This research analyses the role and action of the Trade Related Intellectual Property Agreements (TRIPS) and pharmaceutical patents in the public health network of Djibouti, by using an approach largely inspired by actor-network theory (ANT). In doing so, it addresses issues that run beyond the specificities of this case study and relate more broadly to the relevance of ANT to socio-legal analysis. The relation between TRIPS, pharmaceutical patents and public health in developing countries has been a widely debated issue in the past decade. However, the field remains limited by a relative uniformity in the range of approaches and case studies chosen in existing research. This project aims to address some of these limits, by looking at the role of TRIPS and pharmaceutical patents in a small country with no local pharmaceutical industry, no pre-existing official system of intellectual property, and with a largely undocumented public health system. Using ANT in this project allowed for the complexity of the mechanisms of both TRIPS and pharmaceutical patents to be highlighted. It participated in emphasising that they need to be understood as made of multiple, co-existing dimensions. By demonstrating how specific connections and associations have shaped what TRIPS and pharmaceutical patents are and do in the networks of Djibouti, this research emphasises the artificiality of the dichotomy between social and legal, and proposes an understanding of social connections as symmetrical and co-dependent. It discusses the more general relevance of this approach to socio-legal research. The example of Djibouti also allows for new questions to be raised in relation to the actual impact of TRIPS and pharmaceutical patents in “developing countries”. In particular, it emphasises the need to return to a more balanced approach to the relation between pharmaceutical patents and health in poor countries.