Lebanon Cancer Patients Face ‘Humiliating’ Drug Shortages

Cancer drugs are the latest medication to become scarce in Lebanon, with even painkillers disappearing from many pharmacy shelves. (AFP)
Cancer drugs are the latest medication to become scarce in Lebanon, with even painkillers disappearing from many pharmacy shelves. (AFP)
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Lebanon Cancer Patients Face ‘Humiliating’ Drug Shortages

Cancer drugs are the latest medication to become scarce in Lebanon, with even painkillers disappearing from many pharmacy shelves. (AFP)
Cancer drugs are the latest medication to become scarce in Lebanon, with even painkillers disappearing from many pharmacy shelves. (AFP)

As if her cancer treatment was not already agonizing enough, Rita is now wracked with worry about the medication she needs as Lebanon’s crippling economic crisis sparks drug shortages.

“The treatment is like fire shooting through your body,” the 53-year-old patient told AFP, asking that her real name not be given. “But now on top of that, we have to go hunting for the drugs.”

Lebanon is in the throes of one of the world’s worst economic crises since the mid-19th century, which has sparked a flurry of shortages from medicines to fuel as foreign currency reserves run low.

The health ministry has previously provided cancer medication at very low cost to patients without health insurance, but the patients say there are now almost no drugs to be found.

The shortages are threatening the treatment of tens of thousands of people, many of whom have taken to social media in a desperate plea to source the drugs they require.

Since Rita was diagnosed with uterine cancer three years ago, the disease has also spread to her lungs.

“My brother couldn’t find the drugs from the ministry,” said the single mother of three, her face etched with worry at his home in Kfar Nabakh in the Chouf mountains.

For now, she has borrowed money to buy the medicine at a much higher price on the black market. But she says she will not be able to afford to do this for long.

“What am I supposed to do? Sit around waiting for my turn?” she asked. “If you can’t find the drugs, you die.”

‘No drugs left’
The World Health Organization says 28,764 people have been diagnosed with cancer in Lebanon over the past five years, out of a total population of six million.

But doctors say the number of patients undergoing treatment is likely to be much higher.

The head of the Lebanese Society of Hematology and Blood Transfusion, Ahmad Ibrahim, said that around 2,500 new cases of leukemia and lymphoma are recorded each year in the Mediterranean country.

“Very little medication is left for their treatment,” he said. “Yet if they don’t follow regular treatment, some will die.”

Cancer drugs are just the latest medication to become scarce, with even painkillers disappearing from pharmacy shelves in recent months.

“Some have neared the end of their treatment and are about to get better, but now suddenly there are no more drugs left,” Ibrahim added.

This summer many Lebanese expats who return home have flown in with suitcases packed to the brim with boxes of medication for their loved ones.

Some drugs are available at a higher price on the black market, but in a country where three quarters of the population live in poverty, many cannot afford them.

Last month, importers said supplies of hundreds of kinds of drugs had run out, as the central bank owed millions of dollars to their suppliers abroad.

The authorities in turn accused importers of hoarding medicines with the aim of selling them later at a higher price, and blamed smuggling abroad for part of the problem.

‘They don’t care’
Many Lebanese see the lack of medicine as merely the latest outcome of decades of mismanagement of the country by a political class they say is selfish and corrupt.

The Barbara Nassar Association for Cancer Patient Support on Thursday staged a protest to demand better access to cancer medication.

“Can you believe it? In Lebanon, cancer patients -- with all their worries -- are forced to go down into the street and protest to demand medicine,” said its president, Hani Nassar.

“How is it the patient’s fault if the state is incapable of containing the crisis?”

In the Hazmieh suburb of Beirut, Patricia Nassif, 29, said she was afraid she would not be able to finish her breast cancer treatment.

She had been married for only eight months when she discovered in April that she had breast cancer, upending her dream to start a family when all of her friends were becoming pregnant.

“I often lose hope,” she said, wearing a black wig with a purple streak to match her outfit of black T-shirt and jeans.

She has finished a round of chemotherapy, but now fears she will have to spend thousands of dollars buying medication abroad for the next stage of her treatment.

“It’s humiliating,” she said, and accused the ruling class of doing little to help.

“It’s as if they were telling us: ‘Die slowly’. They don’t care about us.”



What Has Assad’s Fall Revealed about the Captagon Drug Trade in Syria?

 A Syrian member of the opposition shows amphetamine pills known as Captagon hidden inside an electrical component at a warehouse where the drug was manufactured before the fall of Bashar al-Assad's government at a facility in Douma city, outskirts of Damascus, Syria, Friday, Dec. 13, 2024. (AP)
A Syrian member of the opposition shows amphetamine pills known as Captagon hidden inside an electrical component at a warehouse where the drug was manufactured before the fall of Bashar al-Assad's government at a facility in Douma city, outskirts of Damascus, Syria, Friday, Dec. 13, 2024. (AP)
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What Has Assad’s Fall Revealed about the Captagon Drug Trade in Syria?

 A Syrian member of the opposition shows amphetamine pills known as Captagon hidden inside an electrical component at a warehouse where the drug was manufactured before the fall of Bashar al-Assad's government at a facility in Douma city, outskirts of Damascus, Syria, Friday, Dec. 13, 2024. (AP)
A Syrian member of the opposition shows amphetamine pills known as Captagon hidden inside an electrical component at a warehouse where the drug was manufactured before the fall of Bashar al-Assad's government at a facility in Douma city, outskirts of Damascus, Syria, Friday, Dec. 13, 2024. (AP)

Since the fall of former Syrian President Bashar al-Assad, industrial-scale manufacturing facilities of Captagon have been uncovered around the country, which experts say helped flourish a $10 billion annual global trade in the highly addictive drug.

Among the locations used for manufacturing the drug were the Mazzeh air base in Damascus, a car-trading company in Latakia and a former potato chips factory on the outskirts of Damascus.

The factory that once produced the crunchy snack in the suburb of Douma under the name, Captain Corn, was seized by government forces in 2018.

"Assad’s collaborators controlled this place. After the regime fell... I came here and found it on fire," Firas al-Toot, the original owner of the factory, told The Associated Press. "They came at night and lit the drugs on fire but couldn’t burn everything."

"From here, Captagon pills emerged to kill our people," said Abu Zihab, an activist with Hayat Tahrir al-Sham, the main group now ruling the country, as his group gave access to journalists to the site.

Syria's nearly 14-year-old civil war fragmented the country, crumbled the economy and created fertile ground for the production of the drug. Militias, warlords and the Assad government transformed Captagon from a small-scale operation run by small criminal groups into a billion-dollar industrial revenue stream.

The recent ousting of Assad has disrupted these networks and has given a closer look at its operations — revealing the workings of a war economy that sustained Assad’s power over Syria. Experts say the change in Syria might create an opportunity to dismantle the Captagon industry.

How did Syria build its Captagon empire?

Captagon was first developed in Germany in the 1960s as a prescription stimulant for conditions like narcolepsy. It was later outlawed due to heart issues and its addictive properties.

Its amphetamine-like effects made it popular in the Middle East among both elites and fighters, as it enhanced focus and reduced fatigue.

Assad's government recognized an opportunity in the cheaply manufactured drug amid Syria’s economic turmoil and the heavy sanctions imposed on it.

Captagon is produced through a simple chemical process that involves mixing amphetamine derivatives with excipients to form tablets, typically in makeshift labs.

The Captagon trade began industrializing around 2018-2019 as the Assad regime — and other armed groups in Syria -- invested in production facilities, warehouses and trafficking networks. This allowed Syria to emerge as the largest producer of Captagon globally, with some production also occurring in Lebanon.

Most seized consignments of Captagon originated from Syria, according to data by the New Lines Captagon Trade Project, an initiative of the New Lines Institute think tank.

Evidence of the Assad regime’s sponsorship of the Captagon industry is overwhelming, the report published in May said. The Security Office of the 4th Armored Division of the Syrian Arab Army, headed by Bashar al-Assad’s brother Maher oversaw operations and created a coordinated production system, the report added.

Where and how was Captagon smuggled?

Captagon was smuggled across the border using various methods, hiding Captagon in trucks, cargo shipments and goods. Some shipments are concealed in food, electronics and construction materials to evade detection.

The primary smuggling routes were Syria’s porous borders with Lebanon, Jordan and Iraq, from which the drug is distributed throughout the region. Some were also shipped from Latakia port.

In Lebanon, the Captagon trade has flourished, particularly near the Syrian border and in the Bekaa Valley. Lebanese authorities struggled to curb the flow of Captagon from Syria, which analysts say was facilitated by the Hezbollah group, a key Assad ally.

Following the discovery of crates of fruit meticulously packed with bundles of the drug hidden among pomegranates and oranges, Saudi Arabia and the UAE implemented bans on Lebanese agricultural products.

Captagon has also found its way into international markets, reaching as far as Southeast Asia and parts of Europe.

How much revenue did it produce for the Assad regime?

The annual global trade in Captagon has an estimated value of $10 billion, with the ousted Assad family's annual profit reaching around $2.4 billion, according to Caroline Rose, director of the New York-based New Lines Institute Captagon Trade Project.

"Seeing the uncovering of so many industrial-scale facilities affiliated with the regime was shocking but not surprising. There was extensive evidence linking key regime-aligned cronies and Assad family members to the trade," said Rose, whose organization tracks all publicly recorded Captagon seizures and lab raids. The discovery of the facilities, she said, confirmed "the concrete relationship between Captagon and the former regime."

The exact number of factories in Syria remains unclear, but experts and HTS members estimate that there are likely hundreds spread throughout the country.

The future of Captagon in post-Assad Syria

Assad has turned Syria into "the largest Captagon factory in the world," HTS leader Ahmad al-Sharaa stated in a victory speech at Damascus’s Umayyad Mosque on Dec. 8. "Today, Syria is being cleansed, thanks to the grace of Almighty God."

While Assad and his circle may have been the primary beneficiaries, there is also evidence that Syrian opposition groups were involved in drug smuggling, opposition groups, local militias and organized crime networks manufactured and smuggled the drug to finance their operations, analysts say.

"Likely, we will see a short-term supply reduction in the trade, with a decline in the size and frequency of seizures as industrial-scale production is largely halted. However, criminal actors are innovative, likely seeking out new locations to engage in production and smuggling, particularly as demand levels remain stable," Rose said.

They may also "seek out alternative illicit trades to engage in instead," she said.

In addition to dismantling the Captagon trade, the country's transitional government should "establish programs for economic development that will incentivize Syrians to participate in the country’s formal, licit economic sphere," Rose said.