When I worked in The Gambia, I watched parents weep as their children slipped away from a mysterious illness. The hospitals were full of young patients whose kidneys had suddenly failed. For days, no one knew why. Only later did we discover that the cause was something as simple – and as horrifying – as contaminated cough syrup. Four brands, made in India and tainted with ethylene and diethylene glycol, had poisoned dozens of children. I still remember the fear in a mother’s eyes as she asked whether her child would be next. It was one of the hardest experiences of my life, and it changed how I think about medicine – not just as a product that heals, but as something that can kill if oversight fails.
That same horror is repeating itself closer to home. In Madhya Pradesh, India, nearly twenty children recently died after taking a cough syrup later found to contain 48.6% diethylene glycol, an industrial solvent used in brake fluid. Two more children died in Rajasthan under similar circumstances. These tragedies echo those in The Gambia and Uzbekistan, where Indian-made syrups caused mass deaths just two years ago. Every incident follows the same script: contamination, deaths, outrage, investigation, promises of reform – and then silence, until the next tragedy strikes.
For Nepal, this should be a wake-up call. Much of our medicine still comes from India, including the low-cost generics and syrups sold in pharmacies and rural health posts across the country. The proximity and affordability make Indian medicines an essential lifeline for millions of Nepalis, especially in remote areas. But that same dependence also makes us vulnerable. If our import controls are not watertight, the next wave of toxic syrups could just as easily find their way to our shelves.
To be fair, Nepal already has systems in place to protect its citizens. The Department of Drug Administration (DDA) regulates the import and sale of medicines through the Drugs Act of 2035 and the Drug Registration Regulation of 2038. Every foreign medicine must be registered before entering the market, and importers are required to obtain recommendation letters from the DDA. These are strong foundations. The DDA also issues guidelines on good pharmacy, storage, and distribution practices, and regularly conducts market surveillance to check for counterfeit or substandard drugs. Compared to many low-income countries, this is an impressive framework.
Rash of child deaths in Gambia linked to cough syrups made in I...
Yet, as my experience in The Gambia taught me, laws on paper do little without consistent enforcement and investment in monitoring capacity. The same applies in Nepal. While the DDA oversees registration and inspection, it operates with limited manpower and resources. With thousands of pharmaceutical products imported every year - many from small, lesser-known Indian manufacturers - quality control often relies on trust rather than thorough testing. Routine laboratory checks of imported batches are rare, and regional enforcement in border towns is patchy at best.
One area where Nepal can learn from The Gambia’s experience is the importance of rapid detection and coordinated response. When the cough syrup deaths occurred there, the World Health Organization mobilized an emergency investigation within days, tracing the problem back to its source and helping the government ban the tainted products. That kind of decisive, multi-agency response should be our model. Nepal must strengthen its laboratory capacity so that suspected drugs can be tested swiftly and results communicated across the health system. Collaboration with international bodies like WHO can help build these rapid-response mechanisms before – not after – a crisis hits.
We also need better traceability. At present, many small pharmacies and informal sellers in rural Nepal operate without digital tracking or licensing oversight. Medicines are sold loose, prescriptions are rarely checked, and storage conditions are often unsafe. These gaps allow expired or substandard products to circulate unnoticed. A nationwide system to digitize medicine imports, registration data, and distribution chains could help flag suspicious products early.
At the policy level, the government could make periodic testing of imported high-risk formulations – especially syrups and liquid medicines for children – mandatory at customs points. This would not only ensure accountability but also build public confidence. More importantly, transparency should become a central pillar: publishing results of drug quality tests and naming non-compliant companies would pressure importers and manufacturers to maintain higher standards.
Still, regulation alone is not enough. As the Indian tragedy reveals, the overuse and misuse of cough syrups also stem from a deeper cultural issue – a belief that every cough needs a syrup, and that “more medicine” means faster recovery. This mentality fuels reckless prescription and self-medication. Nepal should invest in nationwide awareness campaigns for doctors, pharmacists, and parents, emphasizing that most childhood coughs resolve on their own and that unnecessary syrups can do more harm than good.
Watching children die from something as preventable as contaminated medicine leaves a mark that never fades. In The Gambia, I saw how fragile health systems can collapse under the weight of one bad batch of drugs. Nepal cannot afford to learn that lesson the hard way. We already have the laws, the regulatory body, and the will to act. What we need now is urgency, vigilance, and the courage to hold our suppliers – and ourselves – accountable.
Every bottle that crosses our border should be a symbol of trust, not a roll of the dice with a child’s life.
The author has worked in international development for over a decade across multiple countries and is a recent graduate of the Harvard Kennedy School of Government. He can be reached at monikbhatta@hks.harvard.edu
