According to Ajmal Wesal from the Institute for War and Peace Reporting authorities have little control over chemists’ shops in Uruzgan, undermining faith in the health sector.
Khair Mohammad may not be a qualified doctor, but he offers a wide range of treatments to whoever will pay. On a blanket laid out beside a road in Afghanistan’s Uruzgan province, the self-appointed pharmacist sells cures for everything from acne and depression to liver complaints.
Many of Mohammad’s customers in the provincial capital of Tarin Kowt are poor or illiterate. They do not have prescriptions from a doctor, and Mohammad, who cannot read or write, does not ask for them.
"We bring these medicines from Kandahar to Tarin Kowt," he said. "The good thing is that no one demands money from us for selling them, or from selling them from this spot."
Mohammad’s pills enable him to make a living in a particularly isolated and impoverished province in central Afghanistan, where drugs and health professionals are often in short supply. (See Healthcare Crisis in Central Afghan District.)
But he is part of a largely unregulated pharmaceutical trade which some people fear is carries high risks. Sources in Uruzgan say anyone can sell medication, regardless of their level of medical training, or whether the drugs have expired.
Afghanistan imports medicines from countries including Iran, China, Pakistan and India. Regulation is slack, the country’s borders are notoriously porous, and some import companies are unlicensed. This creates ideal conditions for counterfeit or low-quality drugs to enter the market.
Dr Sayed Agha Miakhel, head of Uruzgan’s provincial public health department, said there was little he could do to rein in the free-wheeling pharmaceutical trade.
His officials inspect the town’s 52 formal pharmacies every six months looking for low-quality or expired medication, but when it comes to enforcement they have few options.
In 2009, Miakhel’s department closed down four pharmacies for operating without licences, but they quickly reopened thanks to support from influential local figures.
"I could not take on these four [pharmacists] because they are all backed by local commanders, lawmakers and senators," he said. "For this reason, controlling pharmacies and medical check-up centres in this city is pointless."
Alongside the pharmacies, some 20 to 30 street vendors like Mohammad sell medication around Tarin Kowt.
The lack of regulation has undermined public confidence in the health sector. Residents of Chura, Dehrawud, Charchino and Chanartu districts, as well as Tarin Kowt, say they know of people killed by low-quality or expired medicines.
They include Qasem, a 33-year-old who repairs radios at an electrical store in Tarin Kowt, who lost his baby daughter Samina in December 2011.
Cause of death
The causes of Samina’s death are unclear. The infant appeared to be feeling faint, which her relatives believe may have been caused by a coal or gas heater. After they took her to the provincial hospital she was given an injection. According to Qasem, her condition then declined rapidly.
"As soon as the doctor injected her, I noticed that she became increasingly faint hour by hour, so that her eyes were closing," he recalled.
It is unclear what the syringe contained, but Samina’s relatives claim that one doctor subsequently looked at the packaging, hit his forehead and exclaimed that the medication had expired.
Samina’s family also said that she was prescribed drugs for malaria and typhoid worth about four US dollars, but alleged that when they collected them from the pharmacy, they too had expired.
"While I was planning to take Samina to another doctor the next day, she stopped breathing and died," Qasem said.
Qasem raised his daughter’s death with the pharmacist who sold the medicines, who denied any responsibility.
At the provincial hospital, doctors denied injecting drugs that had passed their expiry date, and said Samina could have died from complications relating to malaria.
Whatever caused the child’s death, officials acknowledge that public health in Uruzgan leaves much to be desired.
In the absence of state support, much of the health work in the province is conducted by the non-governmental group Afghan Health and Development Services, Miakhel said.
"The truth is that public health ministry has forgotten Uruzgan because it is a mountainous, underdeveloped province," he said. “They have not supported it. Without money, people can do nothing."
The health and sanitation problems even appear to have reached the provincial public health department.
In a room opposite Miakhel’s office, which apparently belonged to another senior colleague, the table tops were thick with dust, while dirty plates could be seen on a table in the corner.
A visiting reporter had to cover his nose due to the overwhelmingly pungent smell that wafted from the room into the corridor.