When a pharmacist in Iraq told Umm Mohammed her prescription for a skin ailment would cost about $611, she turned to cheaper natural remedies as some of her relatives had done.
In a herbal remedy shop, the 34-year-old mother-of-two found a treatment eight times cheaper. "Pharmacies are a disaster at the moment, poor people turn to medicinal herbs because of the prices," she said. "Who can afford this? Should one die? So you turn to medicinal herbs."
Ibrahim al-Jabouri, the shop's owner and a professor of pharmacology, told Reuters that he is receiving customers suffering from various health issues, such as skin diseases, bowel troubles, colon infections or hair loss.
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While some Iraqis choose alternative treatments out of conviction, others have no other choice as they can't afford the cost of conventional medicines.
"The economic situation the country is passing through means that the cost of medicine is hard to bear especially for those with a limited income," said Dr. Haider Sabah, who heads Iraq's national centre for herbal medicine, a regulatory state body affiliated to the Ministry of Health.
Iraq's healthcare system, once one of the best in the Middle East, has been wrecked by conflict, international sanctions, the U.S.-led invasion of Iraq in 2003 and rampant corruption.
Although public medical services are free of charge, a lack of medicines, equipment and adequate services mean citizens often need to turn to the more expensive private sector.
In recent years, Sabah has seen more herbal centres open in the capital, Baghdad. There are now 460 establishments with a permit to sell herbal medicines, up from 350 in 2020, according to his database.
Standards vary greatly, from shops selling neatly packaged and licensed products in Baghdad's better-off neighbourhoods to more traditional herbologists mixing plants scooped out of jars in front of customers.
"I inherited the job," said Mohammed Sobhi, who followed in the footsteps of his brother and has sold remedies since the 1980s.
"The ones who can't afford medicine don't go to the doctor to begin with," he added.
But replacing medical prescriptions with herbal products can be dangerous and result in harm for patients if not administered properly, said physician Ali Naser.
He recalled the case of a patient who had replaced his prescription with a herbal treatment and "reached the point of what we doctors refer to as diabetic ketoacidosis and the patient had to be admitted to the ICU," Naser said.
At the heart of the problem is Iraq's failure to establish an adequate medical system or regulatory framework for the country's multitude of health service providers, he added.
According to Sabah, inspection teams monitoring establishments selling herbal medicines have closed down 10 for serious violations since 2019. "Most of the violations detected by the inspection teams are corrected," he said.
