LONDON, March 16 (Reuters) – War in the Middle East is disrupting the flow of critical medicines to the Gulf, imperilling supply routes for cancer drugs and other treatments that require refrigeration and forcing companies to reroute flights and find overland access into the region, industry executives said.

The conflict, sparked by U.S. and Israeli attacks on Iran ‌two weeks ago and broadened by Iranian strikes around the region, has knocked out key air transit hubs and closed shipping routes, snarling the movement of goods for many products ‌from medicines to food and oil.

While there are few signs yet of major shortages, that could change if the conflict drags on, some executives said. The Gulf relies heavily on imports and some medicines have short shelf lives and need strict ​cold-chain storage, making lengthy overland shipping less practical.

Executives at Western drugmakers said they were seeking alternative routes into the Gulf and trucking some drugs overland from airports like Jeddah and Riyadh in Saudi Arabia. Other options were Istanbul and Oman.

Major airports in the region including Dubai, Abu Dhabi and Doha have been closed due to strikes by Iran in response to U.S. and Israeli attacks. Dubai and Doha are major cargo hubs linking Europe with Asia and Africa, with airlines Emirates and Etihad and logistics firms such as DHL handling temperature-sensitive drugs that must be kept within a narrow range to remain safe and effective.

Wouter Dewulf, ‌a professor at the Antwerp Management School, cited industry data showing ⁠over a fifth of global air cargo — the main route for critical or life-saving drugs and vaccines — are exposed to Middle East disruption.

One executive cautioned that alternative “cold-chain corridors”, or temperature-controlled routes used for sensitive medicines, could not be set up overnight and were not always available.

Another pharmaceutical company executive said it had ⁠set up internal teams to prioritise patient-critical shipments, including of cancer treatments, and warned some temperature-controlled shipments could miss connections unless proper storage and handling were secured.

A medical device company executive said the first step was to map shipments already in transit or ready to depart, then decide which pallets needed to be diverted and whether new shipments had to be planned.

The executive, who like others spoke on condition of anonymity to discuss internal ​operations, ​said some Europe-Asia cargo that typically move through Dubai or Doha airports was being rerouted via China or Singapore. ​Sea routes were not practical due to longer journey times, as well as ‌closure of the critical Strait of Hormuz by Iran.