When the street becomes a pharmacy: The booming black market in Central Africa

When drugs are scarce, unaffordable, or too far away, illegal drug sellers have proven able to fill the void.

These dynamics are explained in a new report released on Tuesday by the United Nations Office on Drugs and Crime (UNODC). Illicit trade does not only include counterfeit medicines. This includes genuine medicines diverted from legitimate supply chains, unapproved products, and medicines smuggled across borders.

251 tonnes confiscated

From 2020 to 2025, authorities seized 251 tonnes of medical products in Cameroon, Republic of the Congo, Gabon, Central African Republic and Chad. Annual seizures increased from around five tonnes in 2020 to nearly 116 tonnes in 2024, before exceeding 97 tonnes in 2025.

The UN warned against interpreting the increase as a direct measure of trade growth. Larger seizures may reflect greater human trafficking and more aggressive law enforcement, and available data vary widely between countries and from year to year.

However, the scale is striking. Cameroon accounted for almost all of the recorded seizures in 2025, with 96 tonnes seized, compared with just 2.5 tonnes in the previous five years. Products intercepted across the region range from antibiotics, antimalarial and anti-inflammatory drugs to painkillers and psychoactive substances such as tramadol and pregabalin.

“This report outlines a multimodal trade system that uses maritime, river, air and road routes and involves a wide range of actors,” said Sylvie Bertrand, UNODC regional representative for West and Central Africa.

High costs fuel a black market

However, a report made jointly with the World Health Organization (WHO)WHO) and the Central African Economic and Monetary Community (CEMAC), show that the roots of these trade problems lie partly beyond the reach of law enforcement.

Malaria, tuberculosis and HIV remain widespread in the region, while public health systems often struggle to provide treatment. In 2023, WHO’s universal health coverage index ranked the six countries in the Central African economic bloc as the worst performing countries in the world. Chad scored just 26 out of 100, compared to a global average of 71.

Distance and cost add to the problem. In the Central African Republic and Chad, more than half of the population lives at least two hours from a public hospital that provides emergency care, according to data cited in the report. In Chad, the price of one prefilled insulin syringe is equivalent to 16 days’ wages for the lowest-paid government employee.

Competitive pricing

In circumstances like these, buying medicine on the street is no longer an alternative to the formal health system, but instead becomes a necessity. Consumers in the Central African Republic told researchers that informal sellers let them “buy one or two tablets for about 100 CFA francs” – roughly 20 cents – rather than “buying the drug in a box of 12 tablets.” [at a pharmacy]”.

The result is a market in which legitimate, counterfeit, and substandard drugs are difficult to distinguish.

From 2013 to 2025, the WHO surveillance system recorded incidents involving 228 medical products in the Central African economic bloc. Of these, 71 percent were classified as counterfeit and 11 percent substandard. Perhaps more troubling is that a third of these incidents are detected in regulated supply chains. This shows that buying drugs from official outlets does not eliminate these risks.

In April 2025, WHO reported batches of amoxicillin counterfeited in Cameroon and the Central African Republic that do not contain the active ingredient listed on the label. In September 2026, Cameroonian authorities seized thousands of cartons in Yaoundé containing, among other things, fake medicines, packaging materials used to repackage medicines and psychotropic substances.

From ports to armed groups

Human trafficking routes largely follow legitimate regional trade routes. The ports of Apapa in Nigeria and Douala in Cameroon, as well as the river ports of Brazzaville and Bangui, were identified as key entry points. Authorities also confiscated 7.3 tonnes of medical products at airports across the region from 2020 to 2025.

The criminal networks behind this trade are also diverse. They include illegal manufacturers, wholesalers, informal traders, couriers, health workers, corrupt public officials, and online sellers.

Armed groups have also found ways to profit, the report said, by looting health facilities, reselling drugs or collecting “taxes” from convoys passing through territory they control.

Dire consequences for the patient

For patients, the impact can be very bad. Medications that contain the wrong ingredients or the wrong dosage can cause poisoning, treatment failure, and death. They also contribute to antimicrobial resistance, allowing bacteria and other pathogens to evolve, making existing drugs less effective.

This black market responds to a demand that the formal health system fails to meet

In 2023, 12 children in Cameroon died after consuming children’s syrup containing contaminated ingredients, according to UNODC.

However, the weaknesses that expose patients to illegal drugs also complicate efforts to eradicate the trade.

“No country can address these transnational challenges alone,” said Ms. Bertrand, the agency’s regional representative.

The report calls on countries to harmonize their laws, strengthen controls and increase cross-border cooperation. However, they also argue for expanding access to safe and affordable medicines, as the black market responds to demand that the formal health system fails to meet.

Cutting the illegal supply without addressing the shortages, high prices and distances that drive patients to those locations risks leaving large parts of the illicit drug market intact.

Read us Human trafficking in the Sahel series Here.