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Street 'Pharmacies' Taint Iraqi Health Care
By: Yochi J. Dreazen
Published: The Wall Street Journal
Date: September 2, 2004
Website: www.wsj.com
BAGHDAD, Iraq -- It is shortly after sunset in the Baya market here, but Hamid Ali's workday is just beginning.
Leaning over a wobbly wooden cart, Mr. Ali stacks foil-wrapped sheets of green, blue and red medications and antibiotics into tidy piles, spreads out some small plastic bags filled with white anti-nausea tablets, and places a few bottles of children's cough syrup behind the pills. He glances into the street to make sure no police are around and then sits on the curb to wait for customers.
The 23-year-old Mr. Ali sells the same medications as a pharmacist down the street, but that's where the similarities end. He doesn't require prescriptions, offers no warnings about side effects and makes no attempt to ask customers about the other types of drugs they might be taking. What he offers are low prices: Mr. Ali sells most of the drugs for half of what the pharmacist charges.
Across Iraq, black-market pharmacists like Mr. Ali are roiling the country's already-fragile health-care system, prompting authorities to launch a major effort to put them out of business. Officials at the Ministry of Health say that hundreds of Iraqis have fallen sick and dozens have died after taking drugs that were either contaminated, mislabeled or had expired.
Baghdad druggist Yassir Nabil says street sellers' cheaper prices threaten to put him out of business.
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The existence of a thriving underground market for drugs and medicines is also being blamed for numerous instances of fraud and theft inside Iraq's vast network of state-owned pharmaceutical warehouses. In several cases cited by officials, employees at the warehouses have been arrested for stealing drugs and then selling them on the black market for a quick profit.
In an attempt to shut down the black market, the health ministry is finalizing the details of a large-scale media and law-enforcement campaign designed to persuade Iraqis not to buy medicine from men like Mr. Ali while simultaneously marshaling police and security resources to arrest those selling the drugs.
At a summit last month, the ministry asked religious leaders to issue an edict banning the practice and denounce it from their mosques during Friday prayers. The authorities also urged university professors and union officials to condemn it.
Officials from the ministries of health and the interior also recently inaugurated a task force to crack down on black-market pharmacists. Police officers are stepping up their patrols of outdoor markets known for offering unregulated medications, and security officials are scrutinizing government run warehouses for fraud or theft.
Mr. Ali, a reed-thin former soldier who was thrown out of work when the U.S. disbanded Iraq's military last year, insists he has never sold unsafe drugs and says he is mystified by the effort to drive men like him out of business. "I help people with cheap medications that they couldn't afford otherwise," he says. "I'm providing a service, and what could be wrong with that?"
The unregulated sales of prescription drugs are one of the array of problems bedeviling Iraq's health system after decades of neglect under former leader Saddam Hussein and widespread looting after last year's U.S. invasion.
Public-health officials are wrestling with a growing shortage of surgeons and other specialists because hundreds of doctors fled the country amid a wave of kidnappings. Health Minister Alaa Din Alwan, meanwhile, is asking the international community for $1 billion to pay for new hospitals, clinics, drugs and other supplies.
Still, officials at the Ministry of Health say their first goal is to stop the unauthorized drug sales. The number of drug sellers is believed to be no more than a few hundred nationwide, and increased patrolling of the markets where they work and the government warehouses where they often obtain the medicines is likely to make it tough for them to remain in business.
The officials also say that showing progress in eliminating the black-market in medication is a prerequisite for persuading foreign governments, international organizations, private companies and charitable organizations to donate the large quantities of pharmaceuticals that the system needs.
The man charged with stemming the tide of unregulated pharmaceutical sales here is Adel Mohsin Abdullah, the ministry's inspector general. A kidney specialist by training, Dr. Abdullah returned to Iraq last year after spending 22 years in England, where his wife and children still live.
Dr. Abdullah blames the black market in medications for a surge of recent thefts and frauds at state-owned drug warehouses. In one case, Iraqi police arrested two health-system employees after they submitted forged papers, purportedly from a small regional hospital, to obtain more than $10 million of fertility drugs that police believe they sold on the black market here and in neighboring Jordan.
More important, Dr. Abdullah says the illicit trade is causing illnesses and deaths. "Who knows what's really inside the pills you buy from someone on the street?" he says. "Pharmacists know about dosages and side effects, but these people don't even know the names of the drugs. They go by the color of the box."
Dr. Abdullah's concerns are echoed by Yassir Nabil, a 54-year-old pharmacist who has a small shop near where Mr. Ali sets up his cart. He says a male patient of his recently asked a street seller for steroids -- and had to be hospitalized after receiving a drug meant for pregnant women instead.
Copyright ©2004 Dow Jones & Company, Inc.
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