in Mohandiseen and Nasr City, we had to buy blood from a black market dealer. There were no tests conducted on this blood, and this put her life at risk," he said.

On the other hand, head of Kasr al-Aini Hospital Blood Bank and clinical pathologist Heba Gouda believes that Egypt's blood transfusion problem has more to do with failures in policy implementation amid an ailing healthcare system. "We are far from implementing ongoing scientific developments in the blood transfusion field. There are new transfusion guidelines every year, there is new research, but we are still adopting old techniques in a decaying framework," she explained.

The lack of a blood donation culture further complicates the problem. When asked about reasons that prevent them from regularly donating blood, several people interviewed expressed concerns over hygiene and the possibility of infection.

Pharmacist Ayman Elewa tells Mada Masr that he was once donating blood at Kasr al-Aini hospital when the cannula fell on the ground. "The nurse wanted to clean it with alcohol and re-insert it. I never went to donate at this hospital again," he said.

However, Gouda asserted that the blood donation process is completely safe for donors, but adds that "It is natural that donors will be skeptical when they sit on donation chairs that are dirty and torn, or see the medical staff wearing gowns that are not really clean or the staff not adhering to safety guidelines," she added.

Aiming to counter misconceptions about blood donation in Egypt, Bloodegy is an online initiative that started four years ago to connect blood donors with those in need through social media. The initiative founders hope that one day they can develop a strong blood donation culture in Egypt.

One of the administrators of the Bloodegy page, Mahmoud Abdel Aziz, said that voluntary blood donation initiatives and charity organizations are working on filling the gap, but "as long as volunteers are working alone without support or coordination with the state, our work is like painkillers, unfortunately."

Khattab tells Mada Masr that she has had enough of heartbreaking stories that have to do with people needing blood and not being able to access it. In one story, she lost her best friend. "In a country where people's blood is shed in the streets in vain, those in charge won't care about providing the blood for those they kill every day," Khattab says.