Enab Baladi – Mays Hamad
“A few days ago my uncle suddenly fell unconscious, while he was bathing. We carried him and we headed to al-Mouwasat University Hospital quickly. We did not know at the time that he had leukaemia.” With these words, Tamim recounted to Enab Baladi his uncle’s story with cancer, and his treatment journey at a public cancer treatment hospital in Damascus.
Tamim continued: “as soon as we arrived, my uncle was rushed to the emergency room. Later, when he left the emergency unit, we sat on the floor in one of the ground floor lobbies waiting until my tired uncle got a bed.” He added: “I rushed to a nurse asking for a painkiller or medication; however, he replied that cancer medicine is unavailable for the time being.”
Cancer medicines are out of stock in Syrian public hospitals, but available in private pharmacies. There are no official statistics on the number of cancer patients in Syria, which raises questions about the extent of the Ministry of Health’s awareness of the availability or shortages of cancer medications in Syria.
The Syrian National Cancer Registry, established in 2001, was concerned with documenting the number of cancer patients. However, the head of the department of pathology at the Faculty of Medicine, Tishreen University, Dr. Zuhair al-Shihabi, told the state-run newspaper Tishreen, on 11 November, that the Registry has not been updated since the outbreak of war in Syria.
The complaints of patients and their families are constantly reported by government and local newspapers, which began to discuss the severe shortage of all types of medications in several public hospitals, in conjunction with the suspension of a number of pharmacies surrounding Damascus public hospitals by the Ministry of Health, mid 2019.
In February, The Syrian Ministry of Health stated, via its official website, that “free diagnosis, treatment and follow-up services are still available to cancer patients in Damascus Hospital, Ibn Al-Nafees Hospital, and Ibn Rushd Hospital in Aleppo, Hama National Hospital, Zaid Al-Shati Hospital in Sweida, and Al-Basel Hospital in Tartus.
At the same time, the government offered incentives to investors in the pharmaceutical industries, such as providing free plots in the industrial zones and exemptions from taxes and duties, so as to increase cancer medication manufacturing.
Medications sneaked out of hospitals.. How?
Pharmacist N.H. from Damascus, who spoke on condition of anonymity because of security reasons, said: “Some people come regularly to visit the pharmacy where I work, offering medicine cans or analgesic syringe ampoules for chronic diseases and cancer patients. I refuse to buy these medications, which must be available and given free of charge in public hospitals.”
The pharmacist stated that she knows nothing about how those individuals managed to get the medications or how they thought of selling it at exorbitant prices. However, she mostly thinks that the source of the smuggled drugs is public hospitals.
Enab Baladi also interviewed C.H., a pharmacist who used to work in a public hospital pharmacy, in Damascus, before starting her independent practice. She indicated that the staff of public hospital pharmacies asks the patient to show the entry registration receipt and the full doctor’s report before giving him or her the cancer medications.
According to the pharmacist, smuggling medications from public hospital pharmacies is very likely, as sneaking drugs is done via legal methods, i.e. the smuggler and the nurse work to obtain a doctor prescription, which enables the former to obtain the medicine.
However, the pharmacist excluded the assumption that the smuggling phenomenon is the reason behind the shortage of cancer medication in public hospital pharmacies. Instead, she attributed the problem to the fact that doctors may allow cancer patients, who come from other governorates, to seek treatment in Damascus or Latakia, to get more than one dose, in order to spare them the hardships of travelling each time they needed a treatment dose.
Enab Baladi tried to reach out to one of the nurses working at al-Mujtahid Hospital in Damascus, which is undergoing a medication shortage, while different types of medicines are being sold in nearby pharmacies (some of them were shut down in August). However, the hospital staff declined to comment on the ongoing situation.
Government bound to provide medications
European and US sanctions imposed on the Syrian government and the companies with which the regime has been cooperating since 2012 have weakened the medical sector, though the sector has been somewhat excluded from the sanctions range, to the extent that some companies became indifferent whether the Syrian public hospitals were supplied with cancer drugs or not.
In an interview with Enab Baladi, a businessman supplying cancer drugs from Lebanon, who spoke on condition of anonymity, said that he concluded in mid-September two deals to import syringes for the treatment of cancer to Syria; noting that the second deal cost about 54 million Syrian Pounds
“Working in the pharmaceutical sector is profitable. However, working to supply a country under sanctions like Syria means necessarily to face major obstacles, such as getting involved in complicated transactions with foreign banks, and dealing with payments for the import of medicines,” indicated the businessman. He also tackled the instability of the Syrian Pound price, which affects the pace of Syrian imports, in addition to the low allocations provided by the Ministry of Health.
The government of the Syrian regime allowed the private sector, i.e. some private pharmaceutical companies, to import cancer drugs, as rich patients prefer to receive treatment at their own expense rather than waiting for their turn in public hospitals in order to be diagnosed and get the medication doses they need.
According to the head of the Department of Radiation and Chemical Oncology at Tishreen University Hospital, and a professor at the Faculty of Medicine, Tishreen University, Michel Gerges, the costs of treating cancer patients vary depending on the type of cancer. Thus, some drugs, for breast cancer for instance, cost the state about 3 to 4 million Syrian Pounds per month, while some patients need medication on a continuous basis to treat the tumor.
However, those who pay for their own treatment are also affected by the different prices. Hence, Wafa Keshi, head of the Syrian Pharmacists Syndicate Council, justified the drugs’ different costs, while talking to Tishreen newspaper, by saying that: “most cancer drugs are imported from several countries, so there is a variation in the pricing of each drug category.”
In 2013, the World Health Organization (WHO) indicated that cancer ranks third among the 10 leading causes of death in Syria, and the number of cases is expected to rise amid the ongoing medical crisis, as several hospitals went out of service and others have been partially damaged.
In 2017, the WHO provided treatment to 16,500 cancer patients in Syria, with international support, according to a report released on April 17, 2017.
According to the report, about 25.000 cancer patients need treatment each year, including 2,500 children under the age of 15, suffering from leukemia and lymphoma.
On the other hand, Mahmoud Hassan, head of the Syrian Pharmacists Syndicate Council, told the local newspaper Al Watan, in October 2018, that a laboratory for the production of cancer drugs will be established in the Adra industrial zone, Rif Dimashq. However since Hassan announced the news until the date of writing this article, no real step has been taken on the ground to realize the afore-mentioned project.