In the Iraqi capital city of Baghdad, Sara* is struggling to care for her young child Ahmed,* who has haemophilia. Most of the time she is unable to find the medicine that she needs for him.
The failure of the city’s pharmacies to deliver has revealed to Sara the toxicity of Iraq’s post-2003 patchwork public and private healthcare system. Over the years, she says she has learned a key reason why the medicine frequently does not arrive.
Pharmacies often only contact her at very short notice to indicate the drug is available for collection immediately. If she misses the collection slot, the drug is gone. But her son’s condition cannot stick to such a schedule. This has turned Sara’s life into a struggle for good luck to be in the right place at the right time.
The kinds of medicines Ahmed needs are intended for the public but have often been sold for private profit as part of a system which has generated billions for Iraq’s elite and armed groups at the expense of her boy and many others just like him. The privatization has led to the proliferation of fake and expired medicine, which offer greater profit margins for this elite.
Even when Sara finds the medicine, she says it is often unfit for consumption. On one occasion, doctors and pharmacists switched her son’s medication from a household-name brand to a cheaper one. But there were concerns this new medicine was worsening health conditions by causing patients to develop dangerous antibodies. Sara eventually found out that the drug made by a well-known manufacturer was being sold privately but that she was given a counterfeit drug instead.
Sara’s story is one of many. Of the medicine that does make it to the public, it has been estimated only 30 per cent does what it claims adequately while the rest is likely counterfeit or expired. And more expires before they even reach the pharmacy, meaning most medicines available can at best be ineffective and, at worst, unsafe.
In a country which has struggled to stabilize after decades of wars – the most recent being the capture of one-third of Iraqi territory by Islamic State (ISIS) – it is understandable that medicines may not be seen as a priority issue. But these stories show medicine lies at the heart of Iraq’s failure to overcome conflict.
The system of corruption since 2003 has quietly killed many Iraqis. To them, violence and conflict is not just men with guns, but the networks of elite whose greed profits from the country’s wealth at the expense of providing essential services. According to a former health minister, this network makes between $5 and $7 billion annually.
Iraqi citizens’ lack of access to the drugs they need – from antibiotics to treatments for long-term life-threating conditions such as Ahmed’s – not only puts people’s lives at risk but also damages trust in the medical authorities. During the COVID-19 pandemic, this fatal consequence of the political system costs lives.
To understand why and how the health of ordinary citizens is traded for profit, it is important to trace back where the medicines come from. This is the story of how medicine imported from outside Iraq’s borders moves along a 300 mile-long road from Basra to Baghdad. The supply chain connects doctors, pharmacists, political parties, armed groups, and business people. It starts beyond Iraq’s borders and kills hundreds of people every year.