Eritrea’s pharmaceutical sector functions within a context of economic constraints and a centralised healthcare system, creating distinct challenges for medicine access. This short report provides a descriptive case study analysis of the systemic challenges in Eritrea's pharmaceutical sector and documents its resilience mechanisms. A desk-based qualitative case study was conducted. Data were synthesised from international organisation reports, peer-reviewed literature, and documented policy analyses on pharmaceutical supply chains, regulation, and access in Eritrea. The sector faces profound systemic challenges, primarily a near-total reliance on imported pharmaceuticals. A key finding was the strategic prioritisation of essential medicines, with the public sector responsible for procuring and distributing the vast majority of medicines. Resilience is evidenced by a sustained focus on primary healthcare and the use of a standardised medicines list. Eritrea's pharmaceutical sector demonstrates resilience through centralised control and prioritisation amidst severe external constraints. However, this model presents inherent vulnerabilities due to supply chain fragility and limited diversification. Future strategies should cautiously explore opportunities for regional supply chain collaboration where feasible. Continued investment in local pharmaceutical regulation capacity and human resources is essential to maintain quality standards. Eritrea, pharmaceutical sector, access to medicines, supply chain, essential medicines, health systems, case study This report provides a focused synthesis of a severely under-reported health system, offering insights for policymakers and researchers interested in pharmaceutical access in constrained settings.