Pandemics and profiteers: Middle East medical suppliers and Covid-19
Cloth masks, which do not protect the wearer, can protect others by limiting the transmission of respiratory droplets from asymptomatic individuals, according to the new recommendations.
Despite this, there is still no widespread consensus on the issue. European advisers believe reusable cloth masks could increase the chance of infection, with moisture causing the fabric to retain the virus, the BBC reported.
The change in the CDC's advice on the use of improvised alternatives came in response to a global shortage in surgical and respiratory masks of the FFP and N95 varieties, which has had a devastating impact on healthcare workers across the world.
In poor economies in the Middle East, surging consumer demands for face masks, protective gear and hand sanitiser have led to a bustling trade in black markets, particularly through underground online trade. Expired and counterfeit goods have entered markets in countries such as Egypt and Tunisia, while methanol-based sanitisers circulate in Gaza.
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In Jordan and Morocco, large medical suppliers have circumvented regulation by selling protective equipment to middlemen who hoarded supplies early on in their country's respective outbreaks. As a result, licensed pharmacies, as well as hospitals and health centres, are suffering the drain.
Around the same time, the Egyptian government donated 10 tonnes of medical supplies to China. Domestic manufacturers profited by exporting 145 million face masks to the virus' one-time global epicentre in February, according to Ali Awf, a representative at the Egyptian Chamber of Commerce.
Fears of dwindling local supplies led authorities to subsequently block exports of masks and protective gear in late March.
The country, which has of 14 April reported 2,190 confirmed cases and 164 deaths according to official figures, has seen a rise in the makeshift production of counterfeit facemasks, Dr Muhammad Izz Al-Arab, an infectious disease specialist at the National Egyptian Institute for Hepatology, told The New Arab's Arabic language service.
Scant regard to hygiene standards has led some masks to be re-made from medical waste, a proportion of which has reportedly ended up on the black market at prices higher than those of their genuine counterparts, according to reports.
Like Egypt, Tunisia has seen a rise in the market prevalence of replica masks as well as those no longer fit for use. Last month, 45,000 discoloured masks and some 160,000 medical suits with expiration dates altered were found in a home after tip-off in the city of Sousse, 140km south of the capital, according to Samir Al Warghami, an official at the health ministry.
In the absence of an effective regulatory mechanism, and politicians ignoring pharmacists' calls for laws to protect supplies, trade in the black market will increase with demand, the head of Tunisia's pharmacists trade union, Nuwayfel Amayra, told The New Arab.
Algeria, the hardest hit country in North Africa, has recorded 2,070 confirmed cases and 313 deaths as of 14 April.
Masoud Bilambari, the head of country's pharmacist trade syndicate, told The New Arab that supplies of facemasks had begun to dwindle by the end of February, amid reports that thermometers and facemasks, packed in passenger suitcases and parcels, had reached France.
A week after the health ministry warned the country's customs officials to exercise greater vigilance inspecting luggage, 13,000 face masks were seized from travellers leaving Algeria between 5 March and 13 March.
Online vendors have also emerged in the country, with middlemen hoarding supplies from importers and selling at doubled prices. N95 respirators, in limited supply among the country's healthcare workers, are advertised on social media, according to a domestic consumer rights group, who in March recorded nearly 50 active Facebook pages offering goods.
Suppliers in Jordan hoarded protective gear, including both surgical and FFP2 respiratory masks, until March, when local demand soared, according to Ansar Abu Fara, a local correspondent for The New Arab's Arabic-language service.
Her investigative report last month uncovered a booming online trade for bulk-order masks in the Hashemite Kingdom. While sellers claimed to supply to pharmacies and hospitals, many of those which she reached out to in her investigation were ready to sell boxes containing hundreds, with vendors protecting their anonymity by leaving orders for collection at local retailers.
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Despite legal provision addressing price gouging and hoarding, as well as very limited government attempts to prop up production, commercial supplies have so far failed to meet local demand.
Lebanon, which has 658 confirmed cases, appears to be an exception to dominant trends in Arab countries gripped by Covid-19.
The current shortage of protection for healthcare workers – face masks, protective gowns and hand sanitiser – is a problem whose roots lie in the country's liquidity crunch and freeze on moving assets, according to Ilyas Qabbani, a sales head at a Lebanese medical supply company.
By the third quarter of 2019, local banks refused dollar credit to importers, leaving them with no option but to purchase dollars from foreign exchange brokers, whose rates were far higher than the market price.
Despite the government's policy of allocating subsidised foreign currency to help companies import – roughly 20 million Lebanese pounds a month – the head of one supply consortium said it had only been able to meet five percent of targets over recent months.
Meanwhile in Gaza, counterfeit sanitiser first reared its head in souqs in March, local correspondents for The New Arab reported, with at least three people in the impoverished coastal enclave arrested for production in the same month.
Bottled in unlabelled containers, or carrying labels copied from international brands, tested samples of the heavily dyed hand gels were revealed to contain less than 5 percent alcohol – 55 percent lower than the CDC recommended minimum amount, according to Nizam Al-Ashqar, chemistry professor at the Islamic University of Gaza.
Fears were acute regarding those whose principal ingredient was methanol, as low domestic supplies of medical ethanol have pushed home manufacturers to resort to using the toxic alternative, Abdul Naser Awda, an official at the Gazan economic ministry told The New Arab.
This article is based on a series of investigative reports conducted in March by local correspondents for The New Arab's Arabic-language service, entitled "Exploiting Corona".
Kamal Afzali is a journalist at The New Arab
Follow him on Twitter at @KNIAfzali