Syria: Unlicensed Pharmaceuticals Trade in Kfar Nabel

Abu Hassan has no qualifications beyond his primary school leaving certificate. Nonetheless, he works as a pharmacist, seeing patients, prescribing medication and sometimes suturing wounds.

The pharmacy where he operates in Kfar Nabel, northwest Syria, is unlicensed. Abu Hassan says he could “rent” a pharmacist’s license, but these are very expensive at the moment.

Kfar Nabel, with around 35,000 residents, used to have 17 pharmacies. Now there are 23. The six new ones are unlicensed and their owners have no qualifications.

The official board that licenses legitimate pharmacists is unable to operate in rebel-held areas of Syria.

“From a legal standpoint, even trained professionals shouldn’t be dispensing medication if they don’t have any experience of how it’s made,” pharmacist Ahmad Tajuddin Ramadan said. “You often see cases where a medicine with a name similar to the one required is dispensed, which ends up causing bad side-effects or even problems that adversely affect the patient’s health.”

Ramadan, who is fully licensed as a pharmacist, continued, “Some of them carry out the work of a doctor from their pharmacies, treating children, suturing wounds and prescribing medicines. These aren’t things a certified pharmacist ought to be doing, especially as they usually approach the job as a commercial venture.”

Usama al-Hussein, an English teacher, has worked as a pharmacist’s assistant in a licensed shop for 20 years.

“I can’t dispense any treatment to a patient without first consulting the pharmacist,” he said. “And if we switch from one brand of medication to another, I consult the patient. I don’t dispense anything unless all the required medicines are on hand and the pharmacist has given his approval.”

Abu Ahmad, who owns a pharmaceuticals warehouse in the town, said he was often approached by unqualified retailers.

“Many of them don’t even know the names of the medicines they’re ordering, and just ask for cough medicine or flu medicine without specifying the brand or type,” he said. “I sell them only the simplest medicines – light-dosage painkillers such as cetamol 500 or other fever-relievers and anti-inflammatories. I don’t sell them blood pressure or diabetes medication, or anything else that can only be dispensed with a doctor’s prescription.”

Seeking treatment from an unlicensed chemist can have dire consequences.

Nine-year old Ahmad fell from the rooftop of his family’s home and lost consciousness for a short while. His father, Mahmud al-Stayf, a labourer, carried him to the nearest pharmacy, which was an unlicensed one.

“When we got to the pharmacy, the person there treated my son’s wounds and gave him four injections,” the father said. “He grew weaker and weaker and I felt that he was in danger, so I took him to the hospital to see a paediatrician. The doctor confirmed that those injections shouldn’t have been given to anyone who had lost consciousness, because they put the child’s life in danger.”

Ahmad al-Qassem, a civil servant, took his 34-year old wife to the pharmacy near their home after she noticed hair loss. They asked the pharmacist for something appropriate like a special shampoo or ointment.

“The pharmacist told us he could give her a cortisone injection in the affected area,” al-Qassem said. “I was afraid of possible side-effects, especially as I knew he was unlicensed, so I asked him whether he’d ever treated a case like this before. He said yes, and that he’d given the patient a cortisone injection and there had been significant improvement within a matter of days.

“When my wife heard that, she agreed to have the treatment. He gave her a first injection and told us that she might have to come in for another one. The next morning, my wife woke up with a swollen, discoloured face, with a serious disfigurement to her forehead. I took her to the hospital to see a specialist, and we’re still treating her condition two months later.”

Unofficial chemists like Abu Hassan say they are doing their best.

“I worked in pharmaceuticals administration in Aleppo for 15 years,” he said. “I have a lot of experience and I supervised the training of a number of students from the pharmacy faculty,” he said. “I don’t sell any medicine without a prescription, except for anti-inflammatories, cough medicine, flu medicine and over-the-counter painkillers. There are a number of medicines that certified pharmacists aren’t allowed to sell without a prescription. In any licensed pharmacy, you can find a trained professional who doesn’t have a degree but dispenses medicine as if he owned the place.”

The head of the local council in Kfar Nabel, Ayman al-Klaydo, condemns those who operate without a license or qualifications.

“After receiving complaints from some citizens about the presence of unlicensed workers with no real experience in the field of pharmacy, the local council in Kfar Nabel… passed a number of regulatory measures on January 20,” he said.

These included only allowing pharmacies to be run by people with the appropriate qualifications, as well as cracking down on the sale of expired medication and the trade in medicines donated as humanitarian aid.

The regulations were issued to the Free Police Force, with instructions to take immediate action. As a result, some expired medicines were seized and destroyed, and unlicensed pharmacies were warned to resolve their status.

“We have carried out inspections of all the pharmacies and informed them of the local council’s regulations,” Kfar Nabel’s police chief Ramadan Hamido said. “We have inspected all the medicines to see whether any of them have expired or were originally handed out as free aid, and the central pharmacy, in cooperation with the Sharia court, the local council and a group of pharmacists, has organised surprise inspections to take place at different times.

The sharia (Islamic law) court in Kfar Nabel is working with the council and police to enforce the regulations, and will order pharmacies to close if they are found to be breaking the rules.

“The decision is a necessary one, and the court fully supports it,” the court’s head Ayman al-Bayush said. “We are working with the council and the Free Police Force to enforce it, and every complaint will be referred to the court, which will in turn bring these violations before the appropriate medical committees. These committee’s reports will then be sent to the criminal division, which will decide on the nature of the violation under Islamic and customary law…. The court has organised teams of inspectors to investigate the pharmacies in the city.”

Bayush acknowledged that despite the new measures, “we haven’t received reports of any violations so far”. None of the unlicensed pharmacies has been shut down.

Omar al-Hussein is a Damascus Bureau contributor in Syria.

This story was produced by Syria Stories (previously Damascus Bureau), IWPR’s news platform for Syrian journalists.