Seventy-year-old, Maryam was sitting on a broken wooden bench in her mud hut at the Kababian Afghan refugee camp in Peshawar, the provincial capital of Pakistan's North West Frontier Province (NWFP), looking dazed. "My son introduced me to opium. He used to take it, and offered it to me when I had a cold and cough. It helps me sleep," she told IRIN at the camp.
Maryam has been addicted to opium for the past six years. She said her stock had just run out and she was waiting for relatives to bring more from the fields near the eastern Afghan city of Jalalabad. "We don't have to pay for it. It grows wild, and if I don't eat some every week I get chest pains and constant headaches."
With a total camp population of some 13,000, of whom around half are women, at least 35 percent are addicted to drugs, aid workers say. "The women are totally ignorant of the dangers. They will take anything to relieve pain for something as simple as back pain. Cannabis and tranquilisers are very common here," Sabha Rohi, a field worker for the Pakistani NGO Dost, told IRIN at the camp.
She spoke of a case in the nearby Turkmen camp, where she had examined a woman who was hardly eating, but addicted to consuming opium. "The woman was a carpet weaver, and she said she could not work without taking drugs."
To tackle the increasing problem of drug abuse in the camps, a project funded by the United Nations Drug Control Programme (UNDCP) and being implemented by Dost is in place in most Afghan refugee camps in the country.
Primary prevention is taking place in some 48 clusters of refugee camps in the NWFP and 19 in the southern province of Balochistan covering a total population of 1.2 million. In addition to this, secondary prevention, focusing on harm reduction and treatment is targeting three camps in Balochistan and 10 in the NWFP. Under this programme, information, advice and training on drug abuse is given to camp dwellers.
In each camp, a key group of up to 35 women, such as teachers, doctors at the local clinic, and community leaders, are being trained for two days on the dangers of drugs so they can in turn educate other refugees.
The programme was established following a survey carried out by Dost between February and June 2002 at 22 camps in the NWFP. "We found that 90 percent of women were using tobacco and tranquillisers. There was also a high proportion of residents consuming opium in Chitral and Dir in the NWFP due to poor health services and lack of availability of medicine," Muhammad Ayyub, the project manager for Dost, told IRIN in Peshawar.
He added that one of the aims of the project was to pinpoint people who could be trained to treat addicts. "We found that there was an urgent need for awareness, as they were unaware of the consequences," he said. The NGO staff operate by building up a rapport with the women and revisit the camps to monitor progress.
Despite these efforts, the fact remains that opium is readily available and cheap, particularly following the fall of the Taliban in neighbouring Afghanistan, where poppy production has shot upwards. "Most people ask their relatives to bring over the poppy heads from the fields, and they don't pay for their drugs," Ayyub added.
The scale of the problem in refugee camps, and particularly among women, is huge, according to UNDCP. "If we are just talking about heroin, it is increasing, but it is not such a big problem at the moment. But if we include pharmaceuticals like tranquillisers and other drugs, then it is high," Jehanzeb Khan, the UNDCP project coordinator for drug demand and reduction in Pakistan, told IRIN in Peshawar.
"My niece is reliant on tranquillisers and takes them every day, and her husband doesn't care so long as she gets the housework done. So I have been trying to stop her from taking them," Hazrat Bibi, a community leader at the Kababian camp, told IRIN.
The medicinal use of opium has been common among Afghan refugees for years due to the non-availability of conventional medicine, coupled with high levels of stress associated with loss of family and displacement. "Opium has almost become a traditional remedy and is primarily eaten," Khan said, adding that it was much more difficult to treat when eaten, because it causes acid and ulcers in the stomach.
There are no official statistics on how many women are addicted to drugs in camps across the country, but it is believed to be in the thousands. "We are now trying to promote rational use of drugs and medicine in collaboration with the World Health Organization [WHO]," Khan said.
Female addiction also poses a huge threat to children in the camps, as some women take drugs during pregnancy, causing the unborn child to become addicted also, and causing complications during birth.
"Children have told me that their parents take these drugs, and they often give it to them too," Wahida, the principal of the school at the camp, told IRIN. The main reason for taking drugs, she said, was lack of money to buy proper medicine. "Many children have come to school having been fed these drugs and often fall ill," she added.
"In the camps in Chitral and Dir, women are giving opium to children to treat common illnesses such as coughs and chest pains," Ayub said, adding that it had become part of their medicine cabinet without realising that they could pay a high price ultimately. "Many women also give opium to their children to help them sleep, and this is extremely dangerous," Khan said.
Although there are no statistics on deaths related to drug addiction in the refugee camps, aid workers believe it to be high. "Many will not admit that they are taking drugs, so it is often difficult to establish the cause of death," Ayub explained.
Some refugee women are also resorting to desperate measures to fund their habit, according to Khan. "Some women are even selling their rations to fund their habit, and send their children to work, which exposes them to labour issues and abuse, which is very common, especially in the NWFP," he stressed.
He explained that women eating, rather than smoking, opium to cure illnesses was generally accepted by the husbands. "In general, as long as it doesn't affect the economy of the house, they don't mind."
The aid workers said the main supplier of drugs remained neighbouring Afghanistan, which is the world's biggest opium producer, according to the latest UN drug report. It is believed that Afghan refugees who earlier left Pakistan are now returning bringing drugs with them across the porous border. The problem of drug abuse in the camps is also fuelled by the fact that there is no regulation over the type of drugs available without prescription in chemist shops in Pakistan.
"There is very limited control over stopping this kind of practice in the camps, as opium has been used as a traditional remedy for years," Muhammad Aziz Khan, the head of the narcotics control division of the Pakistan government, told IRIN in the capital, Islamabad.
Despite reports of a resurgence of poppy cultivation in the NWFP, after the country being declared almost poppy free, Aziz said the country was on the right track to beating the problem. In 2000, Pakistan sharply reduced poppy cultivation, dropping from 1,670 to 515 ha, a 67 percent decrease from 1999. However, the country, along with Iran and Tajikistan, remains a vital route for smuggling drugs.
Meanwhile, the only way to keep spirits up for many Afghan refugee women at the Kababian camp is to continue their addiction. "My son went missing four years ago, and I've been taking tranquillisers since then. I can't sleep or think without them," Shulga, who has lived at the camp for 25 years, told IRIN.
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions