ARSAL, Lebanon: By April, Yabroud was back in Syrian regime hands but the persistent clashes with rebels in Omar Ahmad Rifai’s village of Ras al-Maara was enough to compel the pharmacist to pack the entirety of his dispensary and flee.

With 59 boxes of medication and miscellaneous hygienic products in the backseat of his car, the 40-year-old Rifai drove through the rugged terrain separating Syria from Lebanon and crossed illegally into to the border town of Arsal, where he managed to find an apartment.

He made the rounds to Arsal’s chronically under-stocked medical facilities, including a collection of clinics under the town’s mosque run by Dr. Kassem al-Zein, whom he knew back in Syria.

A week into his arrival on May 5, the Internal Security Forces, tipped off by a local about a warehouse stocked with smuggled medicines, stormed Rifai’s apartment and seized his supply. The pharmacist was arrested and referred to ISF’s Bureau for Financial Crime and Money Laundering.

Though the case is considered closed, Arsal’s medicine shortage continues. The town’s strained health care providers are still questioning the validity of the smuggling charge, arguing the town subsisted on the practice well before the Syrian crisis.

“He had brought everything he had,” recalled Zein, sitting in the clinic where Rifai has come asking if he could help replenish medical supplies. “It was a survival strategy, for him. He didn’t have any intention of opening a clinic here, he just wanted to save the medicine.”

“I don’t think it’s accurate to call what he did smuggling,” Zein said. “He came in here illegally, like everyone else. He just brought the medicine with him.”

According to Col. Ghassan Chamseddine, chief of the ISF’s Drugs Enforcement Bureau, Rifai was arrested because he did not declare the medicine to Lebanese Customs. Though his department does not deal with the case, he confirmed that pharmacists must formally register with the Health Ministry to be able to lawfully sell drugs to patients.

However, locals in Arsal argue the arrest was arbitrary as they’ve been counting on cheaper medication, as well as fuel, from Syria for years prior to the 2011 uprising.

Another pharmacist from the Syrian village of Aasal al-Ward had met the same fate as Rifai’s some months before, the doctor said.

“Arsal needs medicine more than Qalamoun does,” Zein lamented.

The clinic’s dispensary was evidently bare and a few boxes of generic medication were piled behind its improvised pharmacy. Zein’s eight facilities as well as the nearby hospital’s emergency room treat up to 1,000 patients per day, most among the over 80,000 Syrian refugee population, more than double that of the Lebanese town.

“This has put a lot of pressure on us to provide refugees with necessary medicine, which we provide mostly for free,” he said.

In addition to refugees and Lebanese residents, the clinic also treats incoming war wounded patients from the battlefields in Syria. Three months after regaining strategic territory in the Qalamoun region from the opposition, rebel fighters are still seeking out Zein’s field hospital for treatment. Three days before The Daily Star’s visit on June 12, fighters were admitted coming from Rankous and Aasal al-Ward.

“We are using the medication we have to treat the wounded but we don’t get anything back in return, we aren’t profiting financially and can’t buy medicine on our own,” Zein said. The clinic has received assistance from the Red Cross, as well as some donors from the Gulf, but these are seldom enough to meet ever rising demands.

Emergency cases aside, the clinic’s top medicinal needs are for patients with chronic or long-term illnesses, such as heart disease, diabetes and hypertension.

The doctor said he too relied on medication from Syria, about four to 10 times cheaper than Lebanese pharmaceuticals. But with the roads to Yabroud effectively blocked, he has resorted to using donations to purchase expensive local alternatives.

But, the road closures have also affected supplies in Syria, Zein explained. Before the crisis pharmaceutical factories in Syria were adept in meeting local demands, but the war has wrought havoc on the industry too. “At the worst of times, we had to provide those in Syria with medication with our supplies.”

Before the crisis, with 70 privately owned pharmaceutical plants producing mainly low-cost generic drugs, Syria was the region’s second-largest drug supplier and met 91 percent of local needs.

The industry, which is concentrated primarily in Aleppo, has been devastated by the fighting with many forced to suspend production due to costs. Production has dropped 75 percent, with a few factories continue to operate at a third of precrisis numbers.

An opposition-aligned Syrian field doctor based in Arsal, who chose to be identified as Dr. Saleh, said he relied on smuggled medicine to treat wounded combatants on the front lines and recuperating in Arsal’s outskirts. He described the current shortage of medicine in Arsal as “severe.”

“Even in Qusair when it was under siege, medication was available in large quantities,” he said. “In Arsal availability is more controlled.”

Dr. Saleh’s smuggling activities have put him in the Lebanese Army’s watch list, he claimed. “They have my name, which is why I can’t go to [UNHCR’s registration center in] Zahle.” Saleh believes he would be apprehended at the checkpoint upon exiting Arsal.

An FSA commander hiding in Arsal, who gave the pseudonym Abu Mohammad, said smuggling medicine was often the only means to treat his men on the field. “If I have a wounded fighter in no man’s land [in the outskirts of Arsal], how would I treat him? Using rocks and sand?”

“The medicines are not being smuggled the way weapons are, or for business. They are being used to treat the injured,” he said.

Even security sources concede that the smuggling of basic items, such as fuel and cigarettes, were natural to border towns like Arsal. Moreover, the head of the Order of Pharmacists, Rabih Hassouneh told The Daily Star the rate of Syrian pharmaceuticals in Lebanese markets has not reached worrying levels. The law itself that penalizes the smuggling of medicines appears to be vague.

“It doesn’t mention smuggling specifically,” explained Chamseddine, leafing through his copy of Lebanon’s Penal Code. “But it does mention fraud.”

Fittingly, Rifai was arrested on charges of fraud because he did not declare his pharmaceuticals to the Lebanese authorities. “It might be that he didn’t know,” Zein said.

Following protocol, upon finding Rifai’s medical supplies the ISF swiftly eliminated them.

“Like drugs, or any other smuggled goods,” Chamseddine explained. “Once you seize it, the prosecutor general gives the order to destroy it.”