The crisis of the fluid known as a kidney or haemo dialysis solution, categorised as a non-taxable item for long, surfaced as Dhaka Customs House at the Inland Container Depot (ICD) in Kamalapur refused to clear about 28,000 litres of the imported solution unless importers pay tax.

The consignment of the solution from Malaysia is the only bulk stock of the solution on which at least 30 private and public hospitals and clinics depend to treat patients.

Doctors say any delay in dialysis can lead to heart attack, swelling of tissues and convulsion.

The existing quantity of the solution, used to purify the blood and excrete toxic fluid in the body, kept in reserve in hospitals and clinics is negligible.

Unless the shipment is cleared from the ICD without delay, many kidney hospitals running short of the solution, may be forced to suspend their services until the main ingredient (solution) arrives again.

The clearing and forwarding agent of importing company JK International failed to convince customs officials that the solution is a non-taxable item.

"We have met a customs official several times since early September, but he did not accept that the solution has long been imported without tax. We referred to books on tax at the official's work but he seems unmoved and stuck to his position," said Quiyaum Hasan, managing director of Bangladesh Health Product that imports the solution.

"I don't mind paying tax to clear the shipment. Perhaps the hospitals will also buy the solution, as it is an emergency medical item, but eventually patients have to bear the cost because of an additional 22.5 percent tax," Quiyaum said.

New tax will push up the price of Tk 1,600 a dialysis considerably and patients cannot afford such costly treatment in a country that needs five lakh litres of solution a year.

"The tax burden may lead to the death of many kidney failure patients who rely on financial support from a few social workers," a kidney specialist said, asking not to be named.

The same dialysis solution, categorised as duty-free and imported by Janata Traders, was cleared from Chittagong Customs House on September 12.

"It's an emergency situation. We are running short of the stock but cannot refuse our patients because of probable public outcry," said Dr Mahmudur Rahman, managing director of Salvation Kidney Care and Dialysis.

ANM Azizul Islam, managing director of Millennium Hospital, echoed the concern saying: "We have about 20 kidney failure patients a day coming here for routine dialysis which is their only hope for survival. If we don't get a fresh supply, the situation can turn worse."

"We are worried. I wonder how I am going to deal with our regular patients who have no option but to depend on us as there is a handful of dialysis machines in Bangladesh which remain booked all the time," said Dr Raffat Lotif of Millenium Hospital.

Contacted, Mir Farid Akhter, assistant commissioner of customs, deputed to oversee the work, said: "The solution can only be categorised as duty-free if it is labelled as hormone- or alkaline-based fluid. The imported solution is none of them and we had to impose tax in line with the rules."

Asked why the customs cleared the similar solution as duty-free, Akhter said: "The officials have made mistakes all these days."

Earlier, the customs official told The Daily Star that he would do all out to release the solution from the ICD soon. But the consignment is stuck at the ICD three days into his assurance.

Five foreign manufacturers operate here which regularly supply two main types of the solution. B Braun is the leading company followed by Fresenius, Baxter, Ain Medicare and Duopharma.

Public hospitals like Bangabandhu Sheikh Mujib Medical University Hospital, Ibrahim Memorial Hospital (BIRDEM), National Institute of Kidney Diseases and Urology (NIKDU) and medical college hospitals in districts rely on the supply from private sources.

Authorities of public hospitals said they have run out of fluid and need an emergency supply to continue treatment for hundreds of poor patients.

The only plant that manufactures the kidney dialysis solution in Bangladesh in the public sector is the Institute of Public Health that cannot supply enough as it functions irregularly.