Enab Baladi -Eastern al-Ghouta

Small shops and unlicensed pharmacies have appeared all over eastern al-Ghouta selling medication without any monitoring or standard pricing. Most of the staff running these shops are not trained to work in the pharmaceutical profession nor do they have the necessary qualifications.

The Pharmacists’ Association and charities are trying to organize the sale of medicines and all pharmacies in order to ensure that they are managed by people with the necessary qualifications and experience.

There are around 120 pharmacies in al-Ghouta including those in hospitals and clinics. Most of these are run by staff who do not have the necessary qualifications.

As part of its investigation into the pharmaceutical profession, Enab Baladi spoke to the Pharmacists’ Association and owners of unlicensed pharmacies, who both gave us their views on the issue.

Pharmacists’ Association Trying But Lacks Necessary Authority

There are no mechanisms for preventing those without a license or authorization from selling medication or working in pharmacies, according to Sami al-Shami, a pharmacist and member of the executive committee of the Pharmacists’ Association. He told Enab Baladi that the Association had resorted to taking legal action on a number of these cases but had received no response until now due to “alliances between those in power and pharmacy managers in al-Ghouta.”

Al-Shami described the pharmaceutical profession as “a scientific profession with humanitarian, economic and social objectives to ensure society’s health.” He clarified that the Association had directed an official statement to the courts “since it is the easier solution rather than going to the Directorate of al-Ghouta, which used to receive applications requesting the closure of irregular pharmacies.” The Association had called on the judiciary to close eight pharmacies considered as “the most corrupt” two months after the Association was formed but no such action has been taken till now.

Al-Shami explained that the same medicinal product is sold at varying prices. He gave an example, “Take the rozflex injection, it’s sold for anywhere between 400 and 700 Syrian pounds but its actual price is no more than 200 Syrian pounds.”

Recently, the Association set prices for a number of medical supply warehouses, which have expressed their commitment to respect the new prices. The Association is now working on setting prices for a further four warehouses.

Al-Shami explained that in addition to the varying prices, a monopoly exists over some types of rare or special medication. This prompted the Association to issue a decision setting five levels of profit based on the price of each medicine. However, not all pharmacies have complied with the decision.

“We contacted the checkpoints in al-Ghouta via which medication is brought into the area but did not get much response. We haven’t been able to hold any unlicensed pharmacy accountable,” al-Shami explained. He confirmed that the Association had “documented some medical errors such as cases of poisoning thanks to excessively high prescriptions or substituting one medication for another on the grounds that it has the same effect, according to what pharmacists tell their customers.”

Residents and institutions are not cooperating with the Association, according to al-Shami. He considers this one of the difficulties preventing the Association from carrying out their work effectively. “Residents know the pharmacies are unlicensed but they buy medicine from them anyway without taking the risks seriously.”

Following meetings between the Association, some of the local councils in al-Ghouta, the residents’ council of Douma, the judiciary and military commanders, a decision was made that all those seeking to open a pharmacy must obtain authorization or a license from the Association. Al-Shami said some were “dissatisfied” at this decision.

The Association has launched a training program over a period of three months in Douma City for those with five years’ experience working in pharmacies, regardless of their qualifications, so that they can continue to work under the Association’s supervision, in order to prevent new pharmacies from opening.

Pharmacies run by Charities

Some charities own their own pharmacies, among them al-Adalet pharmacy, which belongs to the al-Hikmat Collective, an aid organization managed by the al-Bashaer organization. The organization also runs several clinics containing various specializations.

Doctor Basel al-Turk, the organization’s medical manager, told Enab Baladi that the pharmacy provides all kinds of medication, “Pharmacists do not have sufficient capital to import all kinds of medicines, so we work to provide the medication at relatively reasonable prices to put a stop to the traders selling it at the prices they want.”

According to al-Turk, these traders increase the price of medication by 100. He gave an example, “Cystone, a medicine used to treat kidney stones, is sold inside the Collective for around 2000 Syrian pounds. Outside the price reaches 4500 Syrian pounds. Tempra medication for children is sold for 325 Syrian pounds in the Collective while in some pharmacies the price reaches 425 Syrian pounds.”

Regarding the licencing of the organization’s pharmacy, the medical manager clarified that the organization had consulted a pharmacist and members of the Pharmacists’ Association when they first opened the pharmacy. He confirmed, “There is great resentment among some of the traders because we and others are lowering the price of medication.”

How Do the Medicines Enter al-Ghouta?

The medicines entering the area come from various sources as warehouse owners buy the medicines from outside al-Ghouta and bring it in through regime checkpoints. Others buy the medicines from Barza and smuggle them in through tunnels after paying bribes, and then distribute them to pharmacies.

According to the information we received, pharmacies continue to work without regulation and in a context of instability. Prices vary between sellers, margins of profit vary widely between pharmacies and there is no regulatory system to organize the profession.

Yaman al-Agha owns an unlicensed pharmacy in Douma City and considers that he has sufficient experience in the medical field. He sees that the current number of pharmacies in al-Ghouta is insufficient to meet the needs of the entire area and that “someone who embraces the profession and has significant experience would not cheat people.”

Al-Agha’s pharmacy is not licensed by the Association, like dozens of other pharmacies in the area. According to al-Agha, “There is no state to give authorizations, not even a pharmacists’ union.” He pointed out that the Association was unable to shut down any pharmacies despite the issuing of a judicial decision requiring this.

Al-Agha did not participate in the Association’s training program “because they imposed a 300 dollar fee for attending”. He says that he is willing to close his pharmacy “if it is proven that I am not qualified.” However, most of the residents Enab Baladi spoke to said that “tens of pharmacy owners fear that the Association will review them and that they will lose their livelihood, which is what discouraged them from attending the training.”

Al-Agha admitted that the prices of medicines in pharmacies licensed by the Association are “cheaper than elsewhere” and that “there are tens of pharmacies managed by sellers who have no experience whatsoever.”

A solution to these problems does not appear likely to emerge any time soon in al-Ghouta. Residents agree on one thing – that with the absence of government and the entry of traders who see the pharmaceutical field as a business opportunity has added to the challenge of reaching an effective solution.