By Harem Karem: KT Exclusive (Kurdistan Tribune)- 23.6.2013 – Latest victims of the corruption and social-injustice that pervades the Kurdistan region are the 30 unfortunate individuals who were blinded as result of being given illegally imported and expired Avastin medicine at a Hawler public hospital. Nineteen of these patients were transferred to a hospital in Munich, Germany. for treatment. The Kurdistan Tribune (KT) understands that eight of them have had one eye taken out, while one has lost both eyes and another is awaiting an operation to have his second eye removed.

This isn’t, of course, the first time: there have been recent cases, in Suli, Kelar and Hawler, where individuals – including several children – have lost their lives because of expired medicines.


Ministry confirms that officials received Hoz funding

The local giant Hoz Group, which has been accused of smuggling the expired Avastin and bypassing local quality controls, has close links with the oligarchs of the Kurdistan region. KT has obtained documents indicating that Hoz has funded the Ministry of Health’s senior officials – including the head of the malpractice investigation committee – to attend a business gathering in Dubai.

The Hoz Group is thought to have first made an attempt to sign a contract with a German business to import medicine but later abandoned the deal for an unknown reason, before it allegedly smuggled the expired Avastin into the Kurdistan region.

Questions that remain to be answered include:

Where did Hoz import this expired Avastin from?

Who produced and distributed the medicine?

How was it imported without going through quality control?

How did the medicine end up in a public hospital – even though it had not gone through quality control?

When it did, why did the professionals use it although knowing that it was expired and that, anyway, it should not be prescribed for minor sight issues?

Who were the pharmacists dealing with this medicine?

Four doctors initially gave expired-Avastin injections to ten patients. The next day, these patients returned to the hospital with major side effects. Despite this, the hospital staff and doctors went on to give expired-Avastin injections to a second group of ten patients the following week. These patients also returned the next day complaining of similar side effects … And the hospital staff and doctors went on to administer expired-Avastin injections to another group of ten patients during a third week.

Following an investigation, KT understands that some of the patients had four milligrams of Avastin, while others were given as much as 100 milligrams. Avastin was originally approved to treat cancer, not eye disease. There is speculation that the reason it was used is the low cost of this medicine, compared with forty-times-more-expensive treatments such as Lucentis, which was manufactured to treat eye disease. In some special circumstances Avastin has been used around the world on patients who have serious eye disease as result of diabetes. But KT has learned that some of the patients who were blinded in Hawler were not diabetic. They visited the hospital with only minor vision problems. In one case, the patient had issues with the left eye and the expired-Avastin was, for some unknown reason, used on the right eye.

KT spoke with opposition MP Nasrin Jamal, who said: “When the first group were blinded, the prime minister, his deputy and the health minister should have resigned. Unfortunately, the PM hasn’t even had the courage to apologise to the victims who have put their trust in him”.

Asked about the issue of compensation, Nasrin Jamal said: “The idea of compensating the victims is still not being discussed. If the PM is not willing to apologise, how he could guarantee a compensation scheme?”

She added: “The current health system in the Kurdistan region requires a complete restructuring – as the health system, along with a few other main sectors, is used to measure the success and development of a country. Ours is not fit for purpose.”

The only action taken so far by the Kurdistan Regional Government (KRG) is that a Turkish driver has been arrested for allegedly importing Avastin for Hoz, while the ‘public face’ of the company, CEO Ali Qambwr, still roams free in Hawler.

Some of the victims had no major sight issues prior to being injected with expired-Avastin and now they are completely blinded with one or both eyes removed. Most of the thirty blinded patients are living below the poverty line, KT understands. Yet many need to travel to Germany every two months in order to receive appropriate medical care. The big question is: Will the KRG support them?

KT spoke with the Health Minister Dr Rekawt Rashid but he declined to comment on the issue.KT also spoke with some of the traumatized victims to get their side of the story. Some were too distressed to talk – referring us to speak with their relatives on their behalf to recount what they have gone through. They appear to be in need of urgent professional help and a few of them have suffered psychological breakdowns.

Zubeda Mustafa Mohammed, who had an eye taken out in Germany and has since returned to Hawler, spoke briefly to KT. Her distress and anger could be easily felt from her voice, as she complained of poor health and of how, ever since her return, she has been left without care. “I’m not well”, she said. “Losing an eye has caused me a lot of pain and distress, and it has impacted on my other eye. My right eye was taken out and now my left eye with no previous issues has been affected too, requiring laser treatment and an injection every month.” She continued: “My son has taken me to see a specialist who has advised me that I need an injection every month that costs $750 which I cannot afford, although I’m frightened of injections and could never bring myself to have an injection of any sort ever again.”

Zubeda expressed her disappointment with the KRG and the Ministry of Health that she had placed her trust in. She said: “Since I have returned from Germany I have been told to wait, but I’m getting tired of waiting while enduring lots of pain.”

“I was told by the German doctors that I need an artificial eye but the Ministry has so far made no attempt to provide me with an artificial eye.”

KT understands that the ministry’s poor support for the victims and lack of progress is due to the fact that this case has been taken to court and they are awaiting a decision.

In response to a KT question, Zubeda responded: “There is no sign of compensation. We have to go back to Germany to receive further treatment every two months but we cannot afford it. Nine of us who have had one or both eyes taken out have agreed to either stage a protest outside the Ministry of Health or go on strike while we pursue them for what they did to us – the doctors, the Ministry of Health, the KRG and both production and importing companies.”

The situation of an elderly lady, Zakeya Rassul, who has had both eyes removed, is particularly grave. After being transferred to Munich, her son was too concerned to inform her, prior to her being admitted to the operation theatre, that the doctors were going to take out both of her eyes. When she later discovered what had happened, she was deeply shocked and had a psychological breakdown.

The brother of one blinded victim described his brother as being in good spirits, saying that he managed to make the German doctor who had taken out his eye laugh, by joking: “Could you do me a favour and cut off my nose, too? It blocks the view.”

Dr Goran Abdulla, a spokesperson for the ‘Eye Campaign’, set up to seek justice for the victims, told KT: “The Ministry of Health is providing nothing more than rhetoric and lip service to ease the anger and discontent of the public about this disaster. Although the Health Minister visited the victims in Germany, there is no evidence that compensation will be offered unless the victims and their families ask for this compensation specifically. The support from the Kurdish community in Germany has been encouraging.”

In response to a KT question about how well the KRG has responded and who is to blame, Dr Abdulla said: “The KRG responded very badly. Initially, they were not willing to even apologize for this catastrophic mistake. The Minister of Health apologized later under pressure.”

“I would like to use the term responsibility rather than blame”, continued Dr Abdulla. “I think the Ministry is the main body responsible for social health. Furthermore, the Ministry of Health is covering up the involvement of politicians in the drug trade and business in Kurdistan, hence we believe the focus should be on them and they need to be held accountable.”

Having previously served as a doctor in Hawler hospitals, Dr Abdulla refers to this disaster as a system failure. “At the micro level of patient-doctor relationships, you have problems with correct diagnosis and evidence-based treatment and therapy. The services provided in Kurdistan by doctors are not consistent with well-known medical and scientific guidelines. For instance, the National Institute of Health and Clinical Excellence (NICE – UK) do not recommend the use of Avastin for eye problems, nor do the Food and Drug Administration (FDA – USA)”.

“The Ministry of Health in Kurdistan does not issue similar guidelines, therefore health providers are using their judgment and experience to provide services which unfortunately are not appropriate and can lead to disaster such as blinding 30 people”.

“At the macro level you have a political economy that is capitalism on steroid. You have neo-liberal ideas dominating the political-economy. Tariffs are fixed at a minimum 5%, including for drugs. This is making Kurdistan a hub for poor quality and cheap drugs and medicines.”

Dr Abdulla concluded: “At the meso (organizational) level, the Ministry is schizophrenic when it comes to responsibilities and tasks. We are not clear whether we are talking about a centralized or a decentralized system here. The Minister of Health repeatedly blamed the Directorate of Health in Erbil for this disaster, forgetting or ignoring the fact that he is by law responsible for the entire system and the tasks and responsibilities are not well-defined.” 30 innocent Kurdish citizens have been disabled and traumatised by greed and mismanagement. They await a proper investigation and justice. Zubeda told KT: “I will never give up on my rights, and my fellow victims have also said the same.”