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Behind perfectly sealed boxes, shiny labels and compliant logos, sometimes lies emptiness. Or worse: danger. In Lebanon, as elsewhere, counterfeit medicines proliferate, fueled by crisis, corruption and laxity – with potentially deadly consequences. This is Beirut dons its white coat to try to make sense of it all.
It heals; it soothes; it saves. Or at least, that’s what we think. Because not all medicines sold in Lebanon are what they claim to be. Many products escape control: copies without active ingredients, or made from toxic substances disguised in a reassuring appearance.
A Medicine Almost Like Any Other
The World Health Organization’s definition is unequivocal: a counterfeit medicine is “deliberately and fraudulently mislabeled with respect to its identity or source.” It may contain the right molecule, or none at all. In insufficient quantity, or in overdose. It may be totally ineffective, or downright dangerous.
Lebanon, Vulnerable by Default
For years, Lebanon has been identified as a country particularly exposed to this phenomenon. As early as 2007, a report estimated that nearly 10% of circulating medicines were falsified, ten times the European average. The legislative framework, well established in theory, is weakened by patchy implementation and a lack of coordination. While efforts have been made recently – notably reinforced controls at the port, the airport and on certain border roads – a Health Ministry official tells This is Beirut: “Monitoring is improving, but we’re not out of the woods. The networks are well organized, and they still too often escape surveillance.” Free zones, informal deliveries, online sales, lack of traceability… So many breaches that feed an underground market as opaque as it is lucrative.
Pharmacies Trapped or Complicit?
Behind the scenes, some pharmacists fight to preserve the ethics of their profession. Others turn a blind eye – or open them for the wrong reasons. A pharmacist owning a large dispensary in Beirut testifies: “During stockouts of certain highly sought-after drugs, WhatsApp groups are flooded with messages: ‘Two boxes left,’ ‘I received a special delivery...’ Worse: one day, a man walked in with his trunk full of a trendy antidiabetic, also used for weight loss. That product was nonexistent on the market. And yet, no cold chain, no invoice. Nothing.” Another emblematic case illustrates the extent of the problem: Mounjaro, an antidiabetic drug also sought for its slimming effects, was available on the Lebanese market more than seven months before the authorized importer received distribution approval. In other words, thousands of patients accessed a counterfeit or at least uncontrolled product, with no medical supervision or traceability. Another recent drift: the resale of empty inhaler boxes, bought cheaply to be manually refilled, then resold as new. At this stage, this is no longer just fraud – it’s endangering lives.
A Global Industry, a Local Scourge
Falsified medicines come from everywhere: India, Turkey, Egypt and of course, lawless zones near Lebanese borders. A factory located between Syria and Turkey is frequently cited in unofficial reports. Products would be manufactured, packaged, labeled there with copied holograms, then sent throughout the region. The circuits are well-oiled. The margins are huge. And the likelihood of sanctions, nearly nonexistent.
Leaving Lives to Chance
What makes these medicines so formidable is not only their dubious effectiveness. It’s their invisibility. A tablet that appears normal to the naked eye may contain none of what it promises. And in health matters, illusion can kill. In 2022, analyses revealed that some “antibiotics” sold in Beirut contained… flour. Others, lethal doses of fentanyl. The risks are multiple, often underestimated by consumers:
– Therapeutic inefficacy: the patient believes they’re being treated, but their condition silently worsens.
– Worsening of chronic conditions due to lack of real treatment. – Antimicrobial resistance, especially when antibiotics are underdosed or ineffective.
– Direct toxicity: industrial solvents, heavy metals, carcinogenic or neurotoxic substances are sometimes used as fillers.
– Death, pure and simple: several documented cases worldwide have revealed deaths linked to fake vaccines, fake anticancer drugs or fake insulin.
Dr. X, an oncologist, shares a horrible finding: “I’ve had patients whose condition worsened because of fake anticancer drugs. We only discover it at the terminal stage.”
Ethics, the Last Bastion
For A.K., a retired pharmacist, the observation is clear: it is urgent to put the human being back at the center. “The Order of Pharmacists, importers and the Ministry must act together. There must be surprise raids. Offenders must be punished, and young pharmacists should be trained to be vigilant.” She also warns about prices: “Pharmacists have an official margin of around 22.5%. If the price is below that, you should ask questions.” Patients also have a role: check the hologram, ask for the receipt, be wary of good deals.
Legal Framework vs. Reality
Lebanon has clear legal texts, notably Law 367 on the practice of pharmacy, which dictates fines and prison sentences for fraudsters. But the arsenal is rarely applied. Counterfeiting cases lie dormant in ordinary justice drawers, with no specialized jurisdiction. The Brand Protection Group’s report advocates for the creation of an independent regulatory authority, like the American FDA or the French ANSM. Meanwhile, the pharmacist’s vigilance, the last link in the chain, serves as a bulwark.
Concrete Leads, Beyond Good Intentions
Beyond speeches about “political will,” some health professionals call for simple, concrete measures that can be applied in the short term. For M.H., a pharmacologist and public health consultant, “It’s time to come out of resignation.” He advocates for a national awareness campaign for the general public, via media, social networks and dispensaries: “We must talk to patients, not just pharmacists. We still see too many people buying medicines from car trunks or on Instagram, without asking questions.” Another idea: the implementation of a QR code on each box, verifiable via a mobile app. A solution already in place in some countries, which would allow basic traceability without overhauling the entire system. Finally, an anonymous alert line could be set up to report suspicious products or dubious practices, both by pharmacists and citizens. “A simple WhatsApp number, managed by the Order of Pharmacists or a neutral NGO, would already make a huge difference,” he concludes.
And Now What?
Counterfeiting does not only affect so-called “luxury” or expensive medicines. It targets everything: vaccines, anticancer drugs, common painkillers, hormonal treatments, inhaled sprays. No product is safe. Today, Lebanese people die twice: from their illness… and from their remedy. Between the authorities’ inaction and the lure of profit, the health threat is very real. A threat that cannot be seen, cannot be smelled, but that sneaks into the patient’s hand. And sometimes, into their last breath.
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