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My parents had left Somalia before the start of the civil war, and they only had good memories of the place they had called home all their lives. This changed very quickly , as the civil war completely devastated Somalia, a country with a capital that was once hailed the ‘pearl of the Indian Ocean’. I received a Bachelor’s degree in Medical pharmacology from Coventry University where I gained an appreciation for the methodical and rigorous guidelines pharmaceutical companies in the UK must adhere to, thus ensuring consumer safety. Subsequently, I then completed a master’s degree in Global Health and Development at the University College London, where I was able to use my prior knowledge of pharmacology to understand the significance that access to safe, quality medicines have on health systems. My background gave me a unique perspective on the burgeoning health issues around the world. As a first-generation child of immigrants, my Somali heritage and culture were always very close to me , thus it was important for me to write my Master’s thesis on Somalia.
I had heard countless stories from my parents and family friends about people in Somalia who had been fallen ill and used medication they purchased from unlicensed pharmacies and subsequently became worse or even died. This deeply disturbed me and inspired me to delve into Somalia’s pharmaceutical industry. My initial thesis topic was looking at how the unregulated pharmaceutical industry in Somali impacted key health indicators in the country. However, after a preliminary bibliographic search, it was apparent that there was a lack of research and data on this topic. It was very disheartening for me to see , however, it also made me understand that since there was not enough research to base a thesis on, there definitely was not enough to base well-informed health policies on. Consequently, I then revised my research question to look at health system in failed and fragile states, with Somalia following the 1991 civil war as a case study. My research yielded a lot of harsh truths about the current state of Somalia’s ailing pharmaceutical industry and of the health system as a whole.
The current private, unregulated health system has resulted in widespread imports of cheap counterfeit and substandard medicines. Local pharmacies and laboratory services in Somalia have been rapidly expanding as a cheaper alternative to seeking medical services at licenced and certified health centres and pharmacies. UNICEF conducted interviews with healthcare providers in Somalia in 2012 and reported that the majority of pharmacies did not check the quality of pharmaceutical products they had procured. Furthermore, serial numbers and batch numbers were not regularly referenced to ensure that they had received the correct shipment. If quality assurance checks were carried out, the most that would happen would be pharmacy workers confirming that brand names were spelled correctly, and the overall general impressions were ‘good’. A combination of low literacy rates, poor health literacy and low health seeking behaviour levels, made patients more susceptible to ignoring medical advice given by their healthcare workers or to not seek advice on the administration and dosage regiments entirely.
Over the counter medication that patients receive from local pharmacies cannot be regulated and controlled and therefore are not always effective or safe. The usage of these unregulated medicines can be very detrimental and, in some cases fatal. For patients, the lack of regulation allows importers and their international distributers to use Somalia as a pharmaceutical dumpsite for their expired and falsified medications. Dr Dufle, a physician who runs one of the largest private hospitals in Mogadishu said in a recent article that falsified medicines are “worse than bombs, because a bomb kills 10 or 20 people. But these drugs can kill hundreds of people and no one will hear about it”. This profound statement emphasized the magnitude of despair caused by falsified and counterfeit medications in Somalia.
Somali health officials have acknowledged that there is a wide scale problem in accessing safe medicines, however without firstly strengthening the healthcare system, it would be near impossible to provide safer alternative methods to procuring medical products. However, due to a myriad of contributing factors that stem from a poorly funded and weakened healthcare system, it is not feasible to attempt to change this without implementing regulatory policies and investing in the necessary technology and personnel.
This is why campaigns like Fight The Fakes are particularly important in low resource settings, as they are able to raise awareness on this detrimental issue that is very often overlooked. They are able to focus on advocacy and bringing in multi-sectoral stakeholders to the discussion without being anchored down by the never-ending tides of politics in healthcare. My work at Fight The Fakes has allowed me to bring my passion of Global Health and my unwavering hope of a better Somalia to fruition.
Nabina Ibrahim, Fight the Fakes Secretariat
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