Addiction to drugs is an often underestimated phenomenon in Afghanistan. Thousands of people become addicted to drugs every year in a country that is the world’s major producer of opiates, although many of them developed the habit while living abroad as refugees. In Kabul, they concentrate in western areas of the city, living in veritable ‘townships’ under the bridge of Pul-e Sukhta and other nearby bridges. Their plight is only marginally mitigated by the assistance that state medical facilities and non-governmental organisation (NGO) programmes offer. For a majority of Kabul residents, the addicts have come to constitute a social danger or a source of shame to be ignored, reports AAN’s Qayum Suroush.Under Pul-e Sukhta bridge. Photo: Qayoom Suroush
On Pul-e Sukhta, a large bridge crossing odorous, mouldy Kabul river in a dusty, crowded area in western Kabul, people stand along the railings to stare at something underneath it. They are looking at the hundreds of heroin addicts camping under the bridge. Local journalists call this place Shahrak-e Muta’adin (‘addicts’ township’ – mocking the term used for residential areas developing all over Kabul) (see here). Shahrak-e Muta’adin has given shelter to heroin users from different provinces of Afghanistan for years now.
Twenty-four-year-old Abdulhaq is one of the ‘residents’ of the shahrak. He is from Baghlan and has been using heroin for two years; he started doing so when in Iran, mainly to face long working shifts. For the past six months, he has been living under the Pul-e Sukhta. When the author, an AAN writer, asks him if he plans to stop using drugs, he replies that he has no reason to do that. “I am done,” he adds. “No one, including my relatives and the society will accept me anymore. They have forgotten about me, as if I had never been born.”
On the other side of the bridge, two young men in dirty clothes and wrinkled faces have come out to catch some sunshine and beg from pedestrians. Twenty-two-year-old Ali is from Bamyan and Mahdi, 20, is from Daikundi. Both also started using drugs while in Iran. Ali, an addict for five years now, says that he started mainly because he had been longing to earn better wages and thought drugs would help him work even longer hours. After a while, he adds, opium no longer worked, so he started using the “white drug.” Gradually, the drug paralysed Ali, and when he was not able to work anymore, the boss “threw me out on the street.” Then, the Iranian police caught him and sent him back to Afghanistan. Ali’s family still lives in Iran; one of his brothers went to France as a refugee. He regularly asks pedestrians to lend him a cell phone so that he can call relatives and ask them to send money. The author offers him a phone and he calls his father in Iran. The father’s response, Ali says, when returning the phone, is that he can not send any more money. Ali’s friend Mahdi tells the AAN writer that Ali’s family sent money several times so that Ali could go back to Iran or get treatment. But each time, Ali used the money to buy drugs.
At least 300 addicts are living under the bridge, and many more under other city bridges like Pul-e Jumhuriat or Pul-e Doctor Mahdi, both in western Kabul. The 300 only include those who spend all the hours of their days under the putrid bridge, but the author observes many clean-clothed people vanishing under it, apparently to take their daily dose and then leave. In one case, a well-dressed, white-bearded man gives money to an inhabitant of the bridge settlement and waits on the bridge until the man returns and passes him a pea-sized amount of heroin. The addict later tells the AAN writer that the old man is ashamed to go under the bridge and buy heroin himself and regularly gives money to the addict to buy heroin for both of them. In contrast, Ali says some heroin users never leave the place under the bridge. And in some cases, people come and buy drugs for an addicted family member.
Two-to-four die every month
Many of the people under Pul-e Sukhta inject heroin, which increases the risks of HIV, hepatitis and other diseases because individuals share syringes. Shahpur Yusuf, deputy director of the Department for Reducing the Demand for Drugs at the Ministry of Public Health told the AAN writer that their staff is distributing dozens of new syringes for these addicts weekly, but the writer observed that they continue to use old syringes and exchange them with each other. As a result, many are sick, and according to some of the men living under the bridge, every month two-to-four of them die. The number of deaths increases in winter when the addicts do not have sufficiently warm clothes or heating material.
Laila Haidari heads Life is Beautiful Organisation (Zendegi Ziba ast), which gives addicts shelter and food and helps them to recover. She says the conditions under Pul-e Sukhta bridge are so dire that “even dogs will not go” there. But since there are not enough shelters for addicts, many are forced to stay under the bridge. An ex-addict told AAN that just crossing Pul-e Sukhta, located on a main road used daily by thousands of people, is “dangerous for persons who have stopped using drugs, because the scene there stimulates them to try drugs again and increases the chances of relapse.” Aref Rahmani, an MP from Ghazni who lives near the bridge and crosses it every day on his way to work, told AAN that the increasing number of drug users is like “a silent tsunami that threatens the health of our society.”
Inside ‘addicts’ township,’ heroin and other drugs are sold and distributed as naturally as if they were legal. The distributors, whom the addicts call ‘Saqi,’ (an Arabic word literally meaning ‘someone who brings water,’ but in Persian poetry meaning He Who Pours Wine, often a metaphor for the rapturous intoxication of love) come to the bridge from different parts of Kabul city and sell their goods. The saqis are petty drug sellers who can buy up to one kilogram of heroin, which, according to one source, they buy for around 75,000 Afghanis (around 1,300 US dollars). The price of heroin in Pul-e Sukhta is 90 Afghanis for a pea-sized portion (yak nakhod). This author was told that four of such packages weigh one gram, making the price a little higher than the average market price in Afghanistan (see here for drug prices in Afghanistan).
A saqi talking to AAN on condition of anonymity said he got drugs mostly from Karte-e Now, in southeast Kabul, and Shahrak-e Arya, close to Kabul airport. Sellers, he said, have their own networks inside the police ranks that allow them to transfer drugs safely from the other side of the city to the ‘township’ under Pul-e Sukhta. But saqis must pay the individuals in the network to keep it working. According to the saqi, around 20 per cent of the net income of the drug deals goes to the ‘security network’, during ‘lunches’ that they offer to higher officials.
The saqi compared ‘addicts’ town’ to the stage of an old-fashion Bollywood movie: the addicts are actors, saqis are suppliers, and the security officials are the directors. “People only see the actors and hence hate them but they are unable to see the bigger picture of suppliers and directors behind them,” he added.
AAN also talked to security officials of Kabul’s District Six to which the area of Pul-e Sukhta belongs. An official who asked not be named said that stopping the supply of drugs in town was nearly impossible, since the suppliers had connections with high-ranking government officials. “You arrest these suppliers, but their connections have them released and in the end you find yourself behind prison gates,” he said.
An eight per cent increase in adult drug users
Two Afghan ministries – the Ministry of Counter Narcotics (MoCN) with its Drug Regulation Committee and the Ministry of Public Health (MoPH) with its Department for Reducing the Demand for Drugs – in cooperation with other governmental agencies are directly involved in the struggle to decrease drug use in the country and the harm it causes for users. Some national and international NGOs are also working for the treatment of addicts.
According to a United Nations Office on Drug and Crime (UNODC) report, there were around one million drug users between age 15 and 64 in Afghanistan in 2009 – which is 8 per cent of Afghanistan population, a rate “twice the global average.” In this context drug users include those who take cannabis, opium, heroin, opioids or painkillers and tranquilizers. A report from 2010 repeated the number of one million, but detailed that 120,000 of them used heroin. In November 2013, according to the New York Times, the statistics showed 1.6 million drug users. According to Shahpur Yusuf, deputy director of the MoPH’s Department for Reducing the Demand for Drugs, the number of adult drug addicts has increased by 8 per cent in recent years. He said that the main reasons for the high rate of adult drug addiction in Afghanistan are “the decades of civil war, poverty, unemployment and the lack of sports facilities and other venues where youth can release their energies.”
The treatments available
Shahpur Yusuf also told AAN that there are 107 centres for treating drug addicts in state clinics across the country, with a shared capacity of 32,000. A vivid example of the lack of facilities to treat drug addicts is Kabul and its ‘addicts’ town.’ The only working public hospital available for drug treatment is Jangalak state hospital with 120 beds, which offers a 45-day treatment plan. But according to Yusuf, the hospital can accommodate only 300 addicts at any given time and has only seven doctors, four psychologists and four nurses. This means that even if all doctors are at work at the same time, they care for more than 40 patients each, and the psychologists visit 75 patients per day (read here).
According to Yusuf, for each period of treatment the hospital admits 150 addicts drafted from a ‘waiting list,’ of those who volunteer for treatment or who are registered by family members. Another 150 are addicts collected from the streets and under bridges by the MoPH and MoCN, who volunteer to go for treatment and try and give up drugs (see here). The real problem, however, is the high number of addicts in Kabul city. According to the MoPH, around 750 addicts in Kabul city need shelter at all times, but the government only has the capacity for 150 of them.
The approach to treatment in Jangalak hospital is according to the ‘old-school’ method; according to Yusuf, who supervises the programme during the first week of treatment, addicts gradually reduce their drug doses. In the second week, they start a detoxification process with the help of medicines to stop using drugs, and then for one month they go through a rehabilitation process. Yusuf added that the MoPH works in close cooperation with the Ministry of Labour, Social Affairs, Martyrs and Disabled (MOLSAMD) to organise vocational training for addicts who leave the hospital and who need a job to decrease the temptation to return to drugs. According to MOLSAMD spokesman Ali Eftekhari, around 600 ex-addicts have been trained at a MOLSAMD centre. The trainees, depending on their gender, learn vocations: men are trained to become carpenters and electricians, while women are trained as hairdressers, dressmakers and the like.
Moreover, the MoPH sends its staff to follow up four times a week to make sure the treated addicts do not return to drugs.
But the results of the treatment are not satisfying. According to Yusuf, although the hospitalisation of one addict for 45 days costs the government a lot, there is a 40 per cent relapse rate for those treated at Jangalak hospital. For all of Afghanistan, 70 per cent of those treated relapse, according to the MoCN. Yusuf thinks that treatment with methadone, which is widespread in Western countries and was tested by the MoPH on 75 addicts in Afghanistan with “satisfying results,” would be better than the currently used method. With methadone, addicts gradually stop using opiates and instead take a certain amount of methadone which is “a synthetic agent that works by occupying the brain receptor sites affected by heroin and other opiates” (see here for more info). But such an approach has pros and cons: supporters insist that methadone treatment is the most effective for opiate addiction while its opponents claim that it just creates another kind of addiction (see here).
Yusuf believes methadone treatment is a kind of “safe narcotic,” without any major harmful effects to the body, that reduces the criminal activities of the addicts, because the users remain fully conscious of their actions. Yusuf and his colleagues are now advocating for methadone maintenance treatment in the Drug Regulation Committee in Afghanistan. But both Yusuf and the committee have concerns about the possibility of methadone leaking into the black market and the emergence of a new generation of addicts, this time to methadone. Thus the government would need to adopt strict measures for the distribution of methadone and possibly administer it only under the control of doctors.
Apart from the government, some NGOs work on treating the addicts under Pul-e Sukhta, though each runs its own programme and there is no cooperation among them. In particular, Life is Beautiful Organisation (LBO) has been working there for the past four years. LBO head Laila Haidari also established the Taj Begum Restaurant at Pul-e Surkh, also in western Kabul, where she hires former addicts as staff and uses the restaurant income for her addiction treatment facility, the “Mother Camp.”
In August 2013, LBO launched a public campaign to collect funds and attract people’s attention to the need to treat addicts under the bridge (see here and here). The campaign, however, did not effectively change the situation in terms of relocating the addicts from under the bridge or dismantling their ‘township.’ Haidari told AAN that her organisation uses the Narcotics Anonymous (NA) treatment approach in her camp, which has a capacity of 20 to 30 patients at a time. In this approach, the addicts do not receive any medicine and stop using drugs with a 12-step treatment approach (for more info see here, and here). Throughout the NA treatment, LBO conducts weekly Skype conferences among its members across the world and there, ex-addicts share their experiences to help other members quit doing drugs. According to Haidari this treatment approach works only for addicts who are “mentally ready to stop.”
Two years ago, the LBO established a separate camp for treating dozens of female addicts, but Haidari said that pressure from the community and local officials forced her to close it. Haidari said officials argued that such a camp was against Afghan cultural values and “motivated moral crime” (a reference to allegations of prostitution) in the community. But she believes the pressure to close the camp was mainly because people do not have the courage to accept that even women can become addicts, and thus they try to simply hide the fact.
“They hate us”
Asking Yusuf and Haidari why the Afghan government was not removing the addicts from under the bridges and accommodating them elsewhere, both said that since addiction was a sickness not a crime, forcing patients into treatment was against human rights. Yusuf told AAN that the MoPH has an awareness team that regularly visits the addicts under the bridge and “encourages” them to stop using drugs. In the same manner, Haidari said she accepted for treatment only those addicts willing to stop using drugs.
In a sense, such a passive approach may be one of the main reason for addicts to keep living under the bridge. The Afghan government and the NGOs working on addicts have some possible reasons to change their approach and try more proactively to convince them to go under treatment:
First, some research argues that addiction can cause mental inability, because “while a person initially chooses to take a drug, over time the effect of prolonged exposure [to a drug] on brain functioning compromises that ability to choose, and seeking and consuming drugs becomes compulsive, often eluding a person’s self-control or willpower.” This means addicts cannot always be relied on to willingly join treatment; rather the government should help them to recover and find the ability to give up using drugs.
A second problem is logistical: an addict visited by the MoPH team may express the wish to stop using drugs at a moment when the treatment programme is halfway through, reception capacities are exhausted, and no treatment is available. As “potential patients can be lost if treatment is not immediately available or readily accessible,” the immediate availability of treatment services at the very moment people are ready for treatment is crucial, as indicated by the same research by the National Institute for Drug Abuse.
Third, the presence of large groups of addicts in a community has side effects. People living around Pul-e Sukhta are tired of the ‘addicts’ township’ for many reasons. According to residents of the neighbourhood, the addicts harm locals and passers-by and encourage people around them to try drugs, too. The author noticed that many onlookers on the bridge expressed disgust about the addicts beneath. While interviewing them, the author was shouted at by an old woman: “Get out from under the bridge! You are a human being; why did you go there? These addicts will make you a drug user, too.” One heroin user commented, “There are some addicts here who months ago were standing on top of the bridge, spitting down on us. Now they are under the bridge and injecting heroin.” Addicts also told the story of a boy who had been selling fruit on the bridge but then got addicted and joined the people under the bridge.
Fourth, the addicts sleeping under the bridge are unable to work and thus do not have an income. As they need to buy expensive drugs, they have turned to stealing. They become pickpockets or steal car mirrors, fruit, clothes and literally anything on sale in the area. An ex-addict told this author that he was now ashamed to walk on the streets around the bridge because “all the shops remind me of what I stole from them; as I walk on the street, I remember that I stole a shoe from here, a jacket from there and mirror from the other.”
Consequently, such habits have alienated drug users from the community. The people now treat them as criminals and do not allow them to enter their shops or houses or even the mosques. An addict said that people no longer offer them food from wedding parties, or khairat (alms), which in Islam are literally meant to support the poor and beggars. “They hate us,” he said.
This article was last updated on 9 Mar 2020