The citizen, Zuhair Aish, 48, stands inside a Lebanese pharmacy asking for milk for his 11-month-old daughter.
Zuhair complains of his suffering to Al Jazeera Net, as he drains his day’s hours at the expense of his work in search of infant milk in vain, while his daughter has become suffering from health problems because she does not accept the milk that her mother prepares. Read also The price of the lira between banks and the black market.. confusion exacerbates the suffering of the Lebanese people erman companies enter Lebanon on the port’s reconstruction line… Investment incentives or political messages from Europe?Lebanon.. The collapse of the banking sector and the continued deterioration of the living situation Ramadan is not like others and speculation in the markets.. How did the absence of oversight destroy the purchasing power of the Lebanese?
He said that the stock of infant milk containers that he had previously bought in anticipation of losing them from the market has run out, and he expresses his indignation “at a country that does not care to humiliate its citizens in securing medicine, fuel and food,” as he put it.
A few meters away from him, citizen Iman Abdel-Qader asks about a copy of the nerve medicine that she needs monthly, so she does not find it, and she told Al-Jazeera Net that she wanders daily to pharmacies to search for her medicine, and she asks angrily, “Do we need to die in search of medicine?”
However, the pharmacist Nour Al-Saniour – who works in one of the largest Lebanese pharmacies – points out that they suffer from a large number of drugs discontinued, even the most obvious ones, such as painkillers, medicines for headaches, pressure, diabetes and infant milk, in addition to the interruption of some medicines for chronic and cancer diseases in their original and alternative versions (generic). ).
She told Al-Jazeera Net that they send lists of large orders to drug distributors, and they do not arrive in full, “when we order, for example, 500 packages of milk for infants, we receive only 20 packages that are sold in less than an hour.”
Medication and “central”
These stories seem to be a sample of the climax of the drug shortage crisis, after the Lebanese diaries turned into a permanent search for basic materials such as fuel and medicine.
The crisis also affected hospitals that resorted to the policy of rationing some laboratory tests and surgeries (non-emergency) due to the shortage of anesthetic drugs and most medical supplies.
The situation worsened after the Central Bank of Lebanon announced last week its inability to continue to support the health sector with the current mechanism – according to which it provides 85% of the dollar of the import bill of medicines and medical supplies according to the official exchange rate (1507 liras) – unless it affects its mandatory reserves, which it estimates. About $15 billion.
The national currency has lost more than 85% of its value at a dramatic pace since the fall of 2019, and the dollar exchange rate on the black market – which controls the actual value of the lira – recorded about 13,000 pounds recently.
In this context, Noaman Ndour, Director of Parts and Support Officer at the Banque du Liban, points out that with the financial situation reaching a dangerous stage, “it is not possible to continue with the arbitrary policy of support without prejudice to the mandatory employment of commercial banks with the Central Bank, and this is a matter that violates the law.”
Ndour told Al Jazeera Net that the Central Bank is asking the relevant authorities to find a solution and assume their responsibilities, especially after the high cost of supporting the import of medicine and medical supplies.
In the year 2020, according to Nadour, the health sector support amounted to more than $100 million out of the $5 billion total cost of central support for importing wheat, medicine, fuel and food basket, while in the first 5 months of 2021 alone, “the value of bills for medicines and medical supplies alone reached two billion.” and $310 million, and this increase is unacceptable and is linked to the issue of drug smuggling.”
After the central statement, the Lebanese authorities announced an agreement with the Governor of the Banque du Liban, Riad Salameh, to pay frozen bills worth $180 million to drug importers in dollars in return for the delivery of goods and medical supplies to pharmacies and hospitals, and this cost covers quantities that serve a maximum of two months.
Throughout the previous period, the Ministry of Health reassured the Lebanese not to lift subsidies on medicines, and the caretaker government linked lifting or rationalizing subsidies to the approval of the “financing card” project, which has not yet found a source of funding.
This confusion among those concerned with the financial and governmental authorities was manifested in the request of the Minister of Health in the caretaker government, Hamad Hassan, to lift banking secrecy on the accounts subsidized by pharmaceutical companies in order to provide transparency.
On June 1, Hassan considered that there is a missing link, because the ministerial inspection team cannot “obtain from the governorship of the Banque du Liban invoices or the “annual inventory” for the years 2020 and 2021.”
smuggling and storage
Head of the Parliamentary Health Committee, MP Assem Araji, links the collapse of the health sector to the factors of storage and smuggling.
Araji told Al Jazeera Net that “some importers, major traders and pharmacies are storing medicine in anticipation of lifting support for it or smuggling it through illegal crossings, after medicine in Lebanon became the cheapest in the region due to the collapse of the lira against the dollar.”
Here, the captain of the Syndicate of Pharmaceutical Importers, Karim Jbara, explains that in the first 4 months of 2021, the quantities sold by importers to pharmacies exceeded twice the same period in 2020, which means that the volume of imports was sufficient for Lebanese patients.
Jbara also links the aggravation of the drug crisis to the request of the Banque du Liban in May 2021 to obtain prior permissions from it for drug bills, so large quantities were accumulated in stores without the ability to dispose of them, after the debt to international pharmaceutical companies reached about 600 million dollars unpaid.
He added that importers paid the cost of shipments to commercial banks, but the Central Bank did not transfer them to companies abroad.
The annual value of importing medicine is estimated at $1120 million, and there are 12 companies manufacturing medicine in Lebanon compared to 67 companies importing it.
solutions and obstacles
The annual value of importing medicine is estimated at $1120 million, according to International Information. There are 12 companies manufacturing medicine in Lebanon compared to 67 companies importing it, including about 7 companies that import 75% of the medicine’s quantity to Lebanon.
As for the medical supplies import sector, Lebanon imports 100% of these supplies for hospitals, and 126 Lebanese companies are working on importing them.
In the latest study of the Crisis Monitor at the American University of Beirut, the confusion in the health sector is the result of previous policies that made the cost of the drug bill in Lebanon among the highest in the world, as spending on medicine in 2018 before the economic crisis was estimated at 3.4% of GDP, as well as “Expenditure on medicines constitutes the largest share of the total expenditure on health, which is estimated at 44% of the total, which is one of the highest in the world.”
This is due – according to the observatory – “to Lebanon’s dependence on importing medicine from abroad for 81% of its pharmaceutical needs, ignoring the development of local production of medicine.”
How can benefit from the local industry of medicine?
In turn, the Syndicate of Pharmaceutical Manufacturers in Lebanon, Carol Abi Karam, pointed out that there are 3 factories (out of 12 factories) that provide 100% of Lebanon’s need for vaccines, and that 9 pharmaceutical factories have a pharmaceutical portfolio that covers the most important chronic medicines and the most consumed in the Lebanese market, and their share is About 45% of the market need, and that these factories are able to cover 100% of this need.
The captain said in a statement to Al Jazeera Net that these factories import raw materials, in a banking process that is also subject to the Central Bank’s permissions.
Abi Karam explained that local factories provide 23% of the amount of drug consumption in Lebanon, and that the demand for their medicines since the beginning of 2021 has increased by 60% compared to 2019 and 2020.
It considers that there are bold decisions that must be taken to solve the drug crisis, including:
- First: Providing a generalized rationalization policy so that locally manufactured drugs can be subsidized and billed in a quick manner, and fix the imbalance between subsidizing imported drugs in full and subsidizing locally manufactured drugs only with their raw materials.
- Second: Enhancing the support of local medicine, because it saves the Central Bank about two-thirds of what it incurs on subsidizing the imported medicine, so that this savings can be used to support the imported medicines provided that there is no alternative for them in the local pharmaceutical industry.
- Third: The Lebanese state takes similarly generalized decisions in light of the refusal of some countries to import medicines from Lebanon.
Abi Karam explains that Lebanon had previously exported about $57 million in medicines, but it has fallen to about $38 million since 2019, and this year it has not exceeded $5 million.
Abi Karam attributes the decline in exports to the decline in the ability of Lebanese companies to compete in the region, and countries are encouraging their local pharmaceutical industry.
It considers that countries that want to provide “pharmacological security” for their people put their hand in the hands of the local private sector through a short, medium and long-term plan.
She says that the Lebanese pharmaceutical factories have “the ability to secure the full need for 45% of the pharmaceutical market, provided that they support and provide facilities for them.”