How to License and Ship Medical Equipment to the Middle East

Whether your company is executing contingency operations overseas, building global infrastructure, or developing energy resources, your workforce is key to your success. However, keeping your workforce healthy often requires navigating a maze of licensing, regulations, and government agencies to give them access to the medical equipment and medications they need.

As a global occupational health management company with experience shipping medical equipment and supplies to over 130 countries, Remote Medical International has seen it all. In our experience, some of the most complex shipping scenarios we’ve faced are getting medical supplies to federal prime contractors operating in Iraq and Afghanistan, due to the complexity of both local regulations and the relationship the countries have with the United States.

To ensure that your shipment arrives safely, we work hard to plan ahead, build relationships with all the key players, and ensure that we check all the necessary regulatory and licensing boxes. Here are some of the most important lessons we’ve learned.

PLAN AHEAD

When shipping to Iraq or Afghanistan, experience is key. The biggest mistake that a company can make is trying to send an important shipment without adequate planning and support only to have it delayed or stopped at the border, stolen, or even destroyed. Failure to plan ahead can also ruin shipments en route. For example, cold chain refrigerated items like vaccines, which, If not properly handled and monitored, can be damaged, leaving a company without critically needed supplies and with significant financial losses. This is why it’s important to plan ahead and identify issues that may arise before the first item leaves the warehouse.

Any shipment imported under a status of forces agreement and/or a diplomatic note, a document provided by the local U.S. embassy, can invite greater scrutiny simply because these shipments are exempt from import duties and customs officers want to ensure that exemptions are not being misused. However, there are things that can draw even more unwanted attention to a shipment, especially in Iraq and Afghanistan:

  • High value items: As you might imagine, high value items that would otherwise be subject to significant import duties get a lot of attention. If your shipment includes high value items, such as advanced diagnostic medical equipment, make sure to provide the appropriate commercial invoices and documentation that justifies its use in-country.
  • Opioids: These can be a major red flag around the world, but especially in Afghanistan due to struggles with a significant domestic illegal drug industry. Be prepared to answer questions about the source of opioids, where they are being sent in-country, and why they are needed.

KNOW THE KEY PLAYERS

There are personnel that can help or influence successfully shipping into Iraq and Afghanistan, even for a shipment that may not include items that could be flagged in customs. These include:

  • Supplier: This is the company that is supplying the medical supplies, including  equipment, consumables, and pharmaceuticals. In many cases a single company will coordinate the acquisition of supplies from a variety of different manufacturers, allowing you one point of contact for your order.
  • Shipping company: This is the company responsible for getting the supplies from point A to point B. In some cases you will use a known international carrier, but in many cases a specialist shipping company with experience moving commercial shipments will be used.
  • Freight forwarder: These companies act as coordinators for complex shipments. They can coordinate multiple shipping companies, act as your agent at customs, and ensure final mile delivery to the destination in country.
  • U.S. Embassy: The U.S. Embassy  provides the documentation needed to clear imports covered by status of forces agreements.
  • Customs office: The national customs office is the local representative who will review all incoming shipments. Even with shipments that are covered by a diplomatic note, the customs office has the right to inspect and refuse entry to shipments.
  • U.S. Commercial Services: The U.S. Commercial Services is a branch of the Commerce Department with offices in every U.S. Embassy. They are often helpful with resolving import disputes, as they facilitate U.S. overseas commerce.

One benefit of working with a dedicated medical equipment and shipping specialist is having a single point of contact for many of these relationships, and a partner who can support you in managing the rest.

BE CLEAR ABOUT LICENSING AND REGULATIONS

For our customers, some of the most difficult questions often come up around licensing and regulations. Below we address  some of the most common questions in regards to shipments for Iraq and Afghanistan.

Q: What if I need to import a prescription drug or controlled substance?

A: Exporting prescription drugs or controlled substances from the U.S. can be very difficult, since multiple agencies require  separate licenses and registrations. A medical equipment supplier and shipping specialist like Remote Medical International can source medications from local or global supply chains to minimize regulatory hurdles.

Q: What is needed to import prescription medications and controlled substances into Afghanistan or Iraq?

A: For prescriptions, the U.S. Embassy requires a diplomatic note, which must be obtained by the client from the U.S. Embassy. For controlled substances, the ministry of health for the country to which the shipment is being sent needs to issue an import permit. The process for obtaining import permits differs by country and can change over time.

Q: Are there any regulations associated with shipping medical supplies to military bases and other U.S. installations in Iraq and Afghanistan?

A: The most important regulation to be aware of is the Defense Base Act, which requires any personnel involved in shipping materials to U.S. installations be covered by insurance in case of work-related injury, even if they are not a U.S. National. You should ensure that whichever shipping company you use in a country has Defense Base Act Insurance, otherwise your company could be liable under the law.

Q: If my shipment is delayed at customs, what are my options and what legal considerations may apply?

A: For shipments that are delayed, your best option is to work with the customs officials to address any concerns, which may require providing relevant documentation. In complex cases, the assistance of the U.S. Commercial Services can be helpful. It is strongly recommended that for any complex shipments, which may draw additional attention from customs, you work with an experienced freight forwarding company with experience working in Iraq and Afghanistan.

Q: Who is responsible if the shipment is lost, damaged, or stolen?

A: Guidance over liability of lost, damaged, or stolen shipments is guided by the International Commercial Terms (Incoterms), published by the International Chamber of Commerce. They provide a set of guidelines for a variety of situations that outline liability. The specific guidelines applicable to your shipment should be explicitly identified in your PO or contract.

Q: Is insurance required?

A: No, but it is recommended. Even with the best equipment supplier and team, things can go wrong outside of their control, which can lead to expensive losses. For example mishandling of materials by local customs agents, damage due to an equipment failure, or simple graft can lead to the loss of a shipment.

In addition to shipments to Iraq and Afghanistan, Remote Medical International has experience shipping medical equipment to over 138 countries worldwide, with access to over one million medical items, including pharmaceuticals, consumables, vaccines, and advanced medical equipment. Whatever your medical equipment and supply needs, we can help you meet them and ensure your shipment arrives wherever you need it.

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