War, corruption and lawlessness in principal markets of the Middle East have created a hotbed for thriving trade in counterfeit, dangerous and often lethal pharmaceuticals supplying an authoritatively estimated, catastrophic 35% of all drug sales across the region.

Some great ports of the Middle East are being used as illegal trade hubs serving the global commerce in such products worth perhaps $30bn a year, according to World Bank estimates. The trade and health authorities have been unable to arrest the trend in the absence of a global treaty.

But help is on the way. The United Nations is seeking international accord to confront the criminals. The International Criminal Police Organisation (Interpol) has intensified its collaborative raids and investigations. The scientific community has developed some reliable, quick and inexpensive techniques to identify fakes. Prototypes of robust new life-saving equipment based on new technologies are already at work in the Arab World.

The illegal trade in counterfeit and substandard drugs enriching a wide range of traders and manufacturers as well as terrorist organisations has thoroughly infiltrated most pharmaceutical markets of the Middle East, according to an authoritative new study published in Washington. The fakes look like proper pharmaceuticals, but their expensive, life-saving active ingredients are missing – replaced by cheap, ineffective and sometimes even lethal alternatives.

Such adulterated products disseminated across the Middle East, including essential heart and cancer medications and antibiotics, undermine the usefulness and reliability of all medical services there. Worldwide, the number of lives claimed by the fakes is counted in hundreds of thousands.

Syria, Lebanon and Egypt have emerged as the regional focal points of this criminal enterprise, with tentacles extending to Iraq, Iran, Turkey and beyond, concludes Roger Bate, resident scholar at the influential American Enterprise Institute, following an exhaustive, six-year investigation.

A report published by the institute – The Deadly World of Falsified and Substandard Medicines – observes that the proliferation of fake drugs has deprived the Syrian insurgents seeking to topple the regime of Bashar Assad of the means to treat their battlefield wounded.

Syria›s two-year old war civil war has so far cost more than 70,000 lives, according to UN estimates. The UN’s World Health Organisation (WHO) fears the deteriorating medical services may spawn major disease outbreaks. This was a contributing factor to a decision just announced by the United States and its European allies to provide medical, administrative and other non- lethal assistance to the insurgents.

Most of the counterfeit and frequently contaminated drugs consumed in the Middle East originate from India and China. But Assad’s ally Hizbullah, the Lebanon- based organisation implicated in major terrorist murder investigations in Europe and the Americas, has become a substantial source of fakes, according to recently released court documents. Its source of countraband on sale in the Middle East, Eastern Europe and elsewere is believed to be a hub of drug laboratories operating in the Beqaa Valley.

A strategic component of the drive to rid the world of counterfeit drugs was initiated at a recent regional conference in Dubai. It heard that some 9% of all imported pharmaceutical fakes seized in the European Union had passed through the UAE.

The UAE health ministry has since then tightened up the supervisory regime enforced at the country’s transshipment ports as well as the free-trade areas. But it is clear that no administration alone is likely to succeed in arresting this insidious international commerce until the major trading nations manage to evolve a joint strategy.

Deeply concerned by the developing global health disaster, the WHO called a conference late last year in Buenos Aires attended by senior officials from 76 countries in search of collective action. They agreed to improve the performance of the national regulatory agencies and to educate the public on how to spot contraband on the counter. But they failed to lay the groundwork for a global safety regime.

For a prerequisite of that would be international agreement on legal definitions setting the terms of enforcement. And accord is being delayed by vexing issues of generic drugs, trade name and intellectual property protection and profit returns on investment in drug development.

Scientific and industry observers believe that the principal players of the world health marketplace are getting there, albeit very slowly. So the prevailing high profit opportunities and the relatively low risk of retribution continue to encourage the criminal commerce.

Nevertheless, Interpol has just staged its biggest ever global raid on the fake drug industry in collaboration with the law enforcement agencies of 100 countries across the Middle East and elsewhere. The results are still being assessed. Operation “Pangaea V” yielded 79 arrests, the closure of 18,000 online sales outlets and the seizure of millions of doses of fake drugs.

Several eminent research and training institutions have also come together to produce widely available, quick and economic means enabling healthcare workers to clear out the fakes from the medicine chest.

One of them, recently described at a conference of the American Chemical Society in Philadelphia, comprises a strip of chemically treated paper no larger than a business card that changes colour when exposed to the active ingredient of a commonly prescribed and widely faked pain killer.

The potentially life saving test takes about 10 minutes, says Professor Toni L. O. Barstis, head of the scientific team that has developed it at Notre Dame University in Indiana. This compares to several months of waiting when suspect drugs are commonly sent to advanced laboratories abroad for chemical analyses.

Another device developed jointly by the Fribourg College of Engineering, the Geneva-Lausanne School of Pharmacy and the Geneva University Hospital in Switzerland can check out the safety and efficacy of perhaps 80% of the 200 essential drugs listed by the WHO. It deploys electrical pulses applied to chemical solutions moved through hair-thin tubes.

A test takes about 20 minutes. The price of the device has been cut from $110,000 to $11,000. The first three prototypes are earning much praise in Mali and Senegal as well as Cambodia.

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