Women And Children Are The Emerging Face Of Drug Addiction In Afghanistan

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Q breaks into song, and the lyrics reflect something of himself: "My heart aches, my heart aches and my heart aches," he croons. The 10-year-old hopes to go professional one day, but his mother says that first, he has to break his addiction to heroin.

Q began smoking his father's heroin in the summer, unnoticed by his parents, both addicts whose lives revolved around getting high and staying high. "I felt really happy. I felt free," he said. (Q is only referred to by his first initial because of his young age.)

When his mother, Sarvan, realized what was going on, she marched herself and her son to a rehabilitation clinic in Kabul, where they now both live and are undertaking a 45-day detox program.

Shaking off his months-long addiction has been painful. "Every single bone of my body was hurting," he said softly. The drug's physical impact still lingers. Q's eyes are sunken. His cheeks are pinched. You can feel his bones when you give him a hug.

Q and his mother are the new face of drug addiction in Afghanistan. More than ever before, women and children are being entangled in drugs, as the number of addicts aggressively grows.

From an estimated 200,000 opium and heroin addicts in 2005, the number rose to nearly a million in 2009 and reached between 1.9 million to 2.4 million in 2015, the United Nations reported. The growing number of addicts reflects the octopus-like reach of opium and heroin. Husbands often addict wives, and mothers often addict children — by using opium while pregnant, by exposing the children to secondhand opium smoke and by using a pinch of opium to calm them when they are fussing.

"Many children become dependent on drugs, mainly opiates, at an alarmingly young age while in the care of drug-dependent parents or family members," the U.N. reported.

At least 3 percent of women were drug addicted in 2009, a number the U.N. considered to be low, because addiction can be easily concealed and underreported. By 2015, it had risen to 9.5 percent. Addiction among children wasn't properly counted until 2015, when the U.N. reported that 9.2 percent of children up to 14 years old tested positive for one or more type of drugs and were likely to be active drug users.

Four years on, "the number of women addicted is definitely increasing. It's on the rise compared to even two or three years back," said Anubha Sood, a senior program officer for the United Nations Office on Drugs and Crime in the Afghanistan country office.

"Imagine how difficult it would be for a family to cope with that, economically, socially, psychologically, and then multiply it at a country level," said Sood. "It will pull down, today or tomorrow, the entire economy."

Poverty, grinding conflict and a lack of hope make Afghans deeply vulnerable. "It's cumulative," said Sood.

The growing rates of addiction reflect the increased availability of drugs. Afghanistan is the world's largest opium producer, despite the U.S. spending roughly $8.62 billion on counternarcotics efforts there.

The peak poppy cultivation period was 2017, when 328,000 hectares — over 800,000 acres — were cultivated. Last year's crop was 263,000 hectares, the second-largest recorded harvest, despite a devastating drought.

And more of that opium is being converted locally into heroin. Levels of drug addiction are highest in rural areas, where opium is harvested and heroin produced, suggesting that in areas with plentiful supply, people are more likely to become addicted.

One of the biggest rehabilitation centers for women is in Kabul: the 100-bed National Center for the Treatment of Addiction for Women and Children, headed by Dr. Shaista Hakeem.

It opened in 2016 to accommodate the growing numbers, said Hakeem, who has worked with addicts for more than two decades. She said it was once rare to see an addicted woman — partly because they were too ashamed to come forward and because there were just not so many of them.

Dr. Shahpoor Yousef, head of drug demand reduction at the Ministry of Public Health, told NPR that the relapse rate is about 60 percent. The clinic didn't have data on success rates.

"Nobody could be upfront and say, 'Yes, I am addicted.' But now, the numbers are growing," she said. And women are more frank.

"They themselves come up and tell me, 'Yes, I'm drinking. I'm using meth. I'm using heroin.' "

On a recent day in October, the center reflected Afghanistan's new normal. Some 30 women and 40 children were checked in. Five women lay curled in beds in a room designated for detoxing. Mehtab napped beside her 3-year-old daughter and 7-year-old son. It was her third time here. She kept readdicting at home, where she lived with her addicted sister-in-law. "I am really frustrated with this," Mehtab said. "I even tried to kill myself." (The women are only referred to by their first names because of the discrimination they could face if identified.)

The generational ties of addiction was clear in interviews with six women at the center. Nasima, 30, said her friend gave her heroin to smoke to help her relax. She didn't know heroin was addictive. She is illiterate, was married off as a child and has lived her life largely confined to home, like many Afghan women.

Nasima, a mother of seven, said one son left home while she was high. She says that he began using heroin because it was in the house. "My 15-year-old son is roaming the streets. I don't know where he is," she fretted. She breastfed her youngest son as she spoke.

The center appeared to offer respite for the children, at least. Behind heavy steel doors, boys and girls played in a small courtyard, shrieking and manically running. In one room, they worked at sewing machines, making outfits of red pants and purple tops.

Some of the children pushed their mothers into rehab, like Farida. She was only a kid when she became addicted. Farida was forcibly married off when she was 8. Her husband at the time was using opium, and she believes he deliberately addicted her.

Farida and her husband have five children, and she says her husband married off their two daughters to the highest bidders, for a total of about $6,000. They were 11 and 12. That was about two years ago.

"He sold them for money," she said, sitting on a narrow bed, looking out into the Kabul sunshine. "He used it for drugs."

One of her sons bought her here, and she hopes to salvage what she can of her family. Her eldest son, an addict, was thrown in jail after he was caught buying drugs for her. "I live with regret every single second in my heart," she said.

Heroin is not the only drug now flooding Afghanistan. "In the beginning, people were only addicted to opium," said Hakeem, the supervisor. "There is tabletka," a compound drug students use to stay awake, she said. "Now there is sheesha," she said, referring to meth, which she said had been particularly devastating.

She introduced us to Sharifa, 35. She is the daughter of street beggars and worked as a beggar herself on Kabul's roads. Her brothers carry bags of flour for change. Her husband is sick. None of her family have scrambled out of poverty, and she said thinking about that made her increasingly depressed. A neighbor gave her meth during a particularly dark time.

"She said it's going to take away your pain," Sharifa said. "But it made me crazy." She pointed to her short, messy hair. "I shaved my head," she said. "I burnt myself," she said, showing cigarette burn marks on her arm. "I couldn't sleep. I couldn't eat." Her mother took her kids away.

"My mother is taking care of them — she begs with my children — and I came here," said Sharifa. She was desperate to get better, fearing her daughters would fall by the wayside. Her mother and brothers barely made a few cents a day. "How can they keep my children? They have to take care of their own."

NOEL KING, HOST:

Afghanistan grows a lot of opium, more today than almost at any other time since the U.S. invaded the country 18 years ago. Global markets are awash in its byproduct - heroin. But heroin is also tearing holes in Afghan society, too. NPR's Diaa Hadid brought us this from Kabul.

DIAA HADID, BYLINE: Q shows off how well he sings. He wants to do this professionally.

Q: (Singing in foreign language).

HADID: But first, his mother says, he's got to break his heroin addiction. He's 10. He's one of the handful of kids here. We're referring to him by an initial because of his age, and we only refer to the women in the rehab center by their first names because of the discrimination they'll face if they're identified. Q became addicted through his parents. He began smoking his father's heroin in the summer, and nobody noticed. Q's eyes are sunken. His cheeks are pinched. You can feel his bones when you give him a hug. He says shaking off heroin was hard.

Q: (Through interpreter) I went through a lot of pain. Every single bone in my body was hurting.

HADID: Q and his mother are perhaps the new faces of addiction in Afghanistan. They're at a government-run rehab center in Kabul. It's on a quiet street. You can hear the hum of generators. And it seems to offer some respite. Inside, kids play on swings, women chat in the courtyard. One woman starts singing.

HADID: The head doctor here is Shaista Hakeem. She's worked in this field for two decades. She says it was rare in the beginning to see a female addict, let alone a child.

SHAISTA HAKEEM: (Through interpreter) Day by day, with the passage of years, those numbers are growing.

HADID: And the data reflects that. According to the U.N., in 2009, Afghanistan had nearly 1 million drug users. By 2015, the last time a major report was done, that number had grown to 2.5 million. Hakeem, the doctor, says decades of war and poverty have ground women down, making them and their kids more vulnerable to addiction. There's also more supply. There's more opium being grown than nearly ever before, and more of it is being converted locally into heroin. Hakeem says she's seeing things now that were shocking just a few years ago, like women living in drug dens, where some work as prostitutes.

HAKEEM: (Through interpreter) They go there because people offer them drugs. They take the drugs but do whatever is asked of them.

HADID: Q and his mother lived in one of those dens, but she says her husband supplied her drugs. Now at the rehab center, she's learning how to cut hair.

(SOUNDBITE OF SEWING MACHINE)

HADID: In another room, kids learn how to sew. They're making red pants and purple tops. Some of the kids were using drugs; some of them are accompanying their mothers. But just being here makes them lucky. Farida says one of her sons pushed her into rehab. It's her second time here this year. She says she was addicted through her husband. She was only a kid herself when it happened. She was 8 when she was married, and she didn't know what heroin was when he got her to smoke it.

They had five children together, and she says her husband married off their daughters to the highest bidders. Basically, he sold them for about $6,000. They were 11 and 12.

FARIDA: (Through interpreter) He sold them for money. He used it for drugs.

HADID: Now one of those girls is 14, and she has a baby. Her eldest son is in jail. He's an addict, too. Farida desperately wants to break her addiction and salvage her family.

FARIDA: (Through interpreter) I live with regret every single second in my heart. My son is in prison because of my heroin addiction. My daughters were married off very young.

HADID: But heroin isn't the only drug flooding the Afghan market. Sharifa has great dark eyes. She's the child of street beggars, and she's a beggar herself. She says her life was never easy, but it felt like it was becoming harder and harder. Her husband was sick. She was struggling to keep her daughters in school.

SHARIFA: (Through interpreter) Because of my poverty, my situation, I was very upset.

HADID: So a neighbor gave her meth a few months ago. She said it would take away her pain, but Sharifa says it made her crazy. She chopped her hair off. It's short and messy. She burned herself and shows me the scars on her arms. She couldn't sleep, couldn't eat. Her mother took away her kids.

SHARIFA: (Through interpreter) My mother is taking care of them. She begs with my children. And I came here.

HADID: Sharifa wants to get better and maybe get a job here at the rehab center. She says life on the outside isn't going to improve for her; she'd still be begging, and drugs, offering release and escape, would still be waiting for her.

HADID: Diaa Hadid, NPR News, Kabul. Transcript provided by NPR, Copyright NPR.