The general situation of the medicines’ sector in the North of Syria is not different from that in other regions, in terms of the shortage of some types of medications and the total lack of some other ones. However, the main difference between the governorates is the source of these medicines and the absence of official tariffs, which has led to price fluctuations across the different regions.

The prices of medications, whether local, imported, or even smuggled, vary according to its type and source. The medications’ sector also suffers from some irregularities, namely, distributing spoiled or expired medicines.

Local unions and health directorates are responsible for controlling the sector and developing systems and work plans in order to regulate the selling activities and prevent violations.

Four sources of medications in the north

The pharmacies and distribution depots in the north of Syria rely on three main suppliers of medications coming from more than one source, while there is a fourth non-regular source, which is based on smuggling medicines from Turkey.

The head of the pharmacy department at the Idlib Health Directorate, Mohamed Haj Hammoud, told Enab Baladi that the medicines available in the region are either made locally or come from the pharmaceutical laboratories previously founded in the liberated area, such as al-Mansoura laboratories in Aleppo, or other laboratories which have been recently licensed by the Idlib Health Directorate. On the other hand, the medication supplies, which come from other laboratories based in the areas under the regime’s control, enter the province from the border crossings connecting both regions.

According to Hammoud, the third method of fulfilling the needs of the province is to import medications through Bab al-Hawa and Bab al-Salam border crossings with Turkey, including medicines that come through the Health NGOs. He pointed out that most of the medicines, coming from Turkey through Bab al-Hawa border crossing, are subjected to strict inspection routines and that the medical supplies cannot be granted an entrance permit unless they match the chart of “conformance to constitutional requirements”.

Hammoud stated also that the pharmaceutical market is still largely dependent on locally manufactured medicines.

In the northern countryside of Aleppo, which is run and supported by the Turkish government, the difference between the sources of medical supplies is not of much importance. However, the secretary general of the Aleppo Free Pharmacists Syndicate, Salem Abdel Mutti, distinguishes between the sources of medicines in public and private pharmacies. Public pharmacies, which are affiliated to hospitals and medical centres and organizations, receive medical supplies from NGOs, while private pharmacies, owned by pharmacists, buy medications from various sources, namely, laboratories based in areas under the regime’s control, local laboratories, and imported medications. These imported medications come from two different trade circuits, i.e. private warehouses, mostly situated in the areas controlled by al-Assad regime and distribute foreign medications which are imported through border crossings, and other illegal medications which are smuggled through the Turkish-Syrian border.

Prices are not fixed

The medications’ market in general is unstable due to a phenomenon of fluctuating prices which resulted from the absence of strict mechanisms governing the trading process either from the direct seller or from the distribution depots. Thus, the entry of some types of medicines from the areas controlled by the regime to Idlib and the countryside of Aleppo is subjected to royalties imposed by the military formations located at the border crossings.

Ahmed al–Abo, head of the medical office of al-Bab Local Council in the countryside of Aleppo, told Enab Baladi that controlling the prices is not possible due to the “big problem” of importing medicines and the different routes employed to enter the supplies to the area, which have lead to differences in prices. Al-Abo stressed the existence of a state of chaos dominating the sector.

Hammoud, indicated that prices were previously determined by the Health Ministry, i.e. before 2011, and that the prices were fixed and listed on each medical item.

According to Hammoud, the deteriorating situation in Idlib, today, and the reality of imports in addition to the change in the price of the Syrian pound have lead to fluctuating prices, in reference to recurrent manipulative practices of pharmacies and distribution depots.

Hammoud stressed that, generally, it is not possible to determine a precise price for each type of medicine, explaining that the authorities responsible for monitoring the sector are currently taking in consideration the citizens’ complaints.

Hammoud conveyed that the authorities have permitted an acceptable price margin that takes into account the differences in the prices of medications, and that should not be exceeded. Hence, in case of receiving a complaint of overriding the regulations, the authorities request an invoice from the pharmacist and compare it with the price that is supposed to be displayed in the first place to sell the medications. If there is a violation, the pharmacist is to be held accountable.

Breaches and lack of discipline: What are the solutions?

The lack of discipline in the pharmaceutical market is conveyed through the absence of monitoring methods and regulatory mechanisms, in addition to the insignificant range of powers granted to the officials who control the sector, and their inability to impose the rules on pharmacies and depots and oblige them to sell their products in accordance to the norms.

Al-Abo attributed this absence of regulatory mechanisms to the fact that the directorates were not fully activated, noting that even the Health Directorate of Idlib does not have the sufficient powers or even the possibility to fight the phenomenon of smuggled medication, whether fake  or  with manufacturing defects.

Hammoud indicated that the correct method of distributing medications is done through issuing a precise prescription, which is checked by the regulatory authorities and the pharmacist, pointing out that there are unlicensed pharmacies which are not affiliated to the pharmacists’ union in the region.

Al-Abo asserted that all the offices of the Euphrates shield area (Northern countryside of Aleppo) held a meeting to discuss solutions to the problems of the sector in the countryside of Aleppo.  Thus, all the parties agreed on many subjects, including the licenses granted to pharmacies and the standardization of records. The aforementioned offices have initiated the process of permits granting to distribution depots and unifying its records in the cities and towns of the countryside of Aleppo, in accordance to standardized terms and rates agreed upon by all medical offices.

He added that the authorities are attempting to put pressure on pharmacies in order to buy medications from licensed distribution depots, provided that each depot manages its supplies of medicines properly. Such condition is designated to hold the pharmacist or the supplier responsible in case the authorities discover smuggled medications from unknown origins under their possession.

Al-Abo believed that the problem of mobile depots that may sell spoiled medications has ended, adding that the medical offices do not require suppliers to provide microscopic or chemical analysis. However, there are spoiled medicines which are sold without the knowledge of pharmacies.

According to al-Abo, the medical supplies depot is a key point in controlling the process. Each warehouse must have certain powers according to its license, provided that monthly records are handled to the authorities. Additionally, pharmacies are also required to present records to the state specifying the quantities of sold medications.

After the meeting, the medical offices in the countryside of Aleppo also launched a project of a central pharmacists’ syndicate through the expansion of the pharmacists syndicate in the city of al-Bab to include all the cities of the region.

According to Hammoud, the Idlib Directorate of Health has started issuing licenses for all the pharmacies and closing of the pharmacies which committed violations.

He added that each newly licensed pharmacy is provided by a register for medications, especially psychotropic drugs. The inventory control process counts the quantities of supplies and inspects it afterward through periodic reports or inspection tours in order to control the distribution of these drugs.

He considered that the improvement of the medications’ industry is not only the responsibility of the health sector, highlighting that improvement can be realized only through the cooperation between economic and internal trade actors, in addition to controlling the border crossings and other factors involved in the issue.