Gaza City – Abu Issam, 30, from the city of Khan Younis in the Gaza strip attempted to self treat his drug addiction problem at home, with the help of his father.
His efforts were in vain in a city where there are no available medical centres for addicts hooked on “Tramadol”, known here as the “happiness pill”.
He has continued in his addiction spiral for nine years.
Abu Issam is not alone with this problem in Gaza, as this investigative report shows. Dr. Mazen Al-Saqa, professor of Medication at the College of Pharmacy in Al Azhar University, confirms that there are no specialized state-run treatment centres for the rehabilitation of drug addicts and this only adds to the problem.
“Tramadol” is a banned substance smuggled into Gaza from Egypt through the tunnels.
The Palestinian Society for Addiction Treatment is situated in a residential area. A visitor might mistake it for yet another house, where it not for the plaque that carries the name of the society hung outside.
We entered through a large iron gate. One of the occupants greeted us. Inside is large sandy area of about 100 square metres where we found ten other residents lying on the floor smoking cigarettes and listening to the radio. Some were practising sports while one went to pray.
In another corner of the area, family members came to visit their son and a woman carrying a child was visiting her husband. We could hear the shouts of one of the youths going through “withdrawal symptoms” – which usually lasts for about ten days while the body gets rid of the addictive elements of Tramadol.
Eyad from Jabalya worked in a bakery. He was introduced to Tramadol by his friends who told him it was a stimulant, only to become addicted; he reached a stage of taking 5 pills per day.
“After I got hooked I needed the pill everyday to the point that I would demean myself in order to get a fix, this made me very edgy. It caused pain in my limbs and extremities and I started to get constant spasms, in addition to not being able to sleep at night,” he said, tears streaming his eyes.
Al Saqa tells “Emirates Today,” that the “absence of specialized addiction treatment centres has only worsened the problem. There are a large number of addicts who want treatment but are afraid and this makes them hesitant and keeps them hooked.”
Both the Ministries of Health and of Interior, who are responsible for the licensing the setting up of treatment centres, differ over the reasons behind this neglect. The former considers this as a result of a lack of legislature for licensing and combating addiction. The latter cites the lack of stability as reason why the government ignores this drug addiction “phenomenon”.
In light of these discrepancies, the problem is increasing in Gaza where the population is now estimated at two million.
Due to large numbers being treated at the only centre for treatment in the city, treatment periods do not complete their minimum cycle.
There are no alternative treatments to the psychotherapy offered at the Hospital of Psychiatric Medicine administered by the Ministry of Health, which oversees 6500 addicts.
A survey carried out in 2005 by the Medication Department it the College of Pharmacy at Al Azhar University showed that 50,000 people have used drugs and dangerous pills. There are 15,000 registered drug addicts.
Seven years have passed since this survey and the government has not created any new centres for the treatment and rehabilitation of addicts. Meanwhile, addiction to “Tramadol” has increased.
According to the website of the Gazan District Attorney’s Office, the quantities of “Tramadol” and other narcotics which have been captured throughout the past years is an indication of how big a problem it has become. On October 10, 2010 the DA’s office announced that it had destroyed almost two million Tramadol pills in that year.
Officials at the Drug Destruction Conference said on June 26, 2012 that two million and 197 thousand “Tramadol” pills were destroyed in 2011.
The “Emirates Today” attempted to meet with Minister of Health Dr. Mufeed Al Mukhalalati by contacting the media office at the ministry. But the office said he was unavailable for comment. We were referred to the Director of Permits and Licensing at the ministry Ahmad Nasr who confirmed the non-existence of any licensed treatment centre in Gaza because parliament has been unable to meet since the separation with the West Bank.
Nasr says: “the setting up of drug addiction treatment facilities requires a ministerial decision to establish that order; this is the responsibility of the Ministry of Health, whether it is through hospital administration or emergency treatment. The responsibility of the treatment of addicts falls on the shoulders of the Ministry of the Interior.”
He confirmed that it was “the duty of both the Ministry of Health and of Interior to set up such treatment centres” but added that neither ministry have initiated such a step.” He explained: “we are in dire need of such facilities and the two ministries should take measures to set up drug addiction treatment centres.”
This journalist went to the Ministry of Interior and met with Haitham Kulab, the official in charge of Guidance and Counselling on matters related to combatting drug addiction in Gaza. He attributed the lack of treatment facilities to the political instability and lack of security in the city. He also said that the government does not deal with the issue of drug addiction as a problem but a symptom.
Kulab says: “the wars and conflicts that Gaza has witnessed resulted in many problems requiring immediate attention that put the setting up of drug treatment and rehabilitation centres on low priority.”
The health official at the Palestinian Legislative Council, Khamees AnNajar, agreed. “Drug treatment centres are at the bottom of the list when compared with the problems and issues facing the Ministry of Health,” he said.
The Palestinian Society for Addiction Treatment, set up in 2012, remains the sole private centre caring for drug addicts.
In its first year, it received 800 patients brought in by their families or via the Drug Enforcement Agency. But due to its meagre facilities, it was only able to treat 300, all male. And as of August 2013, 280 patients were received but only 180 were treated.
The lack of facilities and medication at the society has forced it to limit the treatment period to 40 days, and for between 10 and 15 patients. The treatment period adhered to at treatment centres around the world, in addition to the “Narconon” centre in Cairo is usually six months during which the patient undergoes several treatments to enable him/her slowly give up his/her addiction.
According to Dr. Mazen As Saqa these treatments need a full team of medical staff with doctors and nurses as well as psychiatrists and social welfare counsellors. The addict undergoes full treatment with medication that would help ease his withdrawal symptoms. He/she is given special attention, which includes specific meals to help them overcome their addiction and be reintegrated into society.
Due to the lack of facilities and internationally recognized treatment measures at the Palestinian Centre, success rates have been low. Of those treated in 2013 only 54 were successful in overcoming their addiction — a rate of 18%.
The remaining 72% reverted to their dependencies. One of them was Abu Issam who relapsed on his first day out of the centre. This is documented in the records of the Palestinian Society and shown to this reporter in addition to an official survey sent to “Emirates Today”.
Addicts receive treatment at the centre for a period of 40 to 50 days at a rate of 300 Shekels per person.
The Palestinian Society, set up by businessman Rajab Abu Sido to treat one of his relatives from “Tramadol” addiction has been licensed by the Ministries of Social Welfare and the Interior. The latter is responsible for taking on the responsibility of providing residents with three daily meals. The Ministry of Health did not issue a license due to the absence of a registered doctor. Due to a lack of finance to improve its facilities, the society relies on the help of a volunteer medical staff.
The head of the Psychiatry Department at the Ministry of Health also explained that the Psychiatry Hospital, which treats addicts, only employs two specialized doctors. It is also a reason why the Palestinian Society was denied licensing.
Samour says: “we were approached by the Society asking us to provide them with a doctor to help treat addicts and we only employ two at the hospital. We informed them that we would await instructions from the Ministry of Health, which as yet have not arrived.”
According to Nasr, the Society did not receive licensing due to the absence of administration that governs such centres.
The Psychiatry Hospital is the only place where the Ministry of Health sends addicts for treatment in Gaza. As of 2013, the number of patients registered exceeded 5,000. More than 600 addicts are supervised by two psychiatrists at the Hospital for Psychiatry Treatment for the citizens of Gaza and the North.
In addition to this, the hospital’s southern branch provides treatment to more than 800 addicts with an additional 120 psychiatry cases registered in 2012. These statistics were provided by Dr. Ayesh Samour the head of psychiatry at the Ministry of Health in the Gaza Strip.
It is evident from the statistics we received during the compilation of this report, which also showed the number of failed cases at psychotherapy centres, that more state and governmental centres are needed for the treatment of addiction. The Palestinian Society, which has a failure rate of 72% and the Ministry of Health’s Psychiatry Hospital are not enough. Dr. Samour confirms that four times the number of patients receiving treatment at the Psychiatry Hospital, estimated at 6500 need new centres to help them with their addiction problems.
This investigation was supported by Arab Reporters for Investigative Journalism (ARIJ).