The New Iraqi Journal of Medicine 2009 ; 5 (3): 91-93
The Iraqi Drug Dilemma
Nabil Al-Khalisi,
Junior House Officer,
Medical City Complex,
Baghdad, Iraq.
nabeelraad@yahoo.com
Talking about pharmaceuticals and
medications in general is an interesting
topic to discuss indeed but talking about
them in Iraq takes us to a whole new
level. The past, the present and the future
events are not just a coincidence, they
are a well connected chain of neglect and
ignorance. Drugs can be a bless if are
used properly and a curse if they ended
up in the wrong hands. In this article I
will discuss the Iraqi drug story which is
somehow unfortunately a sad story to be
told.
Misuse and Abuse
In a nice shiny day I went to Bab Al
Sharqi (A place lies in the center of
Baghdads economic heart where high
tech electronics and other stuff are being
offered for sale). I was amazed by a
crowd of people gathered around a
salesman who is offering a bunch of
non-related drugs on the floor. NSAIDs,
antibiotics, antihypertensive,
multivitamins, anabolic steroids, herbal
preparations, hallucinogens, weight
losing medications, and Viagra are all
being advertised in a bizarre way like
they are not just medications but instead
they are acts of magic! The salesman
was doing a 3 in 1 job in the same time,
a doctor, pharmacist and a salesman!
People were listening to his speeches
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Letter to the editor
about his miraculous drugs one by one
and they were totally taken by his
charisma. When I saw what was really
going on the first thing I said to myself
In fact I was not that surprised by the
scene because it is quite common these
days in Iraq, yet I was surprised by the
large number of crowd and the
increasing success of illegal drug
marketing in Iraq.
Misuse is a very problematic here
especially talking about certain drugs
such as antibiotics, anabolic steroids,
hallucinogens and Viagra. Antibiotic
resistant strains are emerging in an
incredible speed, no one can really tell
the real size of this problem. During my
service in public hospitals I witnessed
the multi-drug resistant strains that are
killing hundreds each day. Anabolic
steroids are given in gyms by
incompetent ignorant persons, they are
overdosed so much, the more you use
them the bigger your muscle will be, and
simply no one talks about any side effect
or precautions. Hallucinogens are used
in low socioeconomic areas especially
by teenagers, they might be seeking
stress relief or they just want to get high.
Viagra in my opinion is used due to
curiosity; sex is an overwhelming issue
in Middle Eastern societies, people here
want to try this blue pill just for a
change! Many kinds of misuse are
present but the real problem is not the
misuse itself. No one can tell what is the
scale of this thing; no one did a
campaign to educate people about what
is really going on; no media awareness
of this crisis. Legislations here do not
prohibit drug purchasing without a
prescription. Anyone can buy whatever
he likes with neither limitations nor
exceptions!
Storage and Transportation
Many drugs are sensitive to heat, light
humidityetc. In Iraq no body knows
for sure whether his medications were
stored properly. Transport is being done
by low scale contractors and none of
them seems to be specialized in drug
transportation; the next day he might be
transporting steel instead of drugs. Even
the ministry of health can not make sure
that its drugs are being stored in the right
way!
A new dimension of the problem lies in
energy sources. Fuel crisis is always a
running news subtitle; this makes air
conditioning very expensive to humans
and drugs. The national power grid in
Iraq is completely out of date. People
can not afford to keep a vial of insulin in
a refrigerator 24 hours a day; same thing
happens in hospitals, pharmacies and
major drug stores.
Quality vs. Cost
If anyone goes to a regular pharmacy;
you can easily notice that 90% of drugs
are manufactured in Indian, Jordanian,
Syria or Iran. There are no brand names
in here, not anymore. Drugs marketed
are cheap and available to the public. No
one is questioning their efficiency
because simply if you want to market a
world recognized brand name no one
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will buy it from you because no one in
Iraq is willing to pay for good stuff as
long as cheap substitutes are available. It
is simply the market push; but it is
pushing too hard as there is no one to
stop it. Quality assurance agencies are
crippled or corrupted; you can easily
bribe a high class official to get whatever
you want into Iraq.
One shocking example of bad drugs
quality that I was terrified by is that
patients undergoing general anesthesia
are being tortured in the operating room
because many of them will find himself
awake in the middle of a procedure due
to anesthetic underdose. Once I assisted
two nurses in stabilizing a female patient
undergoing mastectomy; she was awake
and the surgeon was cutting her deeply;
she begun to moan and then shout; we
all worked as a team to finish this
terrifying session as soon as possible!
New Drugs
Usage of newer therapeutic agents is
quite common these days. Iraq had been
deprived of vital access to international
drug markets since 1991 due to the
embargo. After 2003 things changed
dramatically. Newer agents are being
used in a wide scale and for a variety of
clinical cases. The only limitation
nowadays is the cost since the Iraqi
economic status has not totally recovered
yet and living standards are still low in
comparison with America or Europe.
Otherwise everything in regard to this
aspect is just fine.
Two major sectors of patients were
benefited greatly from newer agents;
cancer patients and rheumatologic
patients. Biological agents and cytotoxic
drugs can offer the main hope for a cure
in cases intractable to traditional
treatments. Despite the high prices, these
drugs are offered for free in public
hospitals but not that often. On the other
hand you can purchase them easily from
private pharmacies if you are in a
desperate need for them; you do not have
to go fetch a drug from Jordan anymore!
Major Crisis
order to coupe with this countrys health
needs. Better planning, better resource
utilization and smarter targeting is the
key. A new way of thinking must be
adopted; we should all work together to
make use of modern techniques and
technologies. Fortunately funding is
always there in Iraq; more and more oil
is being extracted each day; this should
be more than enough if used wisely.

As far as I am concerned there are two The coming generations are eager to be
major drug crises that are worth treated as humans. We all suffered bad
mentioning; one of them happened in the circumstances; all shared the same
eighties and the other happened at 2005. dreams of prosperity and safety.
I will mention the events briefly and National health should be one of our top
explain the significance of each event in list priorities right now. Iraqis endured
details. war, poverty, intellectual deprivation and
many other bad things. Now is a time
During the eighties of the past century where a change is really needed and
the ministry of health imported should be contemplated as soon as
potassium vials; they had different possible.
concentration than the old vial that Iraq
used to import for 30 years. What
happened is that hundreds of patient died
of cardiac arrest due to overdose! The
nursing staff used to handle doses in
terms of volume not in concentration
since the concentration of the vial has
been constant for the past 30 years.
Saddam Hussein executed the Minister
of heath by shooting him in the head;
blaming him for what had happened!
This crisis refers to two major aspects
that are really distressing; ignorance and
poor education. The nursing staff in Iraq
barely can understand English alphabet
and can almost never ever understand a
written sentence; most of them could not
notice the change in concentration and
were unable to calculate a proper dose.

Whats next?
To be realistic, the future neither lies in
more resources nor newer drugs; in fact
it lies in professional management.
Health administration must evolve in

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