E-DRUG: Conflict and drugs
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Dear E-druggers,
I attach below a short report that I have prepared previously about the
drugs and drug use during conflict in Afghanistan. Political instability
and conflict that affected the whole health system not only intensified
the previously existing problems but brought new and unique difficulties.
CONFLICT AND DRUGS:
Afghanistan, once having a relatively satisfactory drug supply system,
faces unique drug-related problems that begun in the early eighties with
the soviet invasion and worsened in recent years with the progress of
political instability and fighting. Although some reports on various
war-born health problems have been published, few has been written on
drugs. Despite the presence of legislation, the registration system, and
the national list of essential drugs, many drugs of different qualities are
pouring into the country because the public drug supply has collapsed,
local manufacturers have been damaged, and the number of registered
importers has decreased. The influx of drugs (ranging from good quality to
substandard or even to spurious and counterfeit) is mainly maintained by
individual merchants who import drugs according to market needs (sometimes
according to orders of individual prescribers). The quantity of imported
drugs varies from less than hundred US Dollars worth in bags to several
thousand dollars worth cartons .The great numbers of products in different
quantities not only increase the prices but it makes prices control and
regulation difficult.
Only part of the imported drugs is inspected and supposed to get permission
from the ministry of health. The damaged quality control laboratory in
Kabul has been partly restored recently, but due to its limited capacity
and the large numbers of products with different quantities, it is very
difficult to get and test samples from all the imported drugs. It should be
mentioned that not all parts of the country have been under the control of
the central governments during the past twenty years. Private sector that
provides drugs to the majority of the population seems to be the most
affected area and less attentions has been paid upon. In the public
sector, drugs are mainly supplied by scattered and decentralized donations.
It is believed that some organizations provide effective, safe and good
quality drugs at reasonable prices, others face difficulties in this domain
(1).There are few up-to-date drug information sources in national
languages. Not all prescribers, especially in the private sector, have
access to Afghan National Formulary published in 1996 which is an unbiased
drug information source in national language. WHO and UNICEF have organized
several workshops on rational drug use, but there is no regular continued
education program in this field. It is worth mentioning that most of the
activities on the essential drug program and rational drug use have been
done with the assistance of WHO and UNICEF. But the problem is too
extensive to be solved by a single organization. The magnitude of the
misery due to the silent bullets, i.e., harmful drugs and or irrational
drug use, remains unrevealed under the blasts of real bullets. These
problems that are as important as other war-born problems like landmines
and refugees; require more international attentions. May be donor
countries, relevant international organizations and drug industries find
possibilities to alleviate drug-related problems during conflicts and
political instabilities.
Reference:1 - Agency Coordinating Body for Afghan Relief. Report of working
group on harmonization & improving drug supply and use by the aid community
in Afghanistan .Peshawar, 1996.
Although the issue is very difficult to deal with but in order to generate
discussions I ask for any experiences or suggestions in improving drug
use and especially in improving the supply of quality drugs in the private
sector during continuous conflicts. The some problems may be seen more or
less in other countries that face conflicts.
Thank you
Dr. A. F. Danish , Former Associate Professor in Pharmacology, Faculty of
Medicine, Kabul, Afghanistan.
Email: afdansih@hotmail.com
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