Bekhal, a young Kurdish woman, realizes that she may not live to see the spring of next year. Leukemia — which has been ravaging her body ever since she received counterfeit medication in a hospital in the Kurdistan region of Iraq — could kill her.
Bekhal, 25, was standing in the courtyard of her house when her father, al-Hajj Salih, told us about the investigation into the counterfeit medication that ruined her chances of being cured of this deadly disease. Just a few days after being given the medication "in a government hospital," the doctors informed her that recovery within Kurdistan had become "impossible."
After much despair and considering bringing criminal charges against those who were negligent, Bekhal's father realized — despite his reluctance to go to the courts — that attempts to fight these "dinosaurs" or corrupt drug dealers who are protected by the influence of money and power in Kurdistan, were worthless.
Now he plans to sell his small house and travel with Bekhal at the end of the year to India, searching for a "last chance" to save his only daughter.
Nowruz Salih has suffered from large distortions on her face and throat since fall of last year as a result of being injected by a "counterfeit syringe." Before receiving this lethal injection, she was only experiencing some basic inflammation in the trachea. However, overnight it turned into a fatal disease.
The same is the case for Aya Abdulkareem, who is still trapped in her house despite two years having passed since she too was injected with a "counterfeit syringe," which caused her to lose the ability to move her right leg. This injection could have killed her, had it not been for a second chance at life she was given following seven days spent in the recovery room, "nearly dead."
Aya survived miraculously, as did 32 year-old Susan Kamal, after doctors saved her from the complications of another "counterfeit syringe" that she was injected with to treat "slight inflammation in the teeth."
Unlike Bekhal, Nowruz, Aya and Susan, 18 year-old Serbest Jaafar did not survive the deadly injection, and died July 15 from an injection of ceftriaxone. Kazaw Abdulbaqi, 40, also didn't survive, dying from the same injection on June 30 of this year. Likewise, Massouma Biro died Aug. 3 as a result of an injection of cefotaxik, which is in the same family of drugs as that which killed Serbest and Kazaw.
Dr. Salam Tayyib, a cancer specialist in Erbil's public hospital, says that the bitter truth here is that these injections were included in the list of banned (medications) that the Ministry of Health in Baghdad issued early last June. This listed was distributed in an official book to all health organizations throughout Iraq. However, these drugs still silently kill many innocent people. The health organization in Kurdistan — whose annual budget exceeds $446 million — is not able to reduce the presence of these [banned drugs].
A factory for "producing death"
Former Health Minister Taher Hawrami estimates that expired and counterfeit medication — which has entered the Kurdistan region over Iraq over the past few years — accounts for 18% of all medication in Kurdistan. Deputy Chairman of the Health and Environment Committee of the Parliament of Kurdistan Hawraz Sheikh Ahmed admits to [the presence of these counterfeit medicines]. According to Ahmed, expired and counterfeit medication "is spread throughout Kurdistan. It enters into the province through all ports, and traders maintain a monopoly and no one can stop them, because — in short — they are backed by influential politicians in the region."
The statements of Ahmed are supported by the fact that, last March, the Ministry of Health in Kurdistan admitted that they had discovered an "unlicensed" factory in Erbil. This factory contained three tons of dangerous chemical materials that had been smuggled into Kurdistan to be used in the production of counterfeit medicines that are not safe to use. These medicines were placed in Syrian or Indian medical packaging, and sold in pharmacies as "globally imported medicines." For some of the medicines, the price reached $50 per pack.
This "unlicensed" factory was producing thousands of boxes of counterfeit medicine, which were later ingested by thousands of Kurdish citizens, with no one daring to pressure for the truth. This issue is just like the scandal involving 2,500 boxes of insulin injections that were sent to hospitals and pharmacies along with an official note from the Kurdish Ministry of Health, before it was discovered that these injections were "counterfeit."
In total, 27 people that were believed to be linked to the case were investigated, including officials from the Ministry of Health. However, this investigation ended with only a "reprimand" for those involved, according to a Kurdish MP who asked to remain anonymous because of the issue's sensitivity.
The director of the Pashmag border crossing, Sirwan Abdullah, confirmed that counterfeit and expired drugs are constantly being smuggled into the region. The procedures [for importing drugs] involve confirming the documents provided by the merchant and verifying that they have been issued by the Ministry of Health. Afterward, samples of these drugs are taken, which are then sent to the Kurdish Directorate of Standards, from which the company is allowed to move the imported goods to its storehouses pending the completion of testing procedures.
Moreover, according to Abdullah, sometimes the crossing's inspectors have doubts regarding a certain shipment of medicine. In this case, they refrain from taking any action until they get the test results from the directorate.
Abdullah revealed that the crossing is holding 47 tons of drugs, which it will not allow to be imported until it has confirmed their legal status. In addition, they have withheld another six tons of drugs that were proven to be expired, while tests showed that 40 boxes of this same shipment were counterfeit drugs.
In March 2012, after nearly a year of continuous work, the Reforms Committee acknowledged that a large quantity of expired and counterfeit medicine had entered the Kurdish region. The report they issued estimated that 90% of medicine in Kurdistan had not been subjected to testing. These large numbers reminded Kurdish citizens of a previous scandal, when 400 tons of expired and counterfeit medicine passed into the region through one of the border crossing in the winter of 2010. The transaction, which involved 20 trucks loaded with expired and counterfeit drugs, involved a senior official at the border crossing, as well as the owners of two companies that were importing these fatal drugs. It was also revealed that the day the drugs crossed the border a government official was working as a crew member at the crossing.
Until now, no one knows where these drugs went, nor the number of victims they claimed. Yet the cases ended, as many in Kurdistan are aware, with the involved official being transferred to another job.
The Ministry of Health confesses
The Ministry of Health denied that the figures put forth by the Reforms Committee were "realistic." Yet at the same time, the ministry did not provide a number — not even a rough estimate — for the quantity of drugs that have entered Kurdistan without being subjected to inspection.
The head of the Department of Pharmacology at the Directorate of Quality Control in Erbil, Rozakar Hamid, reiterated claims made by the ministry spokesman regarding the "lack of staff and the scarcity of necessary equipment needed to test drugs that are entering the region."
Hamid says that standard procedures require that medicine suppliers wait long periods of time until the test results are available. Testing a single sample of medication, on average, can take three months.
No one waits
However, no one in the region can wait until the lengthy testing procedures are complete: not the patient in the Kurdish region — whose population exceeds five million — nor the pharmaceutical traders. One such trader, Abu Ayyub, said that he put his fortune into a pharmaceutical deal involving medication to treat high blood pressure and diabetes. These drugs are still sitting abandoned in the storehouses, waiting for the results of testing that began more than two months ago.
Only 14 pharmacists
Hamid acknowledges that the total number of pharmacists who are working to examine samples of imported drugs does not exceed 14. Their experience "is limited, not exceeding a few years of work." But their task requires examining large quantities of drugs. For this reason, Hamid believes that is is possible — in theory — that a large number of traders are already marketing their products before the testing process has been completed.
According to civil rights activist Ahmed Bira, the [reasons] provided by the Ministry of Health [for these lapses] — weak medical staff and a lack of the necessary equipment to follow up on the screening process — does not fit with the tremendous budget received by the Kurdistan Regional Government (KRG) from the State Treasury in Baghdad (which totaled nearly $12 billion in 2012 alone). This is in addition to the resources derived from oil contracts signed by the KRG, as well as the benefits of massive foreign investment pumped into the region.
When looking at the number of government employees and security agents — which total 1,35 million out of a population of 5 million — the fact that there are only 14 pharmacists to examine thousands of tons of imported drugs to cover the needs of so many people is a "crime," Bira said.
Supporting Bira's claims, Kurdish MP Burhan Rashid said that drug testing operations in Kurdistan have "failed," and that the work carried out by the Directorate of Quality Control is "very bad." Kurdistan has become a "prime location for the sale of anything that is bad quality or expired."
Defects in the system
There is another disaster, which is clearly indicated by the information given by the leader of the Kurdistan Pharmacists' Union, Amir Sheet. There are only 320 pharmacies and 57 medical storehouses with official permits, compared to more than 4,000 unlicensed pharmacies, storehouses and clinics, which discharge the bulk of imported drugs.
These figures mean that the number of licensed pharmacies and storehouses do not exceed 9% of the number of total pharmacies that fill the cities of the Kurdistan region. This also means that 91% of pharmacies and [pharmaceutical] retail outlets not do receive the lists of expired and counterfeit drugs issued by the Ministry of Health.
Drugs "on demand"
The leader of the Kurdistan Pharmacists' Union recognizes the need for the Kurdish region to correct its procedures related to the import and distribution of medicines. As he sees it, the most effective step would be limiting the import of medicine to those who are specialized in the field. Many of the owners of these companies have nothing to do with the pharmacy profession or the world of medicine.
Unlike Sheet, drug trader Ghraib Saadallah believes that the issue is primarily linked to the system for testing imported drugs, not to those who import them. Whether the merchant is a pharmacist or not, the final decision on the quality of the medicine will depend upon tests conducted by the competent authorities, not according to the "conscience of the merchant."
Saadallah notes than any drug merchant could travel to India, China or Iran and choose any type of drug that would bring him great profit. In these countries, pharmaceutical companies offer merchants a number of options for drugs with varying percentages of active ingredients. Drugs with lower percentages have lower prices. According to Saadallah, "whether the merchant is a pharmacist or not," he can agree with the drug manufacturer to purchase medication that contains a very low percentage of the active ingredient, sometimes as low as 1%. Saadallah notes that it is here that "they can make profits that make traders drool."
Mariwan Karim, the owner of a pharmaceutical company, notes that there are influential companies that are partnered with senior government officials. For a long time, Karim has seriously considered leaving the drug trade business. He notes that there are "influential" companies that sell their products immediately after bringing them into the region. On the other hand, companies without "backing" must wait many months, sometimes as long as a year, before they receive test results and can begin the process of marketing.
Karim believes that the purpose of delaying tests and forcing companies to keep there goods in storehouses, is to "block the path for companies that are not affiliated with influential officials, and to force them to withdraw from the market." A report issued by the Kurdish Reforms Committee supported Karim's statements. This report mentioned three senior officials — "whom the report did not name" — who are behind the import of expired and counterfeit drugs.
MP Rashid affirmed these same ideas. He holds the major Kurdish parties responsible for what is happening in terms of violations in the drug trade, because they have "controlled most of the trade in Kurdistan, including the pharmaceutical trade."
Awaiting the concept of accountability
Article 50 of the Pharmaceutical Law in Kurdistan says that the punishment for endangering someone's life as a result of pharmaceutical negligence can reach up to three years in prison. However, the presence of 4,000 unlicensed pharmacies in the Kurdistan region makes it impossible to follow up on details regarding the sale of drugs, or to catch offenders.
Only a small part of the responsibility [for these violations] falls on the owners of pharmacies and clinics. In comparison to the "pharmaceutical whales" — as journalist and activist Mohammed refers to them — these owners only bear a very small portion of the responsibility. At the end of the day, the pharmacy is nothing more than "a victim of large defects in the health system in Kurdistan."
Investigations that were carried out concerning major violations — such as smuggling expired drugs or manufacturing counterfeit medicine within cities, and without a license — did not result in any real determent measures. Mohammed also cited the procedures that were talked about in the report issued by the Kurdish Reforms Committee.
Sheikh Ahmed confirmed that none of the officials who were actively responsible for the annihilation of Kurdish citizens through counterfeit medicine “were taken to the courts, nor were they held accountable in any way.” In this context, Sheikh Ahmed noted that the factory that was discovered in Erbil — which reportedly was manufacturing counterfeit medicine — could once again go back into business, yet under a different name, following efforts made by a number of people.