(Dr. N. Khaleel)
In recent weeks, a horrifying pattern has emerged — dozens of children, mostly under the age of five, have died after consuming cough syrups that were supposed to heal them. What should have been a benign, everyday treatment has turned into a silent killer.
In a tragedy that has stunned the nation, India’s pharmaceutical industry — once celebrated as the “pharmacy of the world” — stands accused of a crime both invisible and unforgivable: turning children’s medicine into poison. Over the past few weeks, at least 17 children have died after consuming cough syrups later found to be laced with diethylene glycol (DEG) — a toxic industrial solvent used in antifreeze and brake fluid.
The government has now declared three syrups — Coldrif (Sresan Pharma), Respifresh TR (Rednex Pharmaceuticals), and ReLife (Shape Pharma) — “toxic and unfit for human use.”
It is absolutely banned in pharmaceutical formulations at any appreciable levels because ingestion—even in small doses—can lead to acute kidney failure, metabolic acidosis, neurological damage, and death.
The permissible limit (if ever tolerated) is extremely low (0.1 % or less, depending on regulations). In the implicated Coldrif batch, concentrations approached or exceeded 48–50 %, i.e. approximately 500 times the safe limit. Once inside the body, DEG is metabolized into toxic compounds (glycolic acid, oxalic acid), causing severe renal tubular necrosis, and catastrophic multi-organ failure.
But the horror does not end there; what is being uncovered is a chilling portrait of neglect, corruption, and systemic failure that has allowed poison to pass for medicine — once again.
A Familiar Tragedy Repeats
This is not the first time India has been here.
In 2022, the world watched in horror as nearly 70 children in The Gambia died after consuming Indian-manufactured syrups contaminated with the same deadly chemical. Similar incidents followed in Uzbekistan and Cameroon. Each time, India promised reforms, stricter oversight, and accountability.
Yet, three years later, history has repeated itself — this time on Indian soil.
In the district of Jabalpur, Madhya Pradesh, anguished parents buried toddlers who had developed sudden kidney failure after taking the syrup. Hospitals reported a spike in renal distress, and post-mortem results confirmed the presence of DEG. By then, it was too late.
Inside the Bottle: The Poison Known as DEG
What exactly is killing these children?
Diethylene glycol (DEG) is not an ingredient found in any legitimate drug formulation. It is a cheap, toxic substitute for pharmaceutical-grade glycerin or propylene glycol — solvents used to make syrups smooth and palatable. A single teaspoon of DEG can cause irreversible kidney failure. In Coldrif samples, tests revealed DEG concentrations nearly 500 times above permissible limits.
The compound is metabolized into glycolic and oxalic acid, which crystallize inside the kidneys, leading to acute renal shutdown. The children of Madhya Pradesh didn’t die from disease — they were effectively poisoned.
Factories of Death
Investigations have revealed shocking lapses inside the manufacturing units of Sresan Pharma, the company behind Coldrif.
Inspections found poor hygiene, falsified testing records, and evidence that raw materials were never properly screened. Samples of glycerin — the syrup base — were sourced from unverified suppliers without mandatory quality certificates.
Following the scandal, Sresan Pharma’s license was revoked, and the facility in Chennai was sealed. Enforcement Directorate (ED) raids across Tamil Nadu uncovered incriminating documents suggesting financial irregularities and collusion with local drug control officials. Several officers from the Tamil Nadu Drug Control Department have since been suspended or are under investigation.
But this raises a darker question:
How many more such factories are still operating undetected?
Regulatory Failure at Every Step
The Central Drugs Standard Control Organization (CDSCO) — India’s top drug regulator — has admitted to “testing lapses” across multiple manufacturers.
The World Health Organization (WHO) has also issued a global medical alert, warning countries to avoid the implicated syrups and to enhance border testing of Indian imports.
Experts say India’s fragmented oversight system — with state-level drug controllers often operating in silos — has become a breeding ground for negligence and corruption.
Inspections are irregular, quality tests infrequent, and penalties too lenient to deter malpractice.
A senior retired official, speaking on condition of anonymity, called it “a crisis of convenience.”
“We inspect only when there’s public outrage,” he said. “The rest of the time, manufacturers know we won’t touch them.” The tragedy in Madhya Pradesh proves him right.
Regulatory Challenges
India’s fragmented dual control system creates significant vulnerabilities in drug safety oversight. While the Central Drugs Standard Control Organisation (CDSCO) sets national policy, individual State Drug Controllers handle enforcement. This results in inconsistent safety standards and implementation across the country. This means drug quality standards vary by state, leaving the national safety net only as strong as its weakest regulator.
The infrastructure gaps are also concerning. A 2023 parliamentary review revealed that nearly half of India’s state drug testing laboratories lack proper equipment or qualified analysts for effective surveillance. Moreover, budget constraints force many smaller facilities to rely on outdated methods and techniques for testing.
The Human Cost
Behind the headlines are families who trusted the system.
In a small village near Jabalpur, a mother named Rukmini Bai still keeps the empty bottle of Coldrif that killed her two-year-old son. “The doctor said it would stop his cough,” she wept. “It stopped his breath instead.”
For dozens of such parents, there is no solace — only betrayal.
Doctors, too, are reeling. The Indian Academy of Pediatrics has urged authorities not to prosecute physicians who prescribed the syrups, insisting that the true blame lies with regulators who failed to test and manufacturers who falsified reports.
A Call for Reckoning
This scandal has forced an uncomfortable national reckoning.
India cannot continue to boast of being a global pharmaceutical hub while its own citizens die from counterfeit or contaminated drugs. The crisis is not merely about a few bad manufacturers — it is about a system that rewards shortcuts and punishes diligence.
Public health experts are calling for urgent reforms, including:
Mandatory batch-wise testing of all liquid formulations, especially pediatric syrups.
Centralized licensing and inspection under an independent national authority, rather than fragmented state controls.
Severe criminal penalties, including permanent bans and imprisonment, for drug adulteration resulting in death.
Transparent public disclosure of failed quality-control tests.
A national victims’ compensation fund for affected families.
Without these changes, experts warn, India risks losing not only lives but also international credibility.
The Global Shadow
India exports nearly 20% of the world’s generic medicines. When DEG-tainted syrups reach foreign shores — as they did in Gambia and Uzbekistan — they taint more than just lives; they tarnish the very reputation of Indian pharma.
The WHO’s recent alert has reignited fears among importing nations. Several African and Southeast Asian countries have begun tightening scrutiny of Indian-made syrups.
If the government does not act decisively, the long-term economic cost could be catastrophic.
The Final Word
This tragedy must mark a turning point. The Indian pharmaceutical industry was built on trust — the belief that a small bottle labeled “cough syrup” brings relief, not ruin. That trust now lies shattered.
Every child lost in this crisis is a silent indictment of a system that valued profit over protection, speed over safety.
Until accountability reaches the highest offices — until regulators, not just manufacturers, are held criminally responsible — India’s claim to be a healthcare leader will ring hollow.
In the words of one grieving father from Jabalpur:
“If our children had died in an earthquake, we could have accepted it. But they died because someone sold poison and called it medicine. Who will answer for that?”
“Poison in the Name of Medicine”
Before the roses of laughter could bloom,
Tiny lips that once asked for water fell silent.
A child who danced in his mother’s arms —
After one spoon of syrup,
Slipped into an endless sleep.
They said, “It will cure the cough,”
But it silenced life instead.
The cap of the bottle closed tight,
But a mother’s tears opened without end.
This crime isn’t caged within factory walls —
It lives in the corners of our carelessness.
Every unchecked vial, every signed lie,
Can steal a child’s breath —
Don’t we know that?
Medicine was meant to be hope.
When it turns to poison,
Where can humanity run for shelter?
O God, you were meant to save mankind,
But now, mankind manufactures its own death.
In the mother’s hands remains a bottle,
And a memory —of a soft voice that once said,
“Amma, I’m fine.”
(Author is prominent Pharmacist)