- The Washington Times - Sunday, August 10, 2008

— Shereen placed a ball of pure opium on a small piece of foil she pulled from a cigarette pack. Balancing the foil with shaky hands, she heated the bottom until the paste turned to crystal, sending sweet smelling smoke through a dangling cigarette deep into her lungs.

After a second hit, a whimper escaped her parched lips.

“I can’t tell how long I’ve been using,” said the woman, her hands now steady as a calm spread outward from her glazed eyes, warming her entire body from head to toe.

Dr. Hakim Shaesta looked on, helpless, throughout the entire episode that took place in Shereen’s tiny home in a run-down neighborhood of Kabul known for the crime that often accompanies opiate addiction.

Shereen accepted some vitamins from Dr. Shaesta, a female physician who runs the Sanga Amaj drug treatment facility for women.

If only she could get Shereen to the center, she could do so much more. She could help Shereen through the terror of opium withdrawal, the paranoid delusions, cold chills and hot sweats, the ribs aching from dry heaves that continue long after convulsing spasms of vomit leave the stomach empty.

As the pain of withdrawal eased, Dr. Shaesta would be there to help Shereen resist the call of opium, which sells for pennies, cheaper than the tobacco needed for a single cigarette.

“My husband won’t let me go to the clinic, and if he knew anyone was here he would kill me,” said Shereen, who like many Afghans, uses one name.

Nearly seven years after the Bush administration ousted Afghanistan’s fanatic Taliban rulers, a growing curse of opium addiction reflects an unintended consequence of America’s attempt to prevent another Sept. 11 attack.

It grips men, women, children and even tiny babies, who are fed opium to ease hunger when no food is available.

First lady Laura Bush has made the liberation of Afghan women a personal cause, especially opening schools for girls who were forbidden by the Taliban from learning to read and write.

“More than 5 million children are in school, almost 2 million of them girls,” the first lady told the U.S.-Afghan Women’s council roundtable at Georgetown University earlier this year.

With the future of Afghan women and girls close to her heart, Mrs. Bush delivered a similar message during a brief visit to Afghanistan in June. Yet it is difficult to imagine Mrs. Bush or any U.S. official protected by layers of security ever seeing women and children addicts imprisoned in sun-baked mud homes by overbearing male relatives.

Hidden plague

Nevertheless, Afghan and U.S. narcotics officials, human rights activists and Afghan intelligence personnel interviewed by The Washington Times are beginning to take notice.

“It’s got to be a concern,” said Richard Boucher, undersecretary of state for South Asia.

A slight drop in Afghan opium production is expected this year from 2007 levels, but “it’s still horribly high,” Mr. Boucher said during a recent visit to The Washington Times.

Afghanistan produced last year an “extraordinary 8,200 tons of opium, 34 percent more than in 2006, becoming practically the exclusive supplier of the world’s deadliest drug, 93 percent of the global opiates market,” says a 2008 report by Afghan and U.N. drug officials.

While most of the drugs are for export, a reporter and photographer for The Times, both women, witnessed and recorded dozens of scenes of women and even children ingesting opium.

“When I hear the U.S. and my government claim they have liberated Afghanistan my heart drops; it’s simply not the truth,” said Wazma Frogh, an Afghan citizen and country director for Global Rights, a nonprofit advocacy group for women.

Thomas Schweich, a former Bush administration ambassador for counternarcotics who now works with the U.N. Office on Drugs and Crime, is even blunter.

“People just don’t want to know the truth,” Mr. Schweich said.

There are nearly 1 million known addicts in a nation of roughly 30 million, according to a survey conducted in 2007 by the Ministry of Counter Narcotics and the U.N. Office of Drugs and Crime in Kabul.

According to the report, 120,000 of the addicts are women and more than 60,000 are children. Even more alarming, the report warns that addiction rates for women are probably much higher in a nation where women rarely show their faces in public.

A paucity of treatment facilities and cultural barriers make it difficult, if not impossible, for women to seek professional help.

Dr. Shaesta’s Sanga Amaj clinic receives funding from the U.S. State Department’s International Narcotics and Law Enforcement Affairs Division and the Colombo Plan, a consortium of 25 nations that promotes economic and social development in Asia and the Pacific.

The facility has the capacity to treat only 20 adults and offers no services or beds for children, who frequently accompany their mothers and, in many cases, also are addicts.

“The majority of women are treated at home,” said Mohammad Nasib, managing director of the Welfare Association for the Development of Afghanistan, which works with the clinic in Kabul but has its own treatment facilities in Paktia, Helmand, Ghazni and Nimruz provinces. “This makes treating them very difficult. The situation in Afghanistan is difficult and the drug crisis grave.”

The suicide option

Nasima, 23, tried to kill herself with rodent poison when her opium addiction became too overwhelming. When interviewed by The Times, she held her 9-month-old nursing child, Hatifa. Hatifa and daughter Fatima, 5, shared her bed at the Sanga Amaj clinic.

All three suffer from opium addiction and have been at the clinic for 20 days, after 30 days of home treatment. Thousands of addicts are on waiting lists for treatment.

Dr. Shaesta said that many times women are forbidden to seek treatment by their immediate families in a culture where honor and shame readily become life and death issues.

“This only makes it worse. In reality, we have a difficult time knowing how many addicts there really are. The situation grows worse by the day and in the last few years has become more unbearable.”

Many of the more than 40 women interviewed by The Times for this report said they were forced or pressured by their husbands or employers to start using opium as a pseudo-medicine for an unrelated malady.

Others said they turned to drugs because they could no longer bear the misery of daily life, which too often is filled with abuse and hunger.

Shereen, for example, describes her own life as “struggle upon struggle.” Sitting on a worn outbed thatnearly filled her one-room apartment, she said her husband would probably return home “any minute” and “beat me again.”

Seconds after inhaling the opium, however, the fear dissipated as waves of drug-induced relaxation took control.

Dr. Shaesta returned to the clinic, conscious that there was nothing more she could do.

Beyond Kabul, a large billboard looming over the desolate highway leading to the northern city of Mazar-e-Sharif provides a tiny hint of recognition that Afghanistan has a drug problem.

In the days of Taliban rule, signs in local script and English warned of execution for anyone caught using illegal drugs.

The anti-drug message on display here simply featured a young girl, her eyes peering through the screenlike fabric of the burqa covering her face. The sign explained that she was an addict who had dropped out of school and given up hope for a better life.

Next to the ghostly looking girl, three smiling boys stood beaming with joy because they had chosen to remain drug-free.

The billboards looked as if they had been designed by an advertising agency in the U.S. that had snagged a multimillion dollar contract from a federal anti-drug earmark for a powerful congressman’s home district.

Similar billboards are part of the Afghan government’s drug-awareness program, which presumably benefit advertising agencies with good political connections far more than potential drug users.

Saleh Mohammad, an author and representative in parliament from Afghanistan’s Panjshir Valley rolled his eyes, bewildered by the absurdity of the display, as he translated the script.

The conversation quickly turned to corruption in his country, where government officials, local warlords, Taliban sympathizers and criminal organizations are ready to dip into government coffers even as they make enormous profits at the expense of the Afghan people and well-intentioned international donors.

Ms. Frogh, of the Global Rights organization, said that in many ways, women are worse off now than during the 1980s, when the Soviets attempted to rule, and the 1990s, when a period of warlord rule was followed by the Taliban takeover.

“It’s worse than the communist regime; it’s in many ways worse than the Taliban regime,” she said. “I’m angry at the hypocrisy of the governments - they give millions and millions of dollars and it doesn’t go anywhere and the women never see any of it.”

Addicted toddler

Two-year-old Muksal held on tightly to her mother’s dress. She sleeps alongside her mother, Bibi Hana, in the Sanga clinic, where both were admitted for a month of rehabilitation in June.

Unlike the other children in the clinic, Muksal has never learned to walk. The little girl with large blue eyes also has a difficult time forming words.

Bibi Hana said she gave opium to her daughter so she wouldn’t feel hunger pains.

“It feeds the belly,” said Bibi Hana, who admitted using opium when she was pregnant with her daughter. “You don’t feel hungry when you smoke. It helps the babies sleep and not cry when there is no food to feed them. But really, I didn’t know it was dangerous at all. I want to quit. I want Muksal to learn to walk.”

Dr. Toorpaikay Zazi, the head physician at the clinic, said that since the center opened in June 2007, it’s been “very difficult and impossible to attend to the number of patients coming to the clinic for help.”

The center is required by donors, including the U.S. State Department and the India-based Colombo Plan, to monitor its patients. According to the center’s latest progress report, which covers June 2007 to the end of February 2008, 103 out of 156 admitted patients completed treatment. There were 149 on a waiting list for admission.

“Laboratory checkup problems and lack of medications for the treatment of other diseases” are among the problems the clinic faces, the documents state. There are also serious security issues. “It is necessary to inform sometimes our social workers are threatened by the husbands of women addicts not to enter homes for the treatment,” the documents said.

In Afghanistan, however, “not everything is what it seems,” said Abdul, an Afghan security adviser who works closely with the government and asked that only his first name be used because he feared retribution.

“The intentions for these programs are good, but there are more criminals and addicts now than before and it’s not getting better,” he said. “There is no accountability in our government for the money, and we truly don’t have accountability in our social sector.” Despite numerous requests by The Times to witness patients going through withdrawal treatment at the clinic, medical personnel refused.

Clinic personnel said they were unable to do so, often saying that the withdrawals were over in less than 24 hours and that the patients had already passed the withdrawal stage - a somewhat dubious claim.

In general, withdrawal from opium addiction begins within hours after taking the last dose. During the first three days, the majority of addicts face the most severe symptoms, such as stomach pains, vomiting, diarrhea, insomnia and often delusional irritability.

Despite numerous visits to the clinic, The Times never once witnessed any of the women or children going through withdrawal.

Were these “Potemkin” patients, brought there for show? The timing alone was enough to make any outsider suspicious.

“They were admitted the other night,” said Dr. Shaesta, regarding a new group of 20 patients at the clinic. They had arrived just in time for a visit by the head of Afghanistan’s Ministry for Women, Dr. Husn Banu Ghazanfar, and personnel from the U.S.-led International Security Assistance Forces.

When asked if patients had been given methadone, which blocks withdrawal symptoms, or if a different drug was being used to help patients through withdrawal, officials at the clinic said “only painkillers” were prescribed. They declined to name the drugs being used.

Sobra, a 40-year-old woman from the Western city of Herat, was among a “new” crop of patients who had been to the clinic before. She sang and danced as the other women played and clapped to the beat of Afghan drums for visiting VIPs and the two visiting Times journalists. A Google search on the Internet, however, showed an image of Sobra and her three children smoking opium in March at an undisclosed location.

Was this simply a show for guests? Clinic staff said “no,” that Sobra had suffered a relapse.

The official visitors crowded around the women. Dr. Banu Ghazanfar promised not to forget them as her entourage passed out gifts and posed for pictures, touting the success of the program. They gave each woman a frying pan, flashlight and other knickknacks.

One patient turned away from the visitors, shrugging. “What will I do with these?” she asked. Several children took the pans and began using them as toy drums.

Such nonprofit rehabilitation programs are considered by the U.S. government and international community as a significant part of the reconstruction and rehabilitation of Afghanistan.

Suspicions aside, clinic head Dr. Zazi lamented the fact that she has no special facilities for children.

“I don’t have a facility for the children, no beds for the children - so they sleep with their mothers in the same bed,” she said. “Everyone, including the husband and sons are addicted, but we only treat the women. So when they leave here, the chances for relapse are great. We need to be able to treat the whole family and the situation is only getting worse.”

A cheap fix

For about 40 cents, Kokojan Azi, a Pashtun grandmother of five, can satisfy her daily opium cravings. That’s the average cost for a pill-size fix of opium in the city, she said.

But some members of her family have been more fortunate.

Since treatment in the Sanga clinic more than three months ago, her daughter and several of her grandchildren say they have managed to remain drug free.

The father, who refused to speak or give his name, is also opium-free, Mrs. Azi said, despite never having gone to the clinic.

Shukria, 13, the eldest of Mrs. Azi’s grandchildren, moved to Kabul with her family from Wardak Province in the east after fighting escalated between local militia and her father lost his job.

Shukria’s father stood just outside the curtain watching and listening as his daughter spoke. The curtain divided the family’s small two-room apartment from a dusty dark hall. There were no doors, running water or bathroom facilities.

“It doesn’t hurt anymore,” said Shukria, referring to withdrawal from opium. “I was very sick when they took me off it. I was throwing up all the time, but now things are better.” Shukria said she used to smoke or ingest opium with her grandmother and mother, Farie, 35, who would give her daughter opium when she was sick.

The family is under the minimal care of Dr. Shaesta who sends Farida, a nurse, to Mrs. Azi’s home to deliver vitamins and check on the family.

“The children were in the clinic with us,” Farida said. “The family is fortunate because they did this together.” Azi began smoking opium after members of the Taliban kidnapped her 7-year-old son a decade ago, she said.

“The fighting then was so bad between the Hazara tribe and the Taliban,” she said. “The Taliban kidnapped my son, Habib, took him to the mountains and killed him there - even though we were not involved.” The opium “took away my tears,” she said.

In downtown Kabul, women in burqas, high on opium, carried listless babies in their arms as they begged for money on one of the capital’s main thoroughfares.

“Please,” said a man in Dari, as he held onto a child he had slung over his shoulder. “Some money for my child.” The child’s eyes were dilated. Thin, malnourished and visibly high on opium, the child was too weak to move on his own.

“You’re dealing with a traumatized population,” said Jeane Kissell of Westminister, Vt., the deputy director for the Welfare Association for the Development of Afghanistan. “The whole population is suffering and unfortunately few are listening. The majority of Afghan people haven’t even been outside the region to see a functional society. Many don’t even know what it is.”

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