Anand Gopal

It faces one of the world’s fastest-rising rates of drug use

KABUL, AFGHANISTAN - When Muhammad Nasir returned to his native Kabul after the fall of the Taliban, he was hoping for a fresh start after years in exile. A certified carpet weaver, the thirty-three year-old managed to get a job and planned to move in to a new home and raise a family.

But today Nasir lives in an abandoned building on the outskirts of the city, victim of what aid agencies say is the fastest growing epidemic in the country, drug abuse.

“I use a gram of opium a day,” Nasir says. “I don’t have the money to get new clothes, so that I can get a job. Would you hire me if I looked like this?” he asks, pointing to his filthy tunic and torn sandals.

Nasir lives with close to seventy other addicts in a field of rubble on the outskirts of town, a former Russian cultural center ravaged by years of war and neglect. Here, in a mass of smashed and toppled concrete, the fragments of some buildings rise abruptly from the earth like Roman ruins, while the skeletal remains of others stand at a state of near collapse. Inside what used to be a Russian cinema house, scores of addicts sleep in flour sacks and smoke in front of a large print extolling the virtues of Soviet culture.

It is one of the most dangerous, least-visited parts of town - police say two people were stabbed to death here just weeks ago - but a growing number of addicts call this home.

A soaring drug trade and a surge of returnees from neighboring countries is giving Afghanistan one of the sharpest-rising drug abuse rates in the world. The United Nations Office of Drugs and Crime (UNODC) estimates that up to one million of Afghanistan’s 34 million are drug users, and that the majority of these live in the country’s principal cities.

Afghanistan is the opium capital of the world, responsible for 92% of global output. The UN agency values the total amount of opium produced at $4 billion, accounting for 53% of the GDP and making drug production easily the most lucrative Afghan industry. The agency also reports that nearly one in ten Afghans have a hand in the illicit trade.

“When people cultivate poppies they don’t wash their hands, and they feed their children with these hands.” says Zalmai Afzari, spokesperson for the Afghan Ministry of Counter narcotics. Afzari notes that seven percent of the nation’s addicts are children and 13 percent are women.

But the majority of the addicts are men who have returned after spending years as refugees in Iran, which has one of the world’s highest addiction rates. “The returned refugees, who started using in Iran, have come back to a difficult situation,” says Jehanzeb Khan, head of the UNODC’s Afghan Drug Demand Reduction Program. “They return home to face uncertainty, post-traumatic stress, joblessness and growing availability because of increased drug production.”

For Nasir and his friends, the lack of government funds - Kabul has only one state-funded treatment clinic -and unstable economy offer little hope. “If I can’t find drugs, I get pain all over my body and I feel like I want to kill myself,” Nasir says. “I want to stop using. But we need help from the government - we need a place to sleep, and we need a hospital.”

Just down the road, hidden in a muddy alley off the main highway, the Nejat Center is attempting to do just that. In a tiny room on the center’s second floor sit about a dozen men, bone thin from years of heroin use and with heads cleanly shaven as a mark of their patient status. Rachman Farouk, 32, started using when he was in Iran. “By the time I came back to Kabul, I was addicted,” he says. “I started smoking in my home, and my children became very ill. After seeing my children suffer, I knew that I had to get better, so I came here.”

“We take people in from the streets, give them a hot shower, new clothes and cup of tea,” says the center’s director, Dr. Tariq Suliman. The staff gives a three-week course to all patients on drug awareness, teaching patients the root causes of addiction and coaxing them to confront their problem. In the subsequent two weeks, doctors administer direct treatments to wean patients off their dependency, and the staff assigns a social worker to follow up with every successful case for up to one year.

While the Nejat center is a boon to those who come to convalesce, a dearth of funds and paucity of clinics like this one mean very few of Kabul’s addicts ever recover. “We only have twenty beds,” says Dr. Suliman. “Most of people who come here for treatment have to sleep in the street or at the Mosque. In addition, only about 100 of Kabul’s 50,000 addiction cases are receiving treatment.”

Like many other clinics in the country, Nejat stays afloat completely by foreign donors. Although some funds come through U.S.-government related programs like USAID, Washington’s supply-side reduction policy - pressing the Karzai administration to spray opium fields and coaxing farmers to plant alternative crops - means that NGOs and the UN bear the brunt of Kabul treatment-clinic funding.

But without more government support, extensive treatment programs are difficult. “We don’t have a long-term treatment program,” Dr. Suliman says. “There are no donors for us to start a program for women and children, and we don’t have a vocational training program.”

Minus vocational training and job prospects, difficult to come by in such a poverty-ravaged and war-torn nation, experts worry that demand-reduction efforts are leaving the underlying causes of addiction untreated.

After twelve years of abuse, this is Ibrahim Mankhel’s prime concern. Mankhel, 64 and now addiction free after passing through Nejat’s program, says “I now have a family. I have three children so I need a job to support them. I just hope there are jobs available, I hope someone somewhere will hire me.”