Idlib – Anas al-Khouli

With a voice choked by sobs of pain, Samir talked about his inability to buy the necessary medicine for his three children after being surprised that the required medical prescription amounted to more than two full days of his wages, especially after a price hike that affected drug prices in Idlib.

Samir al-Mousa, 41, a displaced person residing in Idlib, said that his children had caught a cold, which escalated into severe throat inflammation, coughing, and difficulty breathing. After taking the children to the hospital and having them checked, the doctor prescribed some medications and informed him that the condition was not serious.

However, when the father went to buy the medicine for his children, he was surprised by the increased price and was unable to purchase the full prescription; he asked the pharmacist to give him only the necessary drugs, like the anti-inflammatory.

He added that he had no choice but to search for alternatives for the medicines he could not afford, such as boiling eucalyptus leaves and forcing the children to inhale its steam and relying on cool towels to reduce fever.

The cost of the medical prescription amounted to 240 Turkish lira, while al-Mousa’s daily wage as a construction worker does not exceed 100 Turkish lira and is insufficient to cover home expenses under normal conditions without illnesses.

Recently, drug prices in Idlib have seen a significant increase, ranging between 30 and 50%, which has burdened patients, forcing them to borrow money or resort to less costly alternatives.

Pharmacists explained to Enab Baladi that the price hikes in regime-controlled areas do not affect drug prices in Idlib since they purchase drugs from those areas in US dollars. The increase was attributed to the Syrian Salvation Government (SSG) taking the opportunity to raise the price of imports, aiming to support the locally manufactured pharmaceutical products in Idlib.

Salvation Govt: 400 licensed varieties

Pharmacies abound in Idlib areas, and they are monitored and organized by the Ministry of Health in the Salvation Government and the Pharmacists’ Syndicate. Widespread medications are either locally manufactured from drug factories in the region or sourced from factories in regime-controlled areas.

Medicines enter northern Syria via illegal (smuggling) routes through crossings that connect the two regions, especially from the city of Manbij towards northern rural Aleppo, as learned by Enab Baladi from some pharmacists.

Director of the Drug Control Department at the Ministry of Health in the Salvation Government, Dr. Qasem al-Waho, explained that the Ministry of Health in the regime government increased drug prices in its areas by a percentage ranging between 70 and 100%, leading to a surge in prices in northern Syria.

Al-Waho told Enab Baladi that the Salvation Government’s Ministry of Health conducted a study of the recent increase before issuing the new prices, arriving at several decisions aimed at mitigating the impact of the rise on citizens.

He added that the ministry had decided not to raise prices for drugs with locally manufactured alternatives, numbering approximately 2000 varieties, and to increase prices for drugs needed in the region by varying percentages, depending on the pharmaceutical forms and price ranges, so as to reduce the percentage of the price increase on the citizens.

Regarding the percentage of price increases in Idlib, al-Waho noted that liquids increased by a rate ranging from 5 to 50% depending on the price of the syrup package, while drops, ampoules, and sprays increased by 25%.

Suppository prices rose by 35%, while tablets and capsules priced under 1.5 US dollars increased from 7 to 20%, and those above 1.5 dollars remained unchanged, according to al-Waho.

For ointments and creams, prices rose by 40%, but most of them were not imported due to the existence of a factory specialized in manufacturing them in the northern region, al-Waho said.

According to the Director of Drug Control, the number of licensed varieties at the Ministry of Health has reached nearly 400 varieties, which can replace almost 2000 varieties coming from regime-controlled areas, hence excluding 2000 varieties from the price increase due to the presence of cheaper and higher-quality local alternatives.

Al-Waho considered the locally produced medicines (in Idlib) to be of higher quality than those imported from regime-controlled areas due to the full supervision of the factories’ establishment and licensing of preparations by the ministry.

He also pointed out that the preparation undergoes two stages of analysis in the manufacturing factory’s lab, followed by two stages of analysis by the Ministry of Health before being released to the pharmaceutical market, and a drug vigilance program is applied after it’s available for use and circulation. The possibility of revising the factory’s practices and coordinating with it in case of any defect exists.

During his talk with Enab Baladi, the director referred to deliberate attempts by merchants or individuals from regime-controlled areas to send some pharmaceuticals not suitable for use to the north, prompting the Ministry of Health in the Salvation Government to issue decisions to stop the circulation of certain medicines.

The Ministry of Health granted significant attention to the pharmaceutical sector to increase the number of factories and licensed varieties in 2023. The licensed factories contain all general production lines, and some have received licenses for special sections such as penicillins and cephalosporins, aiming to achieve self-sufficiency in medicine in the future, according to al-Waho.

Pharmacists fear violating the ministry’s decision

Enab Baladi met with several pharmacists in the city of Idlib, who in turn doubted the impact of prices in the north being affected by prices in regime-controlled areas, considering that they purchase drugs in dollars and their value has been stable for months.

The pharmacist “Abu Abdo” (who refused to disclose his real name to avoid inquiry), said that the drugs that experienced a price increase were only those manufactured in regime-controlled areas with local alternatives.

He explained that the price increases of drugs in regime-controlled areas were due to the deterioration of the Syrian pound against the dollar, noting that pharmacies in Idlib originally bought the drugs (from regime-controlled areas) in dollars, meaning that the price hikes in regime-controlled areas did not actually affect the prices in the north.

Pharmacist “Mohammed” (a pseudonym, who refused to disclose his real name) considered that the increase in drug prices aims to boost sales of locally manufactured drugs, noting that drugs without local alternatives such as inflammation injections did not have their prices increased.

He clarified that the quality is comparable between drugs manufactured in Idlib and those imported from regime-controlled areas with the same pharmaceutical composition.

The pharmacist added that raising the price of some drugs has a significant negative impact on pharmacies, especially those containing drugs imported from regime-controlled areas, as they are unable to sell them at the previous price and fear selling them at a lower price so as not to be penalized for not adhering to the ministry’s decided prices.

On December 6, 2023, the Minister of Health in the Salvation Government held a meeting with the General Director of Drug Control and with the owners of drug warehouses in Idlib to discuss the control mechanism for imported drugs, support for the local product, and regulation of the import process, without disclosing the outcomes.

A struggling sector

The medical sector in Idlib suffers from a lack of equipment, insufficient staff, and weak funding. Medical facilities are frequently targeted by Syrian regime forces and their allies.

Patients in Idlib resort to “charitable” pharmacies to get free medications, most of which are expired, as they cannot afford to buy medicine. Enab Baladi documented the intense overcrowding in some of the pharmacies that offer free drugs (which are few in Idlib).