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Rising drug prices make patients sicker in Syria’s Idlib… Who takes responsibility?

Destruction of medicines in Idlib by the drug control authority of Idlib’s health directorate - October 2019 (health directorate)

Destruction of medicines in Idlib by the drug control authority of Idlib’s health directorate - October 2019 (health directorate)

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Enab Baladi – Yousef Ghuraibi

Tayseer al-Youssef has lost his house in the town of Hass in the southern countryside of Idlib during the recent military escalation of the Syrian regime forces in the province, but that’s not his only pain. Al-Youssef is suffering from a chronic disease that needs constant treatment, not to mention his inability to provide for his three children.  

Al-Youssef talked to Enab Baladi about his suffering to obtain his medicine, which keeps him alive. Al-Youssef has got a liver failure (cirrhosis of the liver) since he was 12 years old, and he needs to take his medicine “Cillamin” which helps liver cells to release the copper directly into the bloodstream. Al-Youssef pointed out that in 1986 he was taking a foreign drug that the Syrian government imported free of charge as his father was working in the military sector at that time.

But from 2015 until the moment, drug prices have varied dramatically due to the depreciation of the Syrian Pound (SYP), and about a year ago, a carton of “Cillamin” drug cost 500 SYP (around 1 USD) before it reaches 3,995 SYP (1.7 USD).

Al-Youssef added that whoever secures this drug in the opposition-controlled areas clearly brings it from the Syrian-regime controlled ones, adds a delivery fee, and pharmaceutical warehousing costs. Then, the pharmacist increases the price of the drug at which he buys to gain some profit. Thus, the final price of the medicine amounted to 5,500 SYP (2 USD) in the past few months.

 And now, with the significant decline in the value of the SYP against the US dollar—Syria’s pound deteriorated significantly to reach 2,000 SYP against the US dollar, the price of a “Cillamin” carton increased to 8,000 SYP (3.4 USD). Al-Youssef buys his medicine for 9,500 SYP (4 USD) in his region, describing the prices of drugs by being “too unreasonable” since “Eid al-Fitr”, which was observed at the end of last May.

“For being unable to work, my medicine costs me 42,000 SYP (18 USD) per month, and luckily some good people buy it for me… but their help will not last forever,” al-Youssef said.

“Drug control department” explains reasons for difference in drug prices

Enab Baladi spoke to the head of the drug control department in the Idlib health directorate, Mustafa al-Sayyid al-Dagheem, about the reasons for the massive price discrepancy to be determined by three.

First, al-Dagheem said that the lack of medications and the difficulties in securing them has caused this difference in their prices, noting that the majority of the medicines used in Idlib are “Syrian made” and comprises 85 percent of Syrians’ consumption, while only 15 percent of medicine is foreign. 

The second reason is the difference in the cost of transport service and the provision of the drug from the areas controlled by the Syrian regime. The prices of medicines are going up due to the closure of all crossings between the areas held by the Syrian regime and Idlib, for fear of the novel coronavirus, officially known as “COVID-19.” This caused a shortage of medicines. Thus, several warehouse owners and pharmacies became concerned about their capital, because they buy and sell in the Syrian currency whose value is declining.

The head of the drug control department in the Idlib health directorate, Mustafa al-Sayyid al-Dagheem highlighted that urgent and severe effort is made in cooperation with the “pharmacists’ association,” warehouses owners and drug importers, to regulate their prices and set a new price that suits the income of the citizen and his purchasing power, and somewhat the owners of warehouses and pharmacies, without providing further details. 

Al-Dagheem stressed the importance of holding the manipulators of medicine prices accountable, and this will come into effect after the approval of the new cost of medicines. 

However, the pharmacist operating in Idlib, Ahmad al-Adel, explained that the “drug control department” has nothing to do with the issue of setting medications’ prices at all, because the cost of medicines is being manipulated by the first party which brings the drug from the sources.

Do pharmacists have a role in raising prices?

Al-Youssef said that the price of his medication “Cillamin” varies from one pharmacy to another as he bought a carton from a pharmacy at the cost of 7,000 SYP (3 USD). After one month, he needed another carton, but the same pharmacy could not provide for him, so he had to buy it from another pharmacy for 9,000 SYP (3.8 USD).

Al-Youssef sent an audio recording to Enab Baladi for a conversation with an unidentified pharmacist, whom he asked about the price of the drug. The latter answered that the price has become 15,000 SYP (6.4 USD), while another pharmacist said that the cost of al-Youssef’s medicine is 18,000 SYP (7.7 USD).

The pharmacist Ahmad al-Adel said to Enab Baladi that there are several reasons why drug prices vary at different pharmacies for the exact same medication, the first of which is related to the availability and accessibility to the drug. If the pharmacist has the medicine at the old price, he can control the percentage of profit to sell it at a low cost, but if it is not available in the pharmaceutical market, he will buy it at a high price and sell it as well.

What is the role of the so-called salvation government?

According to al-Adel, the main reason for the difference in the prices of medicines is the monopoly imposed by the party that is considered the first source of drugs (referring to the merchants who control the transport of the drug without mentioning their names). When this party felt that the drugs were cut off from the source (the regime-controlled areas), it stopped selling them to medicine warehouses, which in turn stopped selling them to pharmacists, despite their availability. 

The pharmacist al-Adel indicated the third reason, saying that the merchants offer medicines to pharmacists, and they want the pharmacists to buy both non-consumed drugs along with the most common medications used by people. So, when a pharmacist purchased a particular type of required drug, he was forced to take other unnecessary types of medicines. 

Therefore, the pharmacist will have to throw these medicines that are not commonly used by people, adding their prices to the prices of the most widely consumed drugs by people. Therefore, the citizen is the one who sustains the most considerable loss and burden.

For his part, Tayseer al-Youssef, who suffers from cirrhosis of the liver, during his conversation with Enab Baladi, considered that the so-called Salvatıon Government (SG) is responsible for the high price of medicine in Idlib, denying the presence of measurements to control over the pharmacists or drug stores.

Al-Youssef believes that the SG, being the dominant power in the area, is supposed to control it, by going to pharmacies and fixing the price of medicines. He added, “At the beginning, we took to the streets, in order to reject injustice (in reference to the Syrian regime’s practices), then to be surprised by greater injustice ( in reference to the SG’s practices).

Dominant and governing bodies abdicate responsibility

Hay’at Tahrir al-Sham (HTS), the dominant military force in northwestern Syria, to which the SG is accused to be affiliated, denied via its communications director, Taqi al-Din Omar, claims of responsibility for rising drug prices in Idlib. Omar told Enab Baladi via email that the relevant authority is the SG. 

Commenting on the high prices of medications, Muhammed Assaf, deputy minister of health in the SG, answered questions raised by Enab Baladi, saying that the main reason for the high price of the medications is the fact that the opposition factions are no longer establishing control over the Mansoura region which has the drug factories. 

Although there are large quantities of the drug in stock, this drug stock is running out, and with the interruption of drug shipments through the crossings with the Syrian regime, drug prices have gone up significantly.  

Both Omar and Assaf pointed out that a recent meeting was held between “all those concerned with the health field,” “the pharmacists’’ unions of Idlib and Aleppo”, the “medical association”, the “professional association of medical laboratory”, the “ministry of health” in the SG, health directorates, and owners of private and public drug stores.

This meeting was held after the private drug stores increased the drug price by between 100 to 125 percent in addition to that,  several medicine warehouses ceased to distribute the drugs.

The SG’s ministry of health indicated that the objective of the meeting was “to find solutions to alleviate the effects of the high prices of drugs on people and determine the cost of medical examinations.”

The meeting resulted in “canceling the decision of the drug warehouses regarding the increase in the drug prices, limiting it to a maximum of 75 percent instead of 125 percent. This increase includes high freight charges across areas north of Aleppo. Furthermore, the owners of the private drug stores made promises to re-distribute the drug to pharmacies, and not monopolize it.”

Assaf added that the meeting agreed to form a “high committee for medicines security” whose task is to study all possible solutions to avoid shortages in the quantities of medicines.”

Nevertheless, al-Youssef, a patient with cirrhosis and other patients in Idlib who need to take their medicines permanently, have yet to see any improvement that reduces their suffering. At the same time, the economic and surrounding conditions do not help them hope for a much better drug reality in the short term.

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