Lebanon's 'fake pharma' scandal forcing cancer patients to import own chemo drugs

In a small pharmacy in Beirut's southern suburbs, Maria Fawaz allegedly orchestrated one of Lebanon's most significant medical scandals—selling counterfeit cancer medications to patients through a network spanning 70 pharmacies across the country. The exposure of her case marked not a breakthrough, but the latest chapter in a decades-long crisis that has repeatedly claimed lives while perpetrators escape justice.

Described as the "mastermind behind Lebanon's latest cancer drug smuggling case," Fawaz, who has since fled to Georgia, apparently operated a pharmacy in the Madi neighbourhood within Dahie, a southern suburb of Beirut. She stands accused of smuggling medications through Rafik Hariri International Airport and defrauding businessmen in suspicious pharmaceutical deals worth over $40 million.

The network allegedly included Mohammad Hassan Khalil, a General Security officer and brother of current MP and former Finance Minister Ali Hassan Khalil, who is close to Parliament Speaker Nabih Berri. Also arrested were a captain in the Internal Security Forces and two drug dealers.

The Lebanese broadcaster Al Jadeed's recent investigative report reignited public anger over the country's endemic counterfeit drug trade, revealing how criminal networks have exploited Lebanon's economic collapse to flood markets with fake medicines.

Perfect storm

The 2019 financial crisis transformed Lebanon's drug smuggling from a chronic problem into a crisis of unprecedented scale, with counterfeit medicines now accounting for more than a third of the region's total pharmaceutical supply. The collapse of state subsidies, import restrictions, and emergence of black markets created conditions for criminal exploitation.

H.S., a woman who worked providing medications during the crisis, described how ordinary Lebanese were drawn into the trade. "During the crisis, the need arose initially to provide medications for my late mother, as drugs disappeared from the markets," she said to The New Arab. "I was forced to buy them from a trader and started securing medications for those who needed them."

The economic crisis saw chronic illness patients turning to informal suppliers who sourced cheap and unregulated drugs from Turkey, Egypt, Syria, and Europe. Counterfeit medicines can cost between 10 and 50 times more than their legitimate counterparts, though due to gouging, the costs fluctuated.

Dr Bilal Abdullah, chair of parliament's health committee, confirmed the crisis's scope. "The volume of smuggled and counterfeit drugs equals one-third of the sector's sales volume," he told TNA. He explained how criminal networks shifted focus to high-value cancer treatments sold outside official protocols, meaning many patients died without knowing their medications were fake.

Systemic dysfunction spans decades

The Fawaz case is far from unprecedented. Lebanon's counterfeit drug crisis stretches back to 1998, when a parliamentary exposé first revealed the scope of the problem. That investigation's files were mysteriously stolen from the Justice Palace, establishing a pattern of impunity that persists today.

The crisis continued through the 2000s with counterfeit medical products pulled from markets in 2004, expired and fake medications discovered in pharmacies in 2010, and counterfeit Xanax medications highlighted in 2012.

One notable case emerged in 2009 with Mona Baalbaki, head of the pharmacy department at Rafik Hariri University Hospital. Baalbaki allegedly sold expired drugs to cancer patients, remaining in her position until 2012 despite the allegations.

"This case involved manipulation and forgery of cancer medications dating back to 2010—about 15 years ago—and the judiciary has never reached a conclusion," said journalist Layal Bou Moussa. "There was collective evasion of responsibility. No travel ban was placed on a key suspect like Mona Baalbaki."

To observers, the Baalbaki case exposes the justice system's systemic dysfunction when handling such crimes. In the Baalbaki case, no trial session has been scheduled since March 12, 2020, and no judge has been appointed after Judge Ronnie Shahadeh recused himself.

Lawyer Wassef al-Haraka described a pattern of administrative challenges: "Every time any corruption file is opened, it takes importance then goes to sleep, for several reasons, including bureaucracy and the length of trials and the accountability process that did not conclude."

The 2020 indictment of Mona Baalabaki case identified violations including forgery of expired and counterfeit medications, document fraud, and money laundering crimes.

Yet none of these charges have resulted in convictions.

Targeting the most vulnerable

According to the World Health Organisation, Lebanon ranks first in the West Asia region for cancer incidence, with 240 cases per 100,000 people. This makes the counterfeit drug trade particularly concerning, targeting the country's most vulnerable patients.

The crisis has forced patients into desperate measures. Cancer patients are "importing" their own chemotherapy drugs to continue treatment, while others are rationing or substituting medicine to save money, with serious adverse health impacts.

The counterfeit drug crisis reflects broader governance challenges. As al-Haraka noted: "Different parties took over the Ministry of Health not on the basis of serving people but to strengthen themselves politically, so the ministry became a tool of clientelism."

Health Minister Rakan Nasreddine acknowledged the crisis's persistence despite improved drug availability. "The basic problem was that medication was subsidised at one stage, and unfortunately it was continuously smuggled outside the country," he explained. "Currently, when the state can no longer subsidise medications, it opens the door for drugs to enter from abroad."

Parliament's health committee has developed a roadmap, beginning with establishing a national drug agency and ending with curbing criminal networks and controlling borders. However, Dr. Joe Salloum, head of the pharmacists' union, emphasised that punishment must fit the crime: "The big heads who smuggled subsidised drugs and brought in counterfeit drugs should be arrested."

Minister of public health Rakan Nasreddine announced plans for a national drug agency, with a draft proposal sent to the State Consultative Council for legal review. The ministry aims to establish a central laboratory with international organisations and World Bank support.

However, scepticism remains given the history of reform attempts. Bou Moussa emphasised the importance of accountability: "It's important to shed light on this case again, because if accountability had been achieved in it, no one would have dared to repeat it, so we could actually build a state of law."

As Lebanon manages multiple ongoing crises, the counterfeit drug trade represents a significant threat to public health. Without fundamental reforms to governance and accountability mechanisms, the cycle of scandals, investigations, and impunity is likely to continue.

This article is published in collaboration with Egab.