Health Chief took the witness box in the tragic 2022 Acute Kidney Injury (AKI) outbreak, which claimed the lives of dozens of Gambian children before Justice Jaiteh.
Dr Mustapha Bittaye, the current Chief Medical Director of the Edward Francis Small Teaching Hospital (EFSTH), appeared as the third defence witness (DW3) to provide testimony on the government’s response to the crisis.
The lawsuit centres on the consumption of four contaminated medicinal syrups—Promethazine Oral Solution, Kofexmalin Baby Cough Syrup, Makoff Baby Cough Syrup, and Magrip N Cold Syrup—manufactured in India and imported by the second defendant, Atlantic Pharmaceutical Company.
In his sworn statement, Dr Bittaye, who served as the Director of Health Services during the outbreak, testified that his involvement began on July 27, 2022, after receiving an urgent call from a pediatric specialist regarding a “rising pattern” of AKI cases with an “unusually high fatality rate”.
He stated that he immediately instructed the Epidemiology and Disease Control (EDC) Unit to launch an investigation. Dr Bittaye highlighted that the investigative team initially faced “access challenges”.
He noted that the Head of the Department of Paediatrics initially believed the spike in cases was simply the result of improved detection by a newly recruited specialist.
Dr Bittaye further stated that his office had to issue formal letters authorising full access to the hospital before the EDC team could begin their work the following day.
Dr Bittaye pointed out that the outbreak occurred while the country was experiencing severe flooding in areas such as Tobacco Road, Bakoteh, and Basse. Dr Bittaye testified that, due to these conditions, the initial assumption by health officials—including the President and the Minister of Health—was that the outbreak was a waterborne diarrheal disease caused by bacteria.
To address the issue, Dr Bittaye stated the Ministry adopted a “two-pronged strategy”. The Ministry tested wells nationwide to address potential bacterial or viral infections.
He said as a precaution, a directive was issued on September 7, 2022, to suspend and quarantine paracetamol syrups pending laboratory results. Dr Bittaye further stated that early laboratory results from Senegal did not initially indicate the presence of diethylene glycol (DEG) or ethylene glycol (EG).
Despite these early results only showing paracetamol, Dr Bittaye testified that the Ministry continued to pursue external verification by sending samples to different countries for toxicological testing.
He highlighted that it was only after the overseas tests that the Ministry was able to confirm the presence of contaminants in certain cough and promethazine syrups. Once confirmed, Dr Bittaye noted that a national recall exercise was promptly conducted to remove the drugs from all pharmacies and hospitals.
In his written statement, Dr Bittaye stated that the cause of death for the victims was not always related to the consumption of the contaminated syrups. He highlighted that even the World Health Organisation (WHO) stated the deaths “may be associated” with the syrups but that the link was “not conclusive”.
Dr Bittaye concluded his testimony by stating that the Ministry of Health and its officers acted in “good faith” and in the public interest based on the best available information at the time. He also pointed to long-term reforms, such as the establishment of a new laboratory and a pharmacy school, as evidence of the government’s commitment to strengthening regulatory oversight.
The atmosphere grew tense as Counsel L. Farage began the cross-examination.
Below is the verbatim cross-examination of Counsel L. Farage.
Counsel Farage: Can you explain your duration of working with the hospital?
Dr Bittaye: I have been in the medical field since 2006.
Counsel Farage: Did you have any outbreak of acute kidney injury?
Dr Bittaye: I am not certain about the date of the outbreak. I cannot be specific on the number of AKI outbreaks in the hospital, but AKI occurs many times.
Counsel Farage: Was this outbreak reported?
Dr Bittaye: I cannot tell whether the outbreak has been reported or not.
Counsel Farage: Provide proof of the cause to this court.
Dr Bittaye: The number of children was not established. During the occurrence of AKI attacks, there was flooding in the country which might be linked to it, from June to October 2022. We came to realise that the outbreak was connected to diarrhoea beyond the flooding which contaminated the waters.
Counsel Farage: Flooding occurred in 2021, but nothing like AKI happened then. Can you tell the court the number of children who died due to AKI before?
Dr Bittaye: I cannot tell whether there were cases or not. An expert called Professor Vivian detected that children’s acute conditions might be linked to paracetamol consumption. I was notified about the deaths around July 2022.
Counsel Farage: Can you tell the court the number of dead around September?
Dr Bittaye: I cannot remember it off-hand.
Counsel Farage: Where was the laboratory test conducted?
Dr Bittaye: It was conducted in the Gambia, but the analysis was done in Senegal and Ghana. Drug samples were sent to Senegal and Ghana.
Counsel Farage: You were aware of which drugs were contaminated but refused to reveal the names of all the drugs.
Dr Bittaye: I have no knowledge about it.
Counsel Farage: Around September, the Ministry of Health already knew who the culprits were in this case.
Dr Bittaye: I was not aware of it until the President made a statement about it. I cannot answer for the MCA (Medicines Control Agency).
Counsel Farage: Are you aware that Atlantic Pharmaceutical Company was named in the report from the MCA?
Dr Bittaye: I was not aware of that fact. We engage in risk assessment which could have legal implications for us by calling names without any evidence.
Counsel Farage: What about the systemic issues within the MCA?
Dr Bittaye: There are significant capability problems, human resource gaps, and equipment shortages affecting the health sector.
Counsel Farage: Was there a conflict of interest in drug registration?
Dr Bittaye: Personal interest in conflict was affecting the MCA because some MCA staff members are part of the affected group. Most employees of the MCA own pharmacies.
Counsel Farage: Did this affect the agency’s oversight?
Dr Bittaye: We perceive that there was a conflict of interest in the MCA and separation of powers was not ensured. We have now put laws in place to enhance this.
Counsel Farage: You are a witness being cross-examined on your own tendered document. It is abnormal for you to forget relevant periods linked to this case. Be better prepared for the next date.
Dr Bittaye: I cannot say things I do not know. By October, we realised it was 27 dead, and by November it reached 83 dead. Dr Bittaye asserts that the Ministry acted on the best available information and that long-term reforms, including a new laboratory and a pharmacy school, are underway to prevent such a tragedy from recurring.
The case is adjourned to February 26, 2026, for the continuation of the cross-examination.
