Phoney Drugs Put Lives at Risk

Patients’ lives are being put in danger by bogus medicines, which are flooding into the country from India, China, Pakistan and Iran.

Counterfeit cures, packaged to look like the real thing, are widely available throughout Afghanistan. While the brand names may be familiar, the amount of effective ingredients they contain is so low that patients will not get better - and indeed can become much more ill as a result.

A whole range of syrups, tablets, drips and capsules are imported across land-locked Afghanistan’s borders and while some are legal, the majority is not.

This phoney medicine market has been fuelled by the high costs of drugs and the poverty of the Afghan people. For example, ten tablets of the strong stomach antibiotic Cyproflaxin cost 70,000 afghanis – about two US dollars - in Pakistan but a similar number of Indian-made rogue tablets cost only 10,000 afghanis.

The government recognises the problem but feels powerless to act. “The borders with Iran and Pakistan are open and are not under the control of the government,” Mirza Mohammad Ayoubi, deputy of pharmacy affairs at the public health ministry, told IWPR.

“Most of the drugs used in Afghanistan are imported along these borders and we can not control the entrance of medicine to our country.”

The situation is now so bad that some doctors are asking patients to bring their drugs to health centres and hospitals for inspection. “We are very careful when we are writing prescriptions and giving medicine to patients,” said skin disease specialist Dr Mohammad Deen Imamzada.

Unlike the procedure in many western countries, Afghan patients are given a prescription and then have to purchase the drugs in a bazaar, as the local doctors and clinics do not stock such items.

“When the patients buy the medicine, we ask them to bring it back so we can check the company’s name. If the brand is credible, we accept it, otherwise, we ask them to take it back.”

Kabul resident Faiz Mohammad brought his 14-year-old brother to the doctor for treatment for a kidney complaint. “I bought medicine according to the doctor’s prescription. But there was no change when my brother took this medicine - he got even worse,” he said.

“So I went to doctor for the second time and bought more prescription medicine. Unfortunately, this time it still didn’t work and now my brother cannot even walk. Finally I had to admit him to the hospital.”

The rogue medicines are coming mainly from China and India, which makes life difficult for the genuine importers.

“The Chinese medicine that is imported officially is usually of good quality,” said Abdul Khaleq, president of Zazai, an importer of Chinese medicine to Afghanistan.

“However, some traders are bribing the Chinese factories to produce a product that has colourful packaging but very little effective ingredients so traders can buy it cheaply and sell it in the market with more profit. This is the kind of medicine that is being imported illegally.”

Mohammad Daud, owner of the Pesaran Muhsini Pharmacy in Kabul, believes that some customs officials in Herat, in the west of the country, and south-west Kandahar are only too happy to tax of any sort of medicine - legal or otherwise.

“Those in charge of the public health of these provinces do not have the facilities to recognise fake drugs,” he said. “However, by accepting a bribe, they will pass any kind of imported medicine as being of good quality.”

In addition to selling counterfeit products in the markets, the medicine traders of Afghanistan can also get their hands on drugs donated by international organisations to public hospitals and sold on illegally for profits.

One Kabul medicine seller, who did not want to be named, said he often traded in drugs once destined for hospitals. “We can buy and sell medicines brought in by the International Red Cross, Medicines Sans Frontiers, Unicef and other international organisations,” he told IWPR.

“People at some hospitals are selling donated medicine in the market, where it is bought and sold secretly.”

This illegal trade has been made possible by the poor condition of the local pharmaceutical industry. Only a decade ago, Afghanistan was producing the majority of its medicine inside the country and was even developing an export market.

However, the civil war of 1992 put an end to this, destroying factories and creating such high demand for medical treatments that the government could not meet it.

The German pharmaceutical giant Hoechst’s Kabul plant once produced nearly 130 lines of drugs, but today they have only ten. Hoechst’s Kabul director Mohammad Aman Ibrahimi can pinpoint exactly what went wrong.

“Because we don’t have a banking system in Afghanistan it was difficult for the Germans to bring in raw materials, and then the specialists left during the fighting. Now our products are at a minimum and our company is on the verge of collapse, “ he said.

“If the authorities do not pay serious attention to the medicine market in Afghanistan, the lives of the people in this country will be put in danger,” he warned.

Abdul Wali is a Kabul-based freelance reporter.