Opioid Crisis Engulfs Gaza as Poverty Soars

Blockade, high unemployment and never-ending conflict with Israel have caused 'widespread' Tramadol abuse, World Health Organization says

Confiscated drugs and alcohol stored inside the anti-drug department at the main police headquarters in Gaza City, February 11, 2019
Adel Hana,AP

An opioid crisis has quietly spread in the Gaza Strip, trapping thousands in the hell of addiction and adding another layer of misery to the blockaded and impoverished coastal territory.

The scourge can be traced to the mass import of cheap opioid-based Tramadol pain pills through smuggling tunnels under Gaza’s border more than a decade ago. A more addictive black-market form of the drug called Tramal has since taken hold.

“I have seen the top elites taking it — university students, girls and respectful people,” said Dr. Fadel Ashour, who treats addicts in his dimly lit clinic.

There are no reliable estimates for the number of addicts in Gaza, a conservative society of 2 million where it is considered shameful to admit to such a problem. A 2017 study by the World Health Organization estimated that 10,047 males over the age of 15 were “high-risk drug users.”

Ashour, a psychiatrist, neurologist and professor at Gaza’s al-Azhar University, believes the number is much higher.

Prices have shot up in recent years as a result of tunnel closures and an antidrug campaign by Hamas. Yet for the vast majority of sufferers, rehab isn’t available for those who can no longer finance the habit.

Israel and Egypt imposed a blockade on Gaza after Hamas took over in 2007. Aimed at preventing arms from reaching Hamas, the blockade made it extremely difficult for people to move in and out of Gaza, devastating the economy. As conditions worsened, a thriving smuggling industry along the Egyptian border pumped in a cheap supply of Tramadol, an addictive painkiller that found a welcome market among the masses of idle youths.

Boxes of Tramal, an addictive pain killer, are stacked on the table of a pharmacy in Gaza City, February 15, 2019
Adel Hana,AP

Tramadol, a synthetic opioid analgesic, is considered a controlled substance by the U.S. Food and Drug Administration, in the same category as well-known medications like Valium and Xanax.

The WHO study cited the blockade, high unemployment among university graduates and never-ending conflict with Israel as factors associated with “widespread” Tramadol abuse. It said users turned to the drug to “escape problems,” to obtain a “feeling of relaxation,” to “not think” and to fall asleep.

Tramal, believed to be a more addictive black-market form of Tramadol, arrived later, gaining popularity after the first war between Hamas and Israel in 2009.

Tramal was cheap, less than 50 cents a tablet, and people discovered its sedative effects at a time when they were “trying to overcome their anxiety because Gaza was a very traumatic environment,” Dr. Ashour said.

Experts in Gaza say the drug is illegally manufactured in India and has higher amounts of opioid and possibly hashish and toxic substances. The illicit pills are also much more addictive.

Dr. Elyad Davidson, head of the pain relief unit at Israel’s Hadassah Medical Center, said both drugs in Gaza are variants of the medication known generically as tramadex — a type of opioid typically prescribed as a painkiller, but which also increases levels of serotonin, like antidepressants.