GAZA CITY, occupied Gaza Strip (IPS) - They are little white, yellow or green pills and are available almost anywhere. At the pharmacies or in the market, they are accessible, addictive and cheap.
“I take them because it makes me forget, at least for a little while, that I’m in Gaza,” says Abu Alaa, a resident of the strip and father of four. “There is no alternative.”
Looking to escape years of war, searing poverty and an unrelenting economic blockade, medical officials in the Gaza Strip say residents have developed a serious addiction to the narcotic painkiller Tramadol.
The embattled enclave’s borders have been hermetically sealed by both Israel and Egypt for two years, and an Israeli military assault last winter killed some 1,500 Gazans.
Gaza has the world’s highest unemployment rate — at 45 percent, according to the United Nations — and 75 percent of its inhabitants feel unsafe or insecure, a recent UN survey found.
Rumors of Tramadol’s mood-enhancing properties, and its easy availability over the counter have consequently turned thousands of desperate Gazans to the comfort of the tiny pills over the past two years.
Used medically to treat moderate to severe pain, Tramadol is a synthetic opioid related to morphine — and more distantly to the highly addictive heroin.
While altering a user’s perception of pain, its side effects include mild euphoria, sexual stamina and general feelings of relaxation. It also alleviates symptoms of anxiety and depression.
“People in Gaza are in a constant state of panic,” says Dr. Abdel Aziz Mousa Thabet, clinical psychiatrist and senior researcher at the Gaza Community Mental Health Programme (GCMHP). “Their trauma is ongoing — with war and the siege — they need to feel like they have control of their lives.”
But the opiate-like painkiller, also marketed globally under the brand name Tramal, brings both physical and mental dependence, according to health officials, and can be extremely dangerous if used recreationally in high doses or without medical supervision.
Neither the Hamas-run government nor local health non-governmental organizations (NGOs) have official figures of just how many Gaza residents take the drug, but say its use is perilously widespread.
“People of all levels of society are using it,” says the spokesman for Gaza’s civilian police force, Islam Shahwan. “Men, women, youth, university students, fathers. It is really out of control.”
Epilepsy is the most serious side affect, says the head of the health ministry’s pharmaceutical drug department, Waseem Saqer. But Tramal can also cause high blood pressure and long-term damage to the liver and kidneys.
“It will cause confusion, dizziness, and it is very dangerous when taken with alcohol,” Saqer says. “And people don’t know this, because they might not be getting it directly from a doctor. The situation is very serious.”
Packed into tablets or small gel capsules, Tramal is more discreet than other substances like alcohol or marijuana, says professor of pharmacology at Gaza’s al-Azhar University, Dr. Mazen al-Sakka. It is therefore more likely to go unnoticed in a religiously conservative society like Gaza’s.
The territory’s Tramal users dissolve the pills — which come in 100 or 200 milligram doses — in cups of tea or coffee, or even crush them up to smoke out of the hookah, a traditional Middle East water pipe.
Then, they say, they enter another world — calm, happy and without the problems that come with being forced to live in a big prison.
“I take it when I am stressed, and it completely changes my mood,” says Abu Moustafa, an unemployed father of eight. “But now, I need to take more to feel as happy as I did the first time.”
No longer officially available from pharmacies without a prescription — under orders from the healthy ministry — Tramal is smuggled in through the tunnels that snake under Gaza’s border with Egypt to feed the population’s growing addiction.
A strip of ten 100mg tablets costs 20-25 shekels (five to six dollars) with a prescription. Single pills can be bought on the black market for a dollar each. Any more than 400mg in a 24-hour period can be lethal, Saqer says.
Local pharmacists are known to keep stocks of the drug, which they sell for extra profit on the side, or distribute only to friends.
“We didn’t realize how serious the Tramal problem was until we started our crackdown on drugs and drug smugglers last year,” says Shahwan. “At the beginning, we were finding 80,000 pills at a time. A single pharmacy needs only 50-60 pills every six months.”
Tramal has legally been sold in the Palestinian drug market for over a decade, but Shahwan says heavy drug users began taking it only after the blockade choked their normal supplies of hard drugs.
Its use then spread like wildfire among a population wracked by war and isolated both psychologically and geographically from the rest of the world. Its use is particularly prevalent in Gaza’s sprawling refugee camps.
“People are anxious, they are irritated. They can’t sleep, they feel hopeless, they feel angry,” says Dr. Thabet.
“And in a normal society, if you felt this way, what would you do? You would revert to certain coping mechanisms — working more, studying more, channeling your energy. But in Gaza, there is no economy. There is no hope for the future, there is nothing. So they go to Tramal.”
Despite all this, Shahwan says Hamas continues its efforts to stem both Tramal’s abuse and availability in Gaza. The Hamas-run health ministry and local NGOs are conducting workshops on how to address the growing problem, as well as educate and treat addicts.
Smugglers caught transporting or selling Tramal will be fined, possibly imprisoned, Shahwan says, while plans are in the works to open drug treatment centers inside Gaza’s prisons.
But if the political and economic situation remains stagnant, says Dr. al- Sakka, and the threat of war continues to loom, Gazans are unlikely to kick their painkiller habit anytime soon.
Even worse, he fears, when the siege is lifted, not only will the society be tasked with rebuilding, but also with rehabilitating a population addicted to narcotics.
“Does Gaza’s health sector have the capacity to deal with addicts? The answer is no,” says al-Sakka. “In my opinion, this problem we have with Tramal — it will emerge as a catastrophe.”
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