Yasir Ali is a 35-year-old daily wage laborer from Pakistan who makes less than $4 (€3.7) a day. His brother suffers from epilepsy, and requires daily medication.

Talking to DW, Yasir said that the official price for a pack of epilepsy tablets is 300 Pakistani rupees (just over $1) but he is forced to pay five times as much on the black market due to an ongoing drug shortage.

And he is not the only one overpaying for medication. Khalid Anjum, who has been trading pharmaceuticals wholesale for the last two decades, confirms that the goods now cost several times more than just a year ago.

He describes the prices as "totally unpredictable."

"Now, the shortage and disappearance of drugs is a new challenge for us," Khalid added.   

'Drug mafia' makes money of shortages

One of the reasons for the crunch is the ongoing inflation. Pakistan is forced to import the majority of medications or at least their active ingredients from abroad, and with the value of rupee falling, its becoming harder for Pakistani companies to buy them from foreign producers.

"Now we have a situation where several important medicines are becoming scarce or unavailable in the Pakistani market," Doctor Faisal Sultan, who once served as an assistant to ousted Prime Minister Imran Khan, told DW.

Others also point out to what Pakistanis call "drug mafia" — unconscionable traders who stockpile medicine so they can sell them at a massive profit during shortages.

During 2023, drug regulatory officials raided multiple locations to discover medication storage rooms in various parts of Pakistan.

Hospitals out of 'lifesaving' drugs

But the latest blow to patients trying to obtain medicine came in April this year, when the Pakistani government approved a 14% price increase for essential medication, and a 20% hike for non-essential drugs. The decision, which came into force in September, directly affected over 80,000 drugs.

The move was aimed to ensure continuous availability of drugs and raw materials for manufacturers in Pakistan.

Approving drug price hikes is not unusual in and of itself — during the past five years, the Pakistani government has given 15 such approvals. But such a steep increase, combined with import troubles and the stockpiling of medicine, seems to have backfired.

The latest decision has caused the shortage and disappearance of over 200 medicines including lifesaving and essential drugs, and seriously rattled the general public. 

Lawyer and activist Noor Mehr, who is also member of the Drugs Lawyer Forum (DLF), says even hospitals are affected.

"Around 100 lifesaving drugs are... not even available in hospitals for patients," he said.

Peshawar's black market going strong

According to the Pakistan's Pharmacist Association, the country of over 240 million people has some 4,000 licensed pharmacies. At the same time, there is as many as "100,000 other illegal merchants are also selling medications," the association says.

Pharmaceutical trader Khalid Anjum says that in Peshawar, the capital of the country's Khyber Pakhtunkhwa province, black market traders can provide their customers with any pharmaceutical product.

"The ordered drugs or medicine could be delivered at your doorstep within a one-week time period, and these are the medicines that are especially circulating at local medical stores and pharmacies in small towns without any restrictions of prescriptions," Khalid told DW.

Pakistan's small pharma industry 'is no more'

While the black market is booming, Pakistan's domestic pharmaceutical industry is struggling.

Before the latest crisis, Pakistan has had at least 600 registered manufacturing units in various parts of the country. However, domestic manufacturers are still heavily dependent on foreign suppliers. Pakistan imports 90% of raw material for the drugs production from different countries including Germany, China and India.

Obaid Ali has served as a federal regulator for more than two decades in Pakistan and is currently engaged with Center for Quality Sciences. Talking with DW, Obaid confirms that "the government of Pakistan is producing not even a single standard medicine domestically."

The medicines produced by local and international companies are no match for international pharmaceutical standards and could not be exported to the outside world, he said.

Moreover, the current economic crisis has also put the survival of these manufacturing units at risk.

Around 200 small manufacturing plants have been completely shut down due to the ongoing inflation and the financial crunch across Pakistan, Mansoor Qazi, the former Chairman of the Pakistan Pharmaceutical Manufacturing Association, told DW.

"The small pharma industry is no more in Pakistan," Qazi concluded.

Edited by: Darko Janjevic