Weak and sunken-eyed, 51 year-old Multen Khan can barely sit upright on his bed. Unable to pay for his own medication, the former labourer and now heroin addict from Afghanistan’s central province of Kapisa was forced to go “cold turkey” the night before, dropping into unconsciousness three times before doctors were able to revive him. Within the intensive care unit of Afghanistan’s only drug rehabilitation centre, Khan is considered “lucky”. Eight other addicts were turned away the same night for lack of beds. Repatriated six years ago from Iran, where he had become addicted to heroin, Khan, like thousands of others in impoverished Afghanistan, is just one of the victims of the growing problem of drug addiction - the country’s newest plague.
“I spent all my money on heroin,” the father of four told IRIN. “My brother brought me here seven days ago. He brought me back from Iran after he learned of my addiction problem.” Now destitute and desperate for assistance, he says he only wanted an escape from the sadness of daily life.
For many Afghan refugees living in Iran and Pakistan, as well as those displaced within Afghanistan, heroin, opium, hashish and other drugs offer an escape from grim reality. Unable to cope with the immense suffering and loss inflicted by years of war, thousands have become addicts, a fact that is raising growing concern among both UN and Taliban authorities.
“Addiction is definitely on the rise,” Abdul Hamid Akhondzadah, director of the Islamic Emirate (Taliban) High Commission for Drug Control and the most senior official in this field, told IRIN in Kabul. While unable to provide precise figures as to the scale of the problem - pending a survey by the High Commission - Akhondzadah estimated that about 500,000 Afghans living in the country and in neighbouring Iran and Pakistan, were addicts.
He said the problem first surfaced in the last years of the communist regime of former Afghan president Najibullah. “At the end of the communist regime there was no control over anything and the usage of drugs among soldiers in the army was particularly prevalent.”
The situation continued under the Mojahedin in the early nineties, and worsened with the repatriation of thousands of Afghan refugees from neighbouring countries. “Most of the addicted are the repatriated refugees coming from Pakistan and Iran, where they lived in camps under great economic and social pressures,” he said. “When these addicts returned to their rural villages of origin, many of them introduced these drugs to their families and friends,” he said.
According to the United Nations International Drug Control Programme (UNDCP), nearly 40 percent of drug users began their habit in neighbouring countries like Pakistan and Iran, either as economic migrants or refugees fleeing war and conflict. The finding that friends and peers were the main impetus for new addicts illustrates the importance of drug abuse prevention programmes for refugees before they return home.
According to a recent UNDCP report, despite a ban on drug use and the criminalisation of the practice by the Afghan authorities, drug use is increasing due to easier access, unemployment, poverty, “sadness”, and “mental pressures” resulting from war-related trauma.
According to Dr Abdul Ahad Awarah, director of the Kabul mental health hospital, the leading forms of addiction were heroin, followed by opium, injection drugs, analgesic pain relievers, cannabis, prescription drugs, and even addiction to glue and shoe polish. Hospital records since January revealed 106 cases of heroin dependency and 37 cases of opium dependency, the majority of them men. Eighty percent of the heroin cases involved Afghans who were recently repatriated from Iran and Pakistan, where they had been introduced to the drugs.
Resources at Afghanistan’s only drug rehabilitation centre were next to nonexistent, the 40 year-old, Moscow educated doctor said. The centre could barely accommodate 12 cases at a time, and patients and their families were required to bring their own medicine. Awarah said efforts were being made to improve the centre and increase its capacity, but resources were inadequate.
Meanwhile, back inside the clinic, the problem of drug addiction and the damage it was doing to Afghan families and society were more apparent. Chained in his bed, 22 year-old Mohammad Zayan from Afghanistan’s northern Kunduz Province wondered if he would ever be able to rid himself of his need for opium. Asked why doctors had been forced to chain his feet together for the past nine days, his 38 year-old cousin, Karimullah, lying in the next bed, said: “We didn’t have any medicine, and he kept running away. What else could we do?” Karimullah was also being treated for opium addiction. Amid the clutter of the clinic’s foyer, 19 year-old Wahidullah and his 50 year-old father, Habibullah, from the central province of Parvan, were awaiting treatment for opium and glue addiction. Despite having to lie on soiled torn blankets in the clinic’s reception area, the father and son said they were “happy” and considered themselves “lucky” to be receiving what little treatment was available. “I spent all my money on opium,” the father and former vendor told IRIN. “Now I have nothing - look at me.”
UNDCP drug control specialist David Macdonald cited an “endless list” of concerns over drug abuse in Afghanistan and its serious socioeconomic consequences, including a reduction in an already marginal family budget, and the dangers posed by women using opium in pregnancy. The priority was to conduct an accurate survey on drug addiction in the country. He said, however, that it would be difficult to obtain accurate data and figures on drug abuse. “One reason for this lack of information is the Taliban policy of criminalising drug addicts and having them arrested and punished. In such a context, drug addicts are not socially visible and drug use has become a hidden activity.”
Culturally and socially, a sense of shame is still attached to drug abuse in many rural parts of Afghanistan, so community leaders are hesitant to disclose accurate information on usage. What is even harder in Afghanistan is identifying female drug users, although evidence from refugee communities in Pakistan has proved that women are a high-risk group. “How, for example, do you find out how many women misuse tranquillisers in Kabul?” Macdonald asked. According to one social worker, “drugs are like vegetables here - very cheap and infinitely available”.
Combating addiction in Afghanistan is hampered by a lack of funding. Within its limited resources, however, UNDCP has been able to upgrade a drug dependency treatment centre in Kabul’s mental hospital and to produce drug abuse prevention resource material in the local languages of Pashto and Dari. UNDCP has also conducted drug abuse prevention training workshops for various NGOs and agencies. In the new Akora Khattak refugee camp near Pakistan’s western city of Peshawar, a UNDCP-funded community drug treatment centre last year detoxified over 200 addicts, 108 of them women. The agency is also funding a daycare centre for Afghan heroin addicts, providing them with health care, food, washing facilities and motivational counselling.
According to Akhondzadah, Taliban officials in the meantime are performing their role. “Everything that the Islamic Emirate can do regarding the problem is being done, but our resources and possibilities are very limited.” Macdonald maintained that the Taliban could improve matters by revising their policy so as to redefine drug addicts as fellow citizens in need of treatment and help, as opposed to criminals deserving of punishment.