"It's like a mother's womb": Rohingya refugees find a precarious sanctuary in Delhi slums
November 2015, A few days before Myanmar’s historical elections, we meet the Rohingya immigrants that fled their country and now live in exile in one of Delhi’s shanty-towns.
News from home arrives in whispers. Scraps of information that spread like wild fire between the huts of this refugee encampment. Everyone longs for those moments when loved ones back in Myanmar take the risk of making a quick phone call. « Some of our family members have mobile phones, but they have to keep them hidden, because it’s forbidden for Rohingyas to have them» explains Hafiz-Ahmed*, who came to India two years ago with his wife and two children. « If they get found in possession of a phone, they risk up to 7 years imprisonment. »
Despite this risk, Hafiz-Ahmed’s parents called him yesterday evening, to talk about the elections that will be taken place that weekend. It’s the topic that’s filling everyone’s mind. And not with dreams or even with debates, but only with the familiar feeling of fear and dread. « The Rohingyas aren’t allowed out of their homes during the polls. They have a 48 hour lockdown. They don’t know what will happen if they don’t obey. »
Elections and desillusions
On 8th November, the Burmese will take part in the country’s first free elections in 25 years. Some have dared to evoke a democratic transition in this military dictatorship. But the Rohingya muslims, that make up 4 to 10 % of the country’s population, are barred from going to the polls. In 1982, a law stripped this muslim minority of their Burmese nationality. Today, after four decades of atrocities, more than three quarters have been forced to flee their country. One UN report described them as the most persecuted minority on the planet.
Aung San Suu Kyi, the head of the opposition party National League for Democracy, is the face of change against the military junta. However, the Nobel Peace prize-winner has been oddly silent about the grim treatment of the Rohingyas. Prior to the elections, she purged her party of all muslim candidates, in order to gain the support of the buddhist majority. This brought a fatal blow to the Rohingyas’ hopes of change.
20-year-old Abdul explains, “I used to have a lot of faith in Aung San Suu Kyi … I really believed she would make things different. But she abandoned us.” Abdul is wearing jeans and an oversized sweatshirt. He has a shy smile and big dreams.If there is one thing he is sure about, it’s that the future is not in Myanmar. « I want to go to another country,” he tells me. “To America, or London.” But for Hafiz-Ahmed, it’s not so easy to stop looking back. « I want to go home. One day. Inshallah, we will be treated like equals there, like we are in India »
Incognito in India
Equality is not the first word to spring to mind when you reach this vast desolate slum. Several hundred shanty houses fight for space on a dusty field, next to the highway that links Delhi to the suburban town of Noida. This is where the Indian capital is stretching towards the east and hurtling towards the future. The building site of an aerial metro line looms over the camp.
The 62 Rohingya families that live here in Delhi sleep in ramshackle huts, a patchwork of brick, tarpaulin and corrugated iron. But for Hafiz-Ahmed, this slum is a already a kind of paradise. « I feel so safe here. I feel like I am in my mother’s womb. »
He is reluctant to talk about Myanmar. With haunted eyes, he simply tells me : « at the beginning, they kept forbidding things … then the murders began. » Here, in India, Rohingyas merge into the mass of a billion individuals. Better forgotten than pursued.
Munera left Burma with her entire family : her parents, her two brothers, her sister and their children. They took a boat to Bangladesh, then smugglers drove them across the border. A less dangerous trip than the one that leads out into the Pacific, in the hopes of reaching Australia or Indonesia by boat. Munera ushers me into her tiny home. It’s empty apart from mosquitos and a baby in a swinging cot. Her husband used to live here with her, « but he left… he was very violent… he drank very much. »
It happens a lot here, she explains. Men get depressed and turn to alcohol. They might be safe but they are weighed down by precarity. Most of them work as rag-pickers. Behind the community’s make-shift mosque, there are mountains of carefully sorted garbage. They can make a few rupees selling plastic bottles or glass jars. Sometimes they get hired as day laborers on nearby construction sites. But in either case, it’s hard work, badly paid, and unstable. Staying cheerful is hard.
In the Shadow of Progress
A crowd has gathered near the entrance to the slum. Politicians have come to hand out a dozen blankets for over two hundred individuals. When the local councillor, Amantullah Khan, spots me, he insists that I take his photo, as he hands a blanket to an old man in a wheel chair. « Clap ! Smile ! » he orders the crowd.
Once his PR stunt is over, I intercept him to ask what is done to help the refugees that live here. He hesitates, then blurts out a few key words…
« education…erm… water… sanitation… »
« Really ? But it’s not very clean here. There are flies everywhere…”
« Tomorrow… tomorrow we will clean. »
« And the water you provide, is it clean water ? »
« Yes. Everyday, lorries come to deliver drinking water. Twice a day. »
And yet, oddly, Mohammed has been living here for over a year and never seen a single supplier of drinking water. What he has seen is people drinking cloudy water from nearby pumps. People complaining about stomach aches. Children going to hospital and never to school.
Abandoned by the Burmese politicians, exploited by the Indian ones, and ignored by the international community. One of the only people that has done something for them is Mohammed Wassim, their landlord. He leant them the land free of charge two years ago. « I have a big heart… these people have come to my country. I need to help them. » he says. However, he admits that he might have to evict them in a couple of months. He mentions behavior problems, fights.
Mohammed Zafural Haque, a student that lives nearby and drops by on weekends to help out the families, is a little sceptical of Wassim’s goodwill. “He lets them stay here for now, to stop people building illegally on his land.” Land that will rise astronomically in value once the metro is built. “In a few months, he will kick them out, saying there were behavior issues. And he will sell the land for a huge profit.”
For now, life in Delhi’s shadow has been a moment of respite for these Rohingya refugees. But this city, that is unrecognizable from one day to the next, may be next in line to push these refugees out. Leaving Myanmar’s “Nowhere People” to their own, far less dazzling, future.
Weathering the streets
Portrait of an elderly prostitute
Gabrielle Partenza lives in a small house hidden behind a flower filled front yard in the quiet suburban town of Joinville. Behind the lace net curtains, her living room is filled with comfy cushions, woolen blankets and twee paintings. Three small but disproportionately noisy dogs jump around excitedly.
It’s the kind of house you would expect to be filled with the smell of your grandma’s freshly baked cookies. A world away from Paris’s red light areas, where 71 year old Gabrielle worked as a prostitute for over 30 years, “30 years of laughter” she assures. She only hung up her fishnets in 2008 because she realized how difficult life was for prostitutes when they got older, and founded the first and only association in France to provide aid to aging sex workers.
Beneath her short grey hair, her face is wrinkled, but she still has the aura of a temptress, with her soft cheeky smile. Her voice is gravelly from years of breathing in the cold night air and the smoke of the cigarettes, and there’s a glint in her eyes as she tells her stories from the streets. “I was young, and beautiful. It was fun, we were all friends, and we had a laugh,” she says. “And there was a lot of money to be made. We wanted to live. And we lived well.”
She lights up a cigarette, and leans back on the sofa. “You don’t become a prostitute for the cash. You come for the freedom. You work when you want. You take the clients that you want.” She refuses to see prostitution as a trauma, as an obligation. “For independent sex workers I mean. I’m not talking about the women that are forced into it by criminal networks. They’re not prostitutes, they are slaves.”
For Gabrielle, the streets are the place you come to to learn about humankind. “It’s the greatest university in the world !” Gabrielle’s university was the Bois de Boulogne, a large park in the west of Paris. A place where everything was possible. “ There was every kind of client, with every kind of sexual fantasy!” Quickly, she learned to tell a bad man from a good man, a potential attacker from an innocent pleasure seeker.
Some came for sex, others to talk. Some came just to cry on her shoulder, or to ask her why their marriages weren’t working. Gabrielle smiles as she recalls how she helped fix marriages by giving sex advice. “Prostitutes aren’t so different from nuns. We learn tolerance, solidarity, forgiveness,” she explains. “You enter prostitution as you would enter a convent.”
Gabrielle herself came to prostitution almost as a family business. “My mum was a whore like I was, and we were proud of it.” Maybe it was an unconscious desire to be like her mum that brought Gabrielle to the streets, to be closer to the mother whom she rarely saw as a child. She was raised by nuns in a children’s home. Her mum rarely visited, but when she did it was heaven. She was beautiful and classy. She had a rich boyfriend with an American car. All the other children were jealous.
And yet all the other children got to see their parents every weekend. Gabrielle was left alone at the boarding house, to roam around the enormous park. She felt like a princess in the orchard. She was happy there, she loved the nuns. The only bad thing in her childhood was her legal guardian. A violent cruel woman who played tricks on her, hit her, forced her to eat mouldy cheese and potato peelings.
It was a childhood with more than its fair share of pain and problems, which Gabrielle quickly puts into perspective. “It wasn’t a happy childhood. But the boarding house made up for it,” she says. “It was home, I was happy there. A lot of children were far worse off than me. My troubles were a joke, compared to some. Even though I didn’t laugh at the time.”
Gabrielle’s past seems to incarnate the stereotype of the traumatic childhood that is a highway to prostitution. Something she denies, with gusto. Prostitution, for her, isn’t a psychological trauma. It isn’t a loss of dignity. “ I most certainly still have mine, anyway !” Yet people persist in judging them, for having a profession that no one understands or knows. “We’ve been forced to live in the margin of society, not because we wanted to, but because we’ve been stigmatised, even though we’re just like everyone else, only with a slightly different job,” she says. “When we’re not working, we do our shopping, we do our cleaning, we’re just like everyone else.”
Gabrielle’s violent fits of coughing break up the interview. “My lungs hurt, my heart hurts,” she says. “My entire body is breaking.” Rheumatisms, lung problems, heart problems, sexually transmitted infections … the professional hazards of prostitution are plentiful. As the women get older, their job gets that much harder. This is what made Gabrielle stop prostitution: she noticed how much prostitutes suffered as they got older and decided to make it her life’s mission to help them, by founding the the ANA association.
Few of the girls think they’ll stay in prostitution for long. But the years flash by, and leave them behind. With no savings and dwindling charms. Money comes less easily, and the long waits get harder. “It gets hard, when you can barely stand, when you have to wait for hours for the client, when you don’t know if you will make any money at all,” she explains. “That’s when it gets really hard”. Many refuse to go to the hospital when they fall ill, because they’re scared to be told that they’re dirty, that what they do is wrong. A lifetime of discriminations slowly takes its toll.
But the hardest thing, that which hurts them “in their heart and soul”, is losing their family. Most prostitutes have children, and grandchildren they rarely see. As they get older, they give less money, and their children cut ties with them. “They’re fine about you being a prostitute, so long as you give them money. But as soon as that money dries up, you’re just an old whore, and your kids turn their backs on you.” There is a hollow look in Gabrielle’s eyes as she explains this, but she refuses to say if the same thing happened to her.
ANA association helps sex workers fill out forms for the “revenu minimum de vieillesse”, a state benefit for impoverished elderly people. “And most stop working the second they get the aid. which just proves they’re fed up.” But Gabrielle also has bigger dreams. She wants to build a health center where “the girls” can come anonymously, convert a derelict building into small studio flats so that they could have a safe haven but keep their independence. For now, however, even though pro-prostitution associations and the state have both applauded her work, none have been willing to finance it. “ I mean, we’re just old hookers. Why would anyone bother ? “ she says, bitterly.
The Paris Underworld
In the shadowy catacombs of the city of light
Over 300 km of dark passages worm their way under the city of light, filled with explorers and party-goers, ancient carvings and modern graffiti, bones and beer bottles, hidden chambers and underground beaches. Head torches on for a brief glimpse at a (very) underground culture.
They have gathered on a street corner in the south of Paris, dressed in tracksuits and rucksacks, looking a little conspicuous in the quiet residential area. Some are regular «cataphiles », others are first timers. They all looking excited for their midnight mission down under the town of Paris,
« Before we start, just know, this is illegal. And be careful. Some places there’ll be water up beyond our thighs, at others we’ll have to crawl under rocks» , Alex*, a 22 year old student who regularly goes down to the catacombs of Paris at night, is giving his friends some advice before they go down. “Oh, and your coat will get utterly ruined,” he remarks to one of the first timers, dressed in a leather jacket. Even before entering the passages, it becomes clear that a trip to the catacombs is no walk in the park: you have to climb over a wall, down some steps, walk briskly along disused railways tracks, through two small holes smashed in concrete walls, before slipping into a crack in the side of the rock, down into the depths.
After a brief crawl, the galleries enlarges until you can stand. Splashing through knee-deep water, and scaling along walls to avoid deep holes, Alex explains his passion with the underworld. « It’s an alternative world, where I can escape the routine of everyday life… You discover new places, and being down here in the dark, it’s an entirely new experience, you see differently, smell differently… ».
It’s not only the place which is different, it’s also the people you meet and how they interact. «You meet great people, and scary ones. This is a space without any laws, so people make their own rules…. it’s a form of anarchy,” says Alex. An autonomous way of coexisting, that seems to mainly work well. “There are some problems. Some people pick fights, others make a lot of mess, but most people respect each other and the place. A month ago, a hundred of us came down for a « Cata-clean », to get rid of all the trash that had ended up down here. »
The group winds on, admiring the brightly colored tags and frescoes, messages left on the walls of the by generations of “cataphiles”. There are occasional street signs, familiar sounding and oddly incongruent. They act as a reminder that the outside world remains. Occasionally, other groups cross their path. Some, fellow explorers that call friendly “hello”s, or offer advice about how best to pass. A few, strange and silent, loom out of the dark with menacing stares.
A half hour half walk half climb leads to a large room : nicknamed the castle, with seats and tables hewn out of stone, where a dozen men are sitting. The room is filled with an unventilated smell of marijuana smoke, and loud rap movement blasts out of speakers. As he ushers the group on, Alex explains the down side of the catacombs recent popularity. «There have been a lot more groups that just come down to party – they don’t actually care about the place, they just like the thrill of breaking the law, and having a place to make a lot of noise, and to take drugs without being caught. »
Entering the catacombs is illegal, and Paris has a special police force dedicated to keeping people above ground, nicknamed the “cataflics”. But they do little to dissuade the passionate cataphiles, for whom breaking the rules is part of the fun. « There are sometimes policemen stationed outside the hole to give fines. And they also close accesses, many of the manhole covers we used to enter through have been cemented up… but cataphiles always come along and open them again. It’s a cat-and-mouse game with the police … and that is part of the fun,” laughs Alex
After scrambling on through the labyrinthine passages, the cataphiles come to an exit, crawl back up into the moonlight town outside, and head back to the real world, coated in a layer of thick clayish mud. Most cataphiles have normal lives on the surface, and seek only to escape society, not to change it. Fighting against the police in an endless game, they reclaim their right to explore and discover in the addictive darkness of a city under the city.
How street harassment keeps women indoors
A wink. A whistle. A lewd comment muttered through the pursed lips of a man that idled by, a little too close. A few “Good evening”s, and an insult for good luck. In the time it takes her to walk from the metro station to her flat – head ducked, and face hidden in a scarf- Adèle has encountered around 15 remarks from men lingering in the streets. And she has even been reprimanded for not smiling back at her harassers’ ‘compliments’. But this, apparently, is nothing special. “I was surprised when I first came to Paris, but it’s something you come to expect. You always have to think about it when you’re planning where to go and when.”
Street harassment can be anything from insults to compliments, from wolf whistles to pointed stares. In the most severe cases, in can lead to women being followed, or even attacked. In it’s most benign forms, it’s something all Parisian women know something about. A survey by the association Stop Street Harassment in 2008 showed that 99% of women in Paris had encountered some form of street harassment.
Though many consider it to be just a harmless nuisance, experts argue that street harassment is one of many elements that makes the urban space masculine, and pushes women back into the domestic sphere. Yves Raibaud, a geographer specialized in male and female inequalities in the urban space, explains that women and men don’t use the town in the same way. “We find men at cafés, stadiums, the street at night, and women at playgrounds, pushchair-friendly pavements, the front of schools and supermarkets. Of course, many women have a different use of the city, and demand it, but its often at their own risk in an urban space controlled by men and which can seem hostile, or even dangerous.”
For Yves Raibaud, street harassment is more than innocent banter. “Street harassment isn’t just a few sexually frustrated individuals, it’s a masculine culture that has deep roots. Often, parents anticipate urban violence and warn their adolescent girls, sometimes exaggerating the dangers they face. And when a woman gets attacked in the street, a lot of people assume she wasn’t careful, that she was looking for it.”
In fact, women’s feelings of insecurity don’t reflect the actual risks they face. In 2011, according to INSEE statistics, 1,9% of women had been victim of a physical assault in the public space, whereas 10% had faced domestic violence. Still, the home is seen as a haven of peace, and the outdoors, like a dangerous place.
Hélène Bidard, deputy Mayor of Paris responsable for Equality between Men and Women, is well aware of these problems. “Street harassment is systematically violent for women. It’s a reminder to respect the gendered order, it says, “woman,this isn’t your place”, or “you’re just a body for men to take”.
Although the Mairie has concrete projects to tackle this problem, Hélène Bidard thinks change will take a long time to come about. “We’re working to include this issue into the training of urbanists, architects and political figures. But there’s a lot of work not only to build spaces for women, but also to ensure they use it and to enable women to go into the street at any time, without having to change their itinerary or choice of clothes in order to feel safe. Advertisers also have a responsibility. When billboards in the metro show degrading images of women, how can you explain to the guy sitting beneath that he can’t think that the women in front of him are also bodies to take ? We also have to work to make people less tolerant of harassment, through publicity campaigns in streets, bars and public transport.”
Faced with these unfinished projects and unchanging realities, several hundreds of women marched from Grands Boulevards to Hôtel de Ville on 25th November to reclaim the streets. Amongst them is Adèle, and this time her face isn’t hidden but openly beaming. She’s brandishing a placard, still glistening with wet paint, and the words “No means No.” The procession walks fast, drawing stares of astonishment from passers by, as their angry chants echo off the walls of the narrow parisian streets. “Who does the street belong to ? It belongs to us ! “ “Veiled, naked, in a skirt or a suit, I do what I want, put your d**k away!.”
We arrive at Stravinsky fountain, where feminist artist Niki de Saint Phalle’s colorful, curvaceous female figures dance merrily in jets of water. The organiser of the march, Laure Mardoc, takes the megaphone. “We’re confronted to a war, and we’ve had enough, this evening, let’s take back the streets. Fear and shame need to change sides.” Adele cheers loudly along with the group. “I usually feel so helpless. Now we’re telling everyone that we won’t shut up and be good girls until it changes.”
Pharma-Pirates saving lives in France
Eloise Stark & Noé Michalon
David Cowley’s kitchen counter is littered with small boxes with obscure names like Sovaldi or Sovefpur. Inside each box rattles a bottle of 48 pills, a twelve-week treatment that can completely cure hepatitis C.
The 58-year-old has salt-and-pepper hair that falls gently across his forehead, where wrinkles and laughter lines hint of adventurous tales from the past. Cowley isn’t a pharmacist, nor a doctor, although he may look like eccentric apothecary. He is in fact a former drug dealer. In the seventies, he was part of the generation of young Europeans that travelled to Thailand and explored life through a drug-induced haze. A life on the edge, which put him behind bars.
Cowley doesn’t know at what point he caught hepatitis C, but it was most likely during this time of shady company and shared needles. He only found out about the disease twenty years later, once he was back on the straight and narrow. Oddly enough this diagnosis would bring him back to his old profession – supplying drugs, but not recreational ones this time. Cowley began helping desperate patients throughout Europe to import lifesaving hepatitis C medicine from India.
But why do patients from Western countries turn to a former drug dealer organising an informal Buyer’s club from his kitchen?
Susan Cox was diagnosed with hepatitis C in 2015. She went to the doctor with pain in her back and wrist, and never expected to learn that she had the disease. « I don’t know when I caught it, because hepatitis C can lay dormant in the system for years, » she explains. The virus has few symptoms in the short term, but in over three quarters of cases it leads to chronic liver damage. A hepatologist told her about the miraculous Sovaldi treatment, but told her that she couldn’t access the treatment, which is rationned and only given to the most advanced patients. « I was furious ! » she recalls. « I was told that I wouldn’t get any care, even though the treatment exists. All I wanted was to get the virus out of my body ! »
In France, an estimated 230 000 people are infected with hepatitis C, and so far only 26 000 have been fully treated with Sovaldi, the medicine that eliminates the virus from the body. « We are under instructions to estimate the gravity of the case, and only provide Sovaldi to the patients in the most advanced stages, » explains Hachid Becher, a heptologist working at Paris’ Hôpital Bichat. The patients that are allowed access to the treatment were those who had already developed stage two fibrosis, a condition that significantly lowers your life expectancy. « This decision isn’t motivated by clinical reasons, as many patients already suffer during the early stages of fibrosis. The only reason is the cost of hepatitis C medicine today », explains the doctor. The fact is, the French social security is forced to ration Sovaldi, because if they treated all the patients that needed it, they would be bankrupt. Each twelve-week treatment costs the State 46 000 euros – that’s like swallowing an iPhone every time you take a pill.
The cost of a revolution
Solvaldi is a medical marvel: in 90% of cases, it makes the hepatitis C virus disappear completely from patients’ bloodstream with next to no side effects. The drug was developed in 2014 by the American pharmaceutical company Gilead. It was immediately hailed as being miraculous, the scientific community compared it to the invention of penicillin. Just as immediately, Gilead placed their patent on the drug, meaning they are the only ones that can produce and commercialize the treatment, and so they can charge as much as like for it.
Although high prices for innovative medicine have been the norm for decades, Gilead took it one step further. Before, pharmaceutical companies had explained their high prices by the amount of research and development that goes into producing innovative drugs, and by the need to have a return on their investment. But in this case, the US Senate found objective proof that the company had fixed their prices without any economic considerations, solely based on the monopole they held on it.
The US lead a thorough investigation into Gilead because of one simple reason: harsh drug laws meant that many addicts had ended up in prison, and amongst them were many hepatitis C patients. The State itself has to take care of the people it puts behind bars, and so paying for Sovaldi suddenly became an issue. The US Senate launched an 18-month independent investigation into the ways the prices of Solvaldi were fixed. The report had worrying results: «Over the eight months Gilead spent determining the price of Sovaldi, the company repeatedly made clear its primary focus was outmanoeuvring potential competitors to ensure its drugs had the greatest share of the market, for the highest price, for the longest period of time. (…) During its pricing process, Gilead also considered what price it could set without risking “external factors,” such as public outrage, media attention, and congressional inquiries—potentially diminishing the drug’s reputation or revenue potential. » Gilead had created a colour coded system that calculated the benefits to be made by placing prices high, against the risk of a public reaction, and using this pay-off, they worked out how high they could fix the price. « The question they asked themselves was : how high can we go, without causing a revolution », sums up Olivier Maguet from Médecins du Monde.
Producing the treatment costs as little as 2,3$ a day, making the retail price 200 times more than production costs. And the majority of research that lead to the little rattling bottles of pills wasn’t even done by Gilead. The molecule had been discovered by public research institutes, it had been further developed by the company Pharmasset, from whom Gilead purchased the patent in 2011, for 11 billion dollars. It is now worth 30 billion. The pharmaceutical company’s actual work didn’t consist in inventing a miraculous treatment that would save lives – it consisted in placing bets, purchasing patents and investing money to make more money. Eliminating hepatitis C definitely wasn’t on their to-do list. Since Sovaldi was discovered, deaths due to hepatitis C in the world have continued to rise, going from 500 000 in 2014 to 700 000 in 2015.
Last hope : pharma-pirates
Fanny turned to the internet in the hopes of finding an alternative solution, and stumbled across David Crowley’s Facebook group. It felt like a dream – the Welshman could import the exact same treatment from India for a little under a thousand euros. Whereas Western countries accepted Gilead’s patent and paid the price for it, India had refused in the name of public interest, meaning the country could produce generic copies of the medicine for less than a thousand dollars.
As Cowley wraps up boxes of medicine in brown paper, ready to be dispatched to hopeful patients, he describes his feelings of the time. « When I found out about what the pharmaceutical companies were doing, I was disgusted. I found out that India had refused the patent, and I decided to begin importing the medicine to help other people get cured, » he explains. Time hadn’t marred Cowley’s rebellious side. He contacted a friend in India, and started importing the drugs to the UK and dispatching them throughout the world, on a voluntary basis. This system is known as a « buyer’s club », a term coined during the 80s. At the time, HIV treatments were also extremely expensive, and similar underground pharma-pirates began importing copies of the medicine from South Africa.
France is one of the countries from which the most patients turn to David for help, because of the country’s strict rationing of the medicine, and the fact that laws on importing medicine are stricter than in the UK. It’s a kafkaien system that spans three countries, but for many, it is the only option. David receives hundreds of desperate emails a day, and helps around twenty people a month acquire treatment. « What I’m doing definitely has an activist element to it. I get quite nervous, because not all of it is legal. But Buyer’s clubs help bring these problems out into the open. » He hopes to raise awareness about the problem. « Pharmaceutical companies aren’t there to help people, all they want is profit, » he states, with a touch of bitterness.
David acts as a middleman between his clients and Indian pharmacies. Out of the 1000 euros sent to him, he pockets 200. The treatment arrives by post, right to the customer’s doorstep. To get the packages past customs, the Welshman has developped creative techniques. One client, Thomas*, explains that he received his bottle of pills, opened and filled with cotton, « so that the pills wouldn’t rattle around and spark suspicion at customs. » Though forbidden in France, in most cases, the pills reach destination thanks to these techniques.
To bypass customs, other sellers prefer handing the treatments over in person. At Porte d’Italie on the outskirts of Paris, dealers frequently wait to sell their treatments. On the forum SOS Hepatite, patients explained having organised meetings with sellers met on the internet to recuperate their medicines.
Susan received her treatment, and is now completely healthy. David Cowley assures that the medicine he imports is all good quality and safe, and he works closely with an Indian pharmacy to ensure this. However, safety standards in the developing country aren’t as high as they are in the West. In 2014, the United States convicted the Indian generic medicine producer Ranbaxy for having falsified their safety and quality texts, and lied to regulators about their procedures. This isn’t an isolated incident. India’s CDSCO, Central Drugs Standard Control Organization, asserts, a little too optimistically, that « only » 4.5% of drugs available within the country are of bad quality, but the reality could be even worse than that. Recent studies show that one in every seven drugs could fail to meet quality and safety standards.
Other shady dealers on the internet provide even riskier options to treat hepatitis C. Just like counterfeit Vuitton bags, or suspicious « Lakoste » polo shirts float around the web, so too do counterfeit drugs. On the website viagra-4u.com, an amazon for questionnable pills, you can by Sovaldi for 100 euros the pill, 5 times less than its cost in France. But impossible to know what you’re getting. Ordering pills online is riskier than playing your life on a game of heads-or-tails, as 62% of medicine on the internet is fake, according to the EAASM, European Alliance for Access to Safe Medicines. Some fake medicines are merely useless, harmless pills made of flour. Others are expired drugs or dangerous mixtures. Drug trafficking kills an estimated 700 000 people a year.
Powerless state, omnipotent industries?
Unable to receive care in their own country, French citizens are being pushed towards far riskier options, all because France fails to stand up to the pharmaceutical industry. WTO agreements allow the use of an « ex-officio licence », which enables countries to ignore patents on medical products when they stall easy access to health treatments. The Indian government applied the law, but in France, the pharmaceutical industry is too strong for the government to risk it. «The government doesn’t have the political courage to do it. Too many jobs hang on the line, » explains the doctor Hachid Becher. The second largest industry in the world employs over a hundred thousand people in France.
Instead of defying Gilead, the French health ministry took a different decision in the beginning of 2017. They decide to treat all patients with a far cheaper drug, that is only efficient for 2 out of 6 genotypes of the disease. Although this decision will enable three quarters of patients in France to be treated, for Olivier Maguet, at Médecins du monde, it’s too little too late. « The rules of the game have changed; we can’t carry on within this system. We need to change it radically. » The doctor runs the campaign « the Price of Life » within the NGO, which fights to restrict the maximum prices of drugs. A lot is a stake, according to the doctor. « We need to send a strong message to the pharmaceutical industry. The US Senate’s report proves that Gilead’s choices with Solvaldi aren’t just a change of scale, they’re a paradigm shift. It’s very dangerous. » For this industry upon which all of our lives hang, profit cannot be the only criteria in determining market rules. « Medicines are part of a market, but it can’t be a market like any other. For drugs, differences in prices don’t just determine whether or not you can afford that new iPhone. Prices determine whether people live or die ! »
For the time being, the pharmaceutical industry is a market like any other, with one exception : it has far higher profit margins. With Solvaldi, Gilead rakes in a staggering 50% profit, even after taking into account research and development costs and taxes. On most markets, that figure is around 10%. Imagine what would have happened if Alexander Fleming had put such a mark-up on the price of penicillin.