Intended for healthcare professionals


Donations of useless medicines to Kosovo contributes to chaos

BMJ 1999; 319 doi: (Published 03 July 1999) Cite this as: BMJ 1999;319:11
  1. Philippa Saunders
  1. London

    Reports are emerging from the World Health Organisation (WHO) and Pharmaciens Sans Frontiàres that quantities of unrequested and unusable medical drugs, sent by governments and others in response to the Kosovo crisis, are contributing to the postwar chaos.

    Despite the WHO's best efforts to control drug supplies, a pattern of inappropriate donations, familiar in many other crises, has again emerged. Additional resources will have to be found to sort and dispose of what amounts to a stockpile of chemical waste.

    It seems that in every humanitarian disaster drug donations take on a life of their own; a cyclical pattern emerges which is resistant to disciplined procedures and defies common sense. As soon as any disaster reaches our television screens, drugs that fail to meet the most urgent, or any, real health needs are dispatched. They arrive in small and large boxes, often without any indication of the contents; some are even half used. They may lack labelling, or be labelled in a language that cannot be read in the region. Some are out of date or nearing their expiry date.

    Why does this happen repeatedly in every emergency? The WHO reports that a similar picture was true after Hurricane Mitch. The answer may be that one of the first and most understandable responses to scenes of human misery is to send medical aid. The desire to respond quickly overrides good practice.

    Governments come under political and media pressure to be seen to be acting—half of the unusable drugs in the Kosovo crisis were sent by governments. In the postwar situation aid agencies, small charities, and church groups continue the flow of medicines in an effort to help reconstruct health services, and so the pattern is perpetuated. The tax rebates that some governments make available to companies for charitable “gifts in kind” may in some cases encourage poor quality donations.

    The WHO Interagency Guidelines for Drug Donations, developed three years ago, are beginning to have some impact on this longer term aid.

    Philippa Saunders is manager of the Essential Drugs Project, an organisation which supports rational use of drugs in developing countries (email: edp{at}

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    Drugs for crisis areas often arrive after their expiry date


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