HERAT, Afghanistan -- The smuggling of expired, shoddy and counterfeit Iranian medicines into Herat province has increased in recent months, degrading health services across Afghanistan.
More than half of the medicines found in Herat markets are either expired or of low quality and have been illegally brought in by smugglers, according to the pharmacists' union for Afghanistan's western region.
"A huge stock of the Iranian-made, low-quality medicines enters the country through illegal routes, and the other through border customs offices after [smugglers] pay bribes," said Abdul Karim Shirzad, the leader of the union.
"Smugglers are very actively importing dozens of types of low-quality medicine into the market on a daily basis," he said, adding that the medicines "enter the market without going through any quality assurance inspection".
"Deficient medicines are imported through difficult terrain and are kept for months in deserts and on mountains at hot and cold temperatures while [the smugglers] ignore health guidelines," he added.
The majority of the low-quality and expired medicines in Afghanistan are imported from Iran, while others are brought from Pakistan, Shirzad said.
"The expired and low-quality medicines imported from Iran are not used in that country but rather are produced under complex and unfamiliar names and exported to Afghanistan," he added.
Degrading Afghanistan's pharmaceutical industry
Dozens of pharmaceutical companies operate legally in Herat, importing quality-controlled and lab-tested medicines from various countries and producing about 120 varieties of medication and various medical equipment.
Registered companies that have invested millions of dollars are facing stagnation due to the volume of medicines being smuggled from neighbouring countries, Mohammad Wais Sahak, CEO of Herat-Wardak Pharma, a pharmaceutical company in Herat city, said.
Most of the Iranian-made medicines are mislabelled as other goods and imported through customs, he said.
"Some customs employees are indeed co-operating and might be complicit with the smugglers," Sahak said, adding that corruption is a major concern in the customs sector.
"We pay customs duties on every imported item. However, the smugglers import poor-quality medicines without paying a penny of customs duties," he said. "The continuation of such a situation will jeopardise the operations of the pharmaceutical importing companies and put their investment at higher risk."
The import of counterfeit and low-quality medicines has negatively impacted business, Ahmad Farid Raufi, deputy director of the Sina Pharma pharmaceutical factory in Herat Industrial City, said.
"We produce 110 types of medicine, but similar [lower-quality] medicines enter the market every day," he said. "This has raised questions about the reliability of our products."
"Low-quality medicines are available at very cheap prices. Our high-quality medicines cannot compete with them on price," Raufi said, adding that the situation has undermined his company's operations.
Abdul Basir Waezi, director of the Hari Pharma pharmaceutical factory in Herat Industrial City, said his factory was forced to decrease production because of the unfair competition from inferior drugs.
As a result, he had to dismiss about 40% of his employees.
"We produce medications of high quality; however, the distribution of inferior medications has affected the sale of our products in the market," he said. "[Customers] prefer to buy cheap medicines because of economic problems."
"While we can produce 46 types of medicine per day, we limit our production to very few varieties because of the existence of second-rate imported drugs coupled with the ... lack of a market," he said.
Deficient and counterfeit medicines from Iran also endanger patients' health, say doctors.
"Unfortunately, there are many low-quality medicines in Herat's pharmacies and doctors inevitably prescribe them for patients every day," said Mohammad Daud Yarmand, an internal medicine specialist in Herat city.
Low-quality or expired medications are dangerous and could lead to patients' death, Yarmand warned.
Those unsuitable medicines "do not treat but rather harm patients' overall health condition and ... could potentially cause other illnesses", he said.
Abdul Aziz Niazi, 54, a resident of Herat city, said he took his heatstroke-stricken son to the doctor four times but that his condition has not improved despite the medicine prescribed.
"My son has been sick for the past three weeks, and the doctor's treatment did not help at all. The doctor prescribed dozens of medications, but no matter how much he took, it was useless," he said.
"If this medicine was genuine and of high quality, why can it not cure a very simple illness?" he said, adding that he plans to take his son to Pakistan soon for treatment.