Drug addiction in Gaza and the illicit trafficking of tramadol

ollowing the December 2008 Israeli offensive, a United Nations survey of Gaza residents found increases in risk taking behaviour, including a significant rise in cases of drug addiction.1 One drug associated with this trend is Tramadol, first developed in Germany during the 1970s and introduced in the 1990s as a centrally acting analgesic with properties similar to codeine and morphine and which is widely prescribed as a pain killer.2 Although illegal without a prescription in some regions, Tramadol is relatively easy to obtain in Gaza, either with fake prescriptions from pharmacies or on the black market. News reports prior to the 2008 offensive suggested that up to 30 percent of males between the ages of 14 and 30 had already been using Tramadol on a regular basis, with some 15,000 showing signs of addiction.3 The escalation of this problem since then was documented by the Aljazeera English satellite television channel in its recently aired program "Uncomfortably Numb. " Under the broad ranging and comprehensive Israeli blockade of the Gaza strip, which has been in place since 2007, Gazan society has come to rely heavily on a vast network of cross border tunnels, some as much as 18 meters underground, which have become crucial supply routes for Palestinians who are cut off from the outside world. Around the clock shifts of tunnel workers transport a wide variety of items, from food and clothing to household goods and even furniture. Recently, illicit pharmaceuticals and other drugs have become hot commodities in the burgeoning tunnel trade. Despite consistent border seizures of the smuggled drugs, thousands of boxes of Tramadol still make their way to Gazans who are increasingly dependent on the drug, some having become seriously addicted. Kamal, an addict interviewed in the program, admitted that, "When I take it, I feel completely relaxed. I forget about all my feelings and emotions. I feel total release when I take one or two pills. The higher the dosage the better I feel, the more relaxed. " Dr Samir Al Zaqout of the Community Health Programme in Gaza, one of the few facilities at which addicts can receive treatment, says of the rising tide of addiction, "Most of the addicts are between the ages of 18 and 30. All my cases are in that age bracket, and herein lies the danger. The danger is that those who are supposed to build our future are the most affected. And if the number of cases I have seen are 150, there are hundreds of others who I have not seen and who would never seek the help of a doctor. Why? Because we live in a traditional society that fears the stigma attached to mental illness, and addiction is not just considered to be a mental health issue. It’s seen as even more serious. " Kamal continues, "I take it because of the hardship we’re under. I take it because of what is happening to us. I used to take one or two a day; now I need six. Since the war we have been in a miserable situation. No jobs, Hamas and Fatah fighting, no reconciliation, nothing. We were promised that things would open up and more jobs would become available for me and others. We want the wall to be opened, we don’t want the siege. " Dr Zaqout adds, "The number of addicts went up after the war in F