The high price of Yemen’s low-cost drugs

Fatima al-Nuwayra finds even getting the right cough and fever medicine for her children can be problematic. “I buy the medicine two or three times, and sometimes I buy two different types,” she says. “I do this until I can see some sort of result.”

The medicines that get imported legally into Yemen are often for less serious

illnesses. Medication for less common, more dangerous – and, crucially, less profitable – illnesses are harder to find. This is where the black market steps in.

Smuggling rings feel they are unlikely to be stopped any time soon, said Dr Hassaan Ghalib, the deputy head of the anti-smuggling unit at the Customs Authority. He says that 131 types of medication are smuggled into Yemen, mostly counterfeit. Runners bring in goods via land and sea. Once inside, medication is stored in villages near the border and then distributed through the rest of the country.  

Cache and carry

Where are these smugglers, and how are they able to defy the law in such a blatant way?

In al-Khashm, a town close to the Saudi border, just south of the Yemeni border town of Haradh, locals confirm that smugglers use their town to store smuggled medicines. The locals do not like it, but there’s not much they can do.

Just outside al-Khashm, the evidence of the pharmaceutical smuggling industry is there for all to see. There’s the three large refrigerated trucks, used to transfer medication and food, and the storage facilities, set far from the main road, guarded by armed men in civilian clothing.

Ostensibly, these facilities are simply places to store foodstuffs. Ali Saadan, however, who lives nearby, said the storage facilities are actually used by traders to store medicine smuggled in across the border from Saudi Arabia.

“Us locals know that they trade food, and at the same time, smuggle medication in,” he said. “The state institutions know this, and yet they do not arrest them.”

Drug danger

The consequences for the average Yemeni could be dramatic.

Most vulnerable, according to Dr Asbeel al-Maqdishi, the executive director of the Kazan Medical Centre, are those suffering from chronic diseases, such as cancer. Taking medication that does not contain the correct proportions of the active drug renders it less likely to be effective. The patient’s condition can worsen and can even cause death.

“The danger of smuggled and counterfeit drugs is that the substances within them can become poisonous and dangerous to humans, as they lose their effectiveness after being exposed to bad storage conditions,” said Maqdishi.

One example of this is the counterfeit version of Anti-D that is sold in Yemen. Anti-D is given to pregnant women with a rhesus negative blood type who carry a child with a rhesus positive blood type. The drug prevents the mother from producing antibodies that could attack the “foreign” blood cells of the foetus. The original Anti-D costs approximately $55 for a one-off injection, while the counterfeit version sells for $35. The problem? The counterfeit Anti-D is essentially just water, and does not help at all, said Maqdishi.

Maqdishi also said that printing presses in the capital, Sanaa, are illegally churning out labels for the counterfeit medication.

Mission to modify medication

Al-Araby al-Jadeed posed as a trader who had imported drugs from China and India, whose business associates had recommended changing the labels so that it would look like the medication was made in Germany or Switzerland.

Many press owners had rejected the work. Some even threatened to take our “trader” to the police. But after three days of contacting dozens of printing presses dotted throughout Souk Hajar, Sanaa’s biggest market, one trader eventually agreed to print the fake labels.

Located on a side street, the place was nondescript, sandwiched between a travel agent and a qat merchant. There was no sign on the entrance, and a passer-by would not have any idea that there were a printing press inside.

The owner is not in. The employee working the press on his behalf is wary, and initially denies that they print labels for counterfeit or smuggled products. However, after he is offered a cut of the profits, he opens up a bit more. Eventually, he says they can do it.

Dr Abd-al-Kareem al-Tarimi, who runs a medical centre in the capital, argued that the spread of counterfeit medication was a result of a lack of legislation – and punishment for those behind the illicit operations. The high poverty levels in Yemen also mean that counterfeit or smuggled drugs are often the only option for patients in desperate poverty.

“I am not surprised that printers in Sanaa are faking labels for counterfeit medication,” said Tarimi. “This is normal when there is an absence of laws or effective institutions.”

This is an edited translation from our Arabic edition