Sweet Syrup Deaths Raise Warning for Pakistan

Rakhi Matan holds bottles of cough syrup in her palm. This is what she gave to her kids two weeks back when they were feeling ill.

When 23 children died in India’s Madhya Pradesh after consuming contaminated cough syrup in early September, the news barely registered across the border. In Pakistan—where self-medication is common and cough syrups are household staples—the tragedy is an alarming warning.

Many in Pakistan remain unaware that these sweet, over-the-counter syrups can be fatal. In the recent Indian case, the children—all under six—died of kidney failure after consuming syrup contaminated with diethylene glycol (DEG), a toxic solvent found at 500 times the permissible limit.

Investigations revealed that the manufacturer, Sresan, had sourced industrial-grade propylene glycol from local chemical and paint dealers instead of certified pharmaceutical suppliers. With no qualified chemist overseeing production, the syrup went untested—and became lethal.

This is not the first such incident. In 2022, Indian-made syrups were linked to the deaths of at least 70 children in The Gambia and 18 in Uzbekistan. Between December 2019 and January 2020, at least 12 children died in Indian-administered Kashmir after consuming similarly contaminated syrup.

In India, the prescribing doctor was the first to be arrested, followed by the suspension of the drug inspector and deputy director. The manufacturer, who had been absconding since September, has now been detained.

“It shows that doctors can face legal and ethical consequences even when unaware of a drug’s quality issues,” said Professor Mishal Khan of the London School of Hygiene & Tropical Medicine. “This tragedy is a warning for Pakistan—weak regulation harms everyone: doctors, pharmaceutical companies, and patients.”

A 2024 study by Khan found that around 40 percent of Karachi doctors accepted incentives in return for prescribing medicines from a fake pharmaceutical company, without verifying its manufacturing standards. Antibiotics and cough syrups were among the medicines they agreed to promote.

As Pakistan enters flu season, Karachi’s hospitals are filling up. “Between 50 to 70 percent of children who visit our clinics have respiratory infections,” said Dr. Wasim Jamalvi of Dr. Ruth K. M. Pfau Civil Hospital Karachi.

And with flu comes a predictable default treatment: cough syrup.

“If a child has fever, cough and cold, many parents feel a prescription is incomplete without a syrup,” said senior pediatrician Dr. D. S. Akram, who stopped prescribing them two decades ago. “Cough syrups don’t work—they only make children drowsy or irritable.”

Jamalvi agrees: “We don’t recommend syrups for under-fives, but parents still give them. They are easily available without prescriptions.”

Self-Medication Culture

In Pakistan, cough syrups—often referred to as sherbet—are widely seen as harmless.

“I swear by this syrup a doctor gave me years ago,” said Mohammad Yusuf, a 31-year-old house worker. “One spoon at night and I sleep better.”

Two weeks ago, when Rakhi Matan’s children, aged 10 and 13, caught the flu, she used an old bottle from last year. “It saved me the doctor’s fee—he would have prescribed the same thing.”

Such casual self-medication is widespread.

Dr. Qaiser Sajjad, former secretary general of the Pakistan Medical Association, said regulating syrup sales is extremely difficult due to thousands of unlicensed practitioners. Pharmacy worker Majid Yusufzai admitted syrups are sold freely without prescriptions and that “entire families use the same bottle.”

Health experts warn Pakistan’s culture of self-prescription—combined with weak enforcement and low-cost medicines—makes the country vulnerable to similar tragedies.

Pakistan imports most raw materials for medicines, including cough syrups, from India and China. While India is a major global supplier of affordable generic drugs, recent deaths have raised serious concerns about safety practices.

Tighter Drug Oversight

“It is of great concern,” said Dr. Obaidullah Malik, head of the Drug Regulatory Authority of Pakistan (DRAP). He confirmed that Pakistan intensified domestic quality checks after receiving a WHO alert on three substandard syrups from India in October.

“Thankfully, the contaminated syrups were not exported to Pakistan,” he said. “There is no evidence of illegal shipments either—but we remain vigilant.”

DRAP has now made pre-testing of additives such as glycerin, propylene glycol, and sorbitol mandatory for all pharmaceutical and herbal manufacturers. Vendor verification has been tightened, and sampling of both raw materials and finished syrups has increased.

There are 700–800 pharmaceutical companies in Pakistan, but only around 300 are members of the Pakistan Pharmaceutical Manufacturers Association—leaving much of the sector without strong oversight.

Since November 2023, DRAP has recalled 63 finished products contaminated with DEG and ethylene glycol, identified 44 impurities, and issued 13 alerts about contaminated raw materials.

As flu cases rise in Karachi, syrup bottles continue to fly off shelves—often with no pharmacist present.

“It’s just a syrup,” said Yusuf.

He does not know—but for dozens of families across the border, that “just a syrup” brought irreversible loss.