Mouin al-Najri, Abdullah Hizam
Al-Thawra Newspaper – An emaciated body, yellow eyes and a lack of appetite: these were the main symptoms Ahmed al-Matri, a 17-year-old student, suffered before he died at Metna Hospital in the Bani Matar directorate, 25 kilometers west of Sanaa, Yemen.
Professor in hepatology and the digestive system at Sanaa University, Dr. Mansour al-Omrani, has been following Ahmed’s case. He explains that “medical test and CT scans confirmed his continuous use of khat for several hours, which raised the level of liver enzymes causing terminal cirrhosis.”
Since 2011, the high school student’s medical condition had rapidly deteriorated. “Ahmed used to chew khat twice a day, for a daily average of 10 to 12 hours,” said his older brother Ibrahim. “We took him to the hospital twice, but the disease had taken over.”
Like many of the six million public students in Yemen, Ahmed fell victim to the khat-chewing tradition, which causes several physical and psychological diseases.
At al-Thawra General Hospital in Sanaa, several secondary school students, wearing al-Nahda school uniforms, were visiting their colleague Ahmed Awad (age 15). He had been under medical supervision in the hospital for several days, due to his deteriorating medical condition.
Ahmed looked thin, pale and with sunken eyes.
Ahmed’s father believed it was khat that brought him to this… He used to chew it twice a day, which affected his mental and nervous abilities.”According to a documented medical report issued by Thawra public hospital, Ahmed became schizophrenic due to the abuse of khat, which made him dangerously aggressive.
The authors of this report conducted a survey of 2,000 male and 400 female students across six schools, including two preparatory [junior high] schools in Sanaa. It revealed that 62 percent of male students use khat, compared to 3 percent of females. Eight out of ten users suffered from insomnia, lethargy and anxiety, in addition to abdominal pain after daily use.
Of the respondents who did not chew khat, 38 percent see the plant as causing several physical and psychological diseases. The survey also showed that 6 out of 10 students who used the substance had learned the habit from their classmates. However, the remaining 4 out of 10 said that parents and relatives led them to this dependency.
84 percent of those who use khat said it was not difficult to find and remains affordable. Some guardians provide khat for their children, who can also get it from family-owned farmland, especially in rural areas. The remaining 16 percent cannot find it easily, so they only use what they get from friends or what they saved from after school or summer vacation jobs.
According to sociologist Ibrahim Saleh Abbad, the figure indicated by the survey is “catastrophic.” He compared it to a study of 800 students he conducted at the end of the 1990s, which showed that the percentage of khat-consuming school students did not exceed 20 percent of respondents at the time.
Yemenis chew khat in daily sessions after the end of official work and schools hours or after a regular meal. The majority of Yemeni families encourage their sons to chew khat. “I want him to become a man,” said Mohammed N. S. (age 55), whose son Abdullah (age 13) was chewing khat and sitting next to him.
A session of khat chewing costs between 200 and 10,000 Yemeni Riyals ($1 to $50). The difference, according to khat-seller Hussein Ali (age 25), depends on “the quantity and quality of the khat – and there are dozens of types. Each type has varying quality levels. This is why some are cheap, others are average priced and some are expensive. Each person purchases according to their ability.”
“I Am Not Crazy”
In the courtyard outside al-Amal psychiatric hospital, 17-year-old Omar Saleh, who has been chewing khat for the past six years, is attempting to escape. “I am not crazy,” he shouted. His mother agreed. “He is not actually crazy, but he suffers from delusions and believes his family wants to kill him,” she clarified.
His older brother Mohammed said it was khat and lack of sleep that has caused his brother’s condition.
“Consuming khat increases a student’s worries, problems and illusions. It contributes to anxiety, depression and paranoia,” explained Dr. Mohamed Amer Zamran, a psychiatrist at the hospital.
After clinically monitoring patients for the past ten years, Zamran concluded that “most of the younger psychiatric patients were hooked on khat. Most teen suicides occur in Yemen after eating khat.”
“The feeling of euphoria and deep concentration for a few minutes or an hour (depending on the khat), is what young people like about the substance. However, the smile soon subsides and focus is lost in a pile of conflicting emotions, emotional anxiety and depression.”
According to Zamra, a study conducted by Dr. Geiger and several psychiatric researchers in 1994 on some cases involving the use of khat at Heath Horton Hospital in Australia, found that “khat increases dopamine levels in the blood, which raises the degree of uncertainty felt by users, especially after quitting.”
Clinical studies conducted by Dr. Geiger and his research teams showed that khat causes paranoia and a type of psychosis similar to that resulting from amphetamine use.
In the survey of school students conducted by the authors of this report, 80 percent of respondents said they felt happy and relaxed during the first hours of using khat. However, nine out of ten said that it caused anxiety and depression. The remaining 20 percent felt an unjustified fear.
This is maintained by Bandar A. O., a 15-year old student. “The first time I chewed khat, I was accompanying my dad to my cousin’s wedding and he gave me a bunch of it,” he said. “That night, I was so afraid I could not sleep.” Bandar, who uses khat twice a week, added that “after I finish [chewing], I am afraid to stay alone, even in my room.”
Psychiatrist Dr. Abdo al-Shalili said the fear results from “levels of particular brain enzymes rising above the normal average, causing these emotional states.” He said that in 2012 alone, he dealt with 120 cases in his clinic. The age of the patients ranges between 15 and 20 years. They represented 20 percent of all patients.
The psychiatric problems of khat users in this age range could develop into something worse. “Continuing use of khat and lack of proper nutrition affect the brain chemically and the disease develops into schizophrenia.” He firmly believed that khat is strongly linked to this ailment among students.
This assertion is reinforced by a field study conducted by Chairman of the Board of Directors of al-Amal Psychiatric and Neurological Hospital Dr. Hameed Ziad. 30 random patients with mental illnesses due to the use of khat were selected, which found that they suffered from schizophrenia.
In his book Khat – the Tragedy of Yemen, Dr. Ziad, who also heads the NGO Yemen Without Khat, writes, “Through our follow-up of psychological cases in some regions planted with khat, [we found that] most young men who ingest the plant suffered from schizophrenia.”
Professor Hosni al-Joshai, chairman of the Higher Council for Medical Education and Professor of Neurology at Sanaa University School of Medicine, described schizophrenia as the most serious illness suffered by teenagers who chewed khat.
Shortest Path to Hepatitis
Lab tests on 20 students, 10 of whom used khat, were conducted by the journalists at the private al-Anwar Laboratories. They showed the presence of varying levels of poisonous organophosphates in the sample of users, while it was completely absent in non-users.
Toxicologist Dr. Mohamed al-Hababi said the high proportion of these compounds in the blood are probably due to the presence of elements in khat that cause stomach inflammation and changes in the mucous membrane. Thus the food will not be completely digested.
“Toxic organophosphate compounds are absorbed into the blood cycle from the stomach causing several illnesses, most seriously cirrhosis of the liver,” Dr. Hababi added.
The tests conducted by the authors of this report showed an uneven rise in enzymes causing jaundice in the blood of the 10 users. They were not present among those who did not use khat.
Specialists concur that the incomplete growth of the immune system in young people prevent the obstruction of toxins absorbed into the blood and increase the presence of enzymes that affect the liver.
Hepatologist Dr. Mohamed Salem Noaman said that 90 percent of liver diseases in Yemen are caused by khat. “There is a correlation between khat and hepatitis E and B infections, which could be transmitted by mouth and the chewing of khat,” Dr. Noaman warned.
Internationally Recognized Drug
After six years of research and experimentation, the World Health Organization classified cathinone and cathine, two substances found in khat, as a Schedule I drugs in 1973. The Drug Enforcement Administration added it to the list in the Control Substances Act Schedule I in 1993.
Dr. Joshai, the Sanaa University neurologist, describes the effects of those substances as “destructive.” He said the “presence of cathinone and cathine in khat impacts various organs.”
Cathinone, an alkaloid, makes up 14 percent of some types of “fresh” khat. But it can be as low as 3.4 percent in some other types. According to three scientific studies conducted outside Yemen, it is more dangerous than the volatile substances, which disappear 24 hours after its picking.
However, the authors of the report could not test for these two substances in the samples, due to the absence of necessary equipment inside the country. Several lab supervisors maintained that the equipment costs around US$350,000. They are not thinking of buying it since “the equipment is primarily used for research.”
It was also impossible to send the samples abroad. “Cathine and cathinone will disappear from the blood within 6 to 8 hours after stopping use,” according to Dr. Khaled al-Baadani, Laboratory Professor at Sanaa University School of Medicine.
Five scientific studies, obtained from four anti-khat NGOs in Yemen, confirm that cathine and cathinone impact the nervous system and slow down involuntary muscle movement, like in the heart. They relax, leading to, for example, food and acid reflux.
It also increases the levels of dopamine in neurotransmitters, which reduce the ability of muscles to protect the skeleton. Cathinone also affects the part of the brain that signals hunger. As a result, users do not feel hungry and suffer malnutrition.
Despite the risks, Deputy Legal Affairs Director at the Education Ministry Mohamed Sarie does not see the feasibility of issuing a law or directives banning or prohibiting the use of khat by school students, due to its non-binding nature. “We can ban the use of khat in schools, but in homes it is impossible. Many parents encourage their kids to use it and this falls within the framework of personal freedoms, just like smoking.”
Sarie recalled the failure of previous measures, such as the 1972 decision to uproot all khat plants and ban its use in government offices. This was in addition to repealing several laws when Yemen was unified in 1990, including the law of 1967 in South Yemen, which used to permit its sale, purchase, and use only during weekends. Another law used to force families to keep children between 7 and 18 from places where it is being used.
Awareness Is the Solution
It seems the only available option to keep school students away from khat is awareness and convincing the citizens of its risks. The most important of those tools are school curricula, which refer to khat only once, in reference to its depletion of water resources.
Ministry of Education Undersecretary for Curricula Ali al-Haimi spoke about “a plan to review the education curriculum and include awareness about the dangers of khat, at the beginning of the current school year.”
However, “awareness, no matter how intensive, will not work, as long as teachers and fathers do not stop chewing khat,” Haimi explained. He also called on all segments of society to participate in a national campaign to combat khat use among students. He added that “entertainment alternatives, such as gardens, promenades, and sports clubs should be provided.”
Director of School Health at the Education Ministry, Abdul-Malik al-Siyani, said that “the provision of health supervisors in schools may limit the growing phenomenon.” He supported the idea of a national campaign to combat khat use among students.
Anti-khat NGOs stress the importance of the national campaign. The believe it should target families in the first place. It should also be sustainable and adopted by the government and the ministries (health, media, education, religious affairs, universities, and concerned religious institutions).
In the meantime, families are going through difficult times because of khat, just like those of Ahmad al-Matari, whose first child was born eight months after his death. The family plans to forbid the child from using khat in the future, so as not to share the fate of his father.
However, a 2011 agriculture ministry study of families whose livelihood depends on growing khat estimated the number at more than 800,000 families. Land used for farming khat was estimated to amount to “162,584 hectares.”
Dr. Morshid al-Daaboush, who teaches at the Sanaa University School of Agriculture, said that areas where khat is cultivated increased 21 times between 1970 and 2012.
This investigative report was prepared with the support of ARIJ (Arab Reporters for Investigative Journalism), under the supervision of Khaled al-Harouji.