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Substance abuse among Palestinians in the West Bank and Gaza Strip: review
Abdel Aziz Mousa Thabet,
Abdel Aziz Mousa Thabet, Abdel Aziz Mousa Thabet,
Abdel Aziz Mousa Thabet, MD, PhD
Associate Professor of Psychiatry-School of Public Health
Khuloud J. Khayyat Dajani
Khuloud J. Khayyat Dajani Khuloud J. Khayyat Dajani
Khuloud J. Khayyat Dajani ,
,,
,MD, MHA, CMD, PhD
Associate Professor & Secretary General
abdelaziz.thabet@gmail.Com - khuloudkdajani@gmail.com
Abstract
This paper aimed to review the current knowledge about the drug addiction
problems in Occupied Palestinian Territories (West Bank and Gaza Strip). In
order to conduct such review, web based research were reviewed including the
Medline, Psycho
info, OBVID, Oxford University Press, and other data bases
available such as UN organizations data bases, and previous reports of
different community based organizations and ministries dealing with drug
addiction. The key words were, Wet Bank, Gaza Strip,
prevalence, incidence,
intervention, drug abuse, drug addiction. The review showed that drug
addiction problem existed among Palestinians in the West Bank and Gaza Strip
despite the religious, legal, and cultural constraints that condemn and
prohibit su
ch mental health problem. Abuse of heroin, sedative, hypnotics,
and hashish were the most common type of drugs abused. No independent,
comprehensive, treatment and rehabilitation centers in Palestine for dealing
with drug abuse people.
Keywords
:
Substance abuse, West Bank, Gaza Strip, Rehabilitation.
Introduction
Demography of Occupied Palestinian Territories
Gaza Strip is a narrow piece of land lying on the coast of the
Mediterranean sea. Its position on the crossroads from Africa to
Asia made it a
target for occupiers and conquerors over the
centuries. The last of these was Israel who occupied the Gaza
strip from Egyptians in 1967. Gaza Strip is very crowded place
with area 365 sq. Km and constitutes 6.1% of total area of
Palestinian territory land.
In mid year of 2005 the population
number is to be 1,389,789 mainly concentrated in the cities,
small village, and eight refugee camps that contain two thirds of
the population of Gaza Strip. In Gaza Strip, the population
density is 3,808 inhabitants/km2
that comprises the following
main five governorates: North of Gaza, Gaza City, Mid-
Zone,
Khan Younis, and Rafah (MOH 2006). Eighty percent of the
population in Gaza falls below the poverty line of US$2 per day
(up from 30 percent in 2000) and the unemploym
ent level
stands at approximately 50 percent. In addition, people in Gaza
have been subject to military occupation, causing significant
psychological trauma, particularly for children. The West Bank is
an area of land between Israel and Jordan, with total
5860
square kilometers. With a population of over 3 million, and
nearly half of the population under the age of 14, growth rates
are high. The West Bank and Gaza together constitute
Palestine, which is administered by the Palestinian Authority
(PA). Most of the population is Muslim, and common Palestinian
values include rootedness to the land, strong family bonds,
social identity from family and community, and a holistic outlook
on life. Refugees account for 73.1% of Gaza Strip and 30.2% of
West Bank populations (1.67 million) (PCBS, 2006).
Drug addiction history
Historically, Palestine is not classified among the countries
concentrated on drug trafficking or contrary to the case of some
Arab countries such as Egypt, Lebanon, for example. Prior to
1967, nu
mber of people who use the drugs was a few tens of no
more and according to available statistics based on the Global
Report on Drugs, issued before 1967 for the Kingdom of Jordan
(where the West Bank was part of it). There have been no cases
of production
or trade of significant drug trafficking. However,
there are large amounts of morphine and heroin manufactured in
Turkey, Lebanon which was smuggled via (Palestine) to Egypt,
Saudi Arabia and other Gulf states
(htpp:/www.aljazeera.net/portal/templates)
Bu
t, the situation was different after the 1967 war, where the
environment created a fertile ground for trafficking in
contraband of all, not just drug trafficking. According to a study
prepared by the Shehata (
www. aljazeera. net/ portal/
templates
), there were limited attempts to cultivate cannabis on
a limited areas in the Gaza Strip especially in the border area
between Egypt
and Gaza Strip and most of them planted in the
greenhouse (htpp:/www. aljazeera.net/portal/ templates).
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As the first Intifada (Uprising) erupted in 1987, it was
observed that the num
ber of hard substance abuse cases
dropped dramatically due local community restriction and fear of
substance abuse people of the punishment from family and
other community members. At the end of the Intifada, problem of
substance abuse started to raised ag
ain. Number of substance
abuse cases came for detoxification in Gaza Community Mental
Health Program increased steadily (Thabet, 1992, GCMHP,
2004). This high number of referred cases gave a clue that the
number of drug abusers is more than we expected. A
statistical
data about the exact number of substance abusers cases in the
Gaza Strip and the West Bank never existed.
From the period of 1995 –
1996, Palestinian National
Authority has been able to destruct completely all the planted
farms, such action fo
rced substance abuse people to cultivate
the marijuana among the flowers basins and gardens at homes.
According to Palestinian police statistics 3415 of the marijuana
plants were captured and destroyed in Gaza Strip. In addition,
the possession and traffic
king of drugs is significant in the
governorates of the West Bank, due to the division of land to A
(complete control of Palestinian Authority) , B (Only civilian
control by Palestinian Authority , C (Occupied area ruled
completely by Israelis) (PADA, 2001).
Prevalence of substance abuse
During the last few decades the use of alcohol and other
drugs has increased greatly in many parts of the world including
the Middle East. Systematic research on substance abuse is
still lacking in the Palestinian terri
tories. However, in spite of
political obstacles and the reluctance of various Palestinian
institutes to divulge information, few studies which have been
conducted among Arabs in the West Bank (Hebron, Bethlehem,
Nablus and Ramallah districts) and East Jer
usalem (Israel)
Gaza Strip had been located.
Thabet et al (1992) in study of 120 drug addicts referred to
Gaza Community Mental Health Program in the Gaza Strip
found that102 cases (85%) abused heroin (In streets known as
Cocaine). Seventy one cases (59%)
abused hashish, 41 cases
(34%) abused benzodiazepines, 21 cases (17.5%) abused
alcohol, 11 cases (9%) abused analgesics contain codeine, 7
cases (5%) abuse methadone,7 cases (5%) abused cocaine, 4
cases (3%) abused anticholinergic, and one case abused
pethidine (0.08%).
United Nations study (1993) showed that heroin was the
main drug abused in the West Bank and Gaza Strip.
In another study of Khamis & Habash study (1995) of a
sample consisted of 350 drug users who were located by social
services, physici
ans and treatment centers. The majority of
subjects came from East Jerusalem and its suburbs and also
from Bethlehem, Nablus, Hebron and Ramallah. About 86%
were Moslems and 14% were Christians. The proportion of
Christian drug addicts in the sample was hi
gher than their
proportion in the population (4± 5%), which may be explained by
the fact that 90% of the Christian population live in the East
Jerusalem and Bethlehem districts, where the prevalence of
drug addiction exceeds other places. Multiple drug use
was
prevalent among the subjects. Only 2.3% of the sample reported
current use of only one type of drug. Users started taking drugs
at an early age. The majority of subjects (91%) who started drug
use at an early age never obtained an education beyond the
most basic levels. About 88.7% of the subjects who began using
drugs before the age of 15 had illiterate fathers; 56.1% of the
fathers were unemployed.
In another study which was conducted in June 1996 in East
Jerusalem, Bethlehem and Ramallah (Abdeen,
1997). The
subjects were 603 school children 11± 17 years old, Moslems
(86.3%) and Christians (13.7%), half males and half females; 6%
of males and 15.5% of females (10.9% of the total sample) had
previously drunk an alcoholic beverage. However, 2% of the
sample reported drinking beer every day, 0.7% reported drinking
wine daily and 3% reported drinking alcohol containing apple juice
every day. About 35% of drinkers had their first drink before the
age of 9, 21% first drank when they were 9 or 10 years old
, and
23.3% first drank when they were 15 or 16 years old. About 1.3%
of Moslems and 9.9% of Christians drank alcoholic
beverages daily; 5.2% of Christians reported using hashish
25 times in the previous year and 2.6% of Christians reported
using LSD 25 times during that period.
In Gaza Strip, a survey was conducted by Al-Hayatt anti-
drug
Association (1998) of 220 drug addicts showed that 67.5%
started using drugs at the age of 16-
21 years, 74.5% started by
using Hashish and Bango, 6.5% used Heroin, 6.5% us
ed
narcotic tables. For cause of abuse, 47% said that they used
drugs with bad peer, 33% said they use drug due to curiosity
28% use it due to family problems.
In another study in the Gaza Strip (UNDCP, 1999) in
cooperation with Anti-Drug administration of
400 drug addicts,
found that 60.5% started using Beer, 48% drink alcohol, 54%
used heroin, 59% used hashish, 58% used Bango (cannabis),
17% used cough syrup with codeine, 35% used narcotic tables.
Another study of (Abu Rassas, 2001) of a sample of 85
out
patient substance abuse patients attending Gaza Psychiatric
Hospital found that 51.1% abused coke, 21.2% abuse cannabis,
20% abuse sedative, and 4.7% abused alcohol. Out of those
patients, 92.9% of them scored above the cut-off point of GHQ-
28. Bango (Ca
nnabis) abusers scored lower rate of mental
health problems than those abused alcohol, heroin, and
sedatives. According to previous studies in Gaza Strip and West
Bank, the most common abused drugs were Hashish
(Cannabis), Heroin, Sedatives and Hypnotics,
Opium, and
Cocaine. The intake of cannabis is 80-92% of cases, 10-
13%
abuse heroin (Saleh, 2007). According to the study, the annual
increase in the number of drug abusers in Palestine was up to
2.4% of the total number of users distributed between 2.43%
in
the West Bank and 2.39% in the Gaza Strip.
In another recent study, Abu Qamar and Thabet (2007) in
study of drug addiction in four universities in the Gaza Strip (Al
Azhar, Islamic, Open Alquds, and Al Aqsa university). A total
number of 1047 universit
y students in the 1st and 4th university
grades of Art and Science colleges, aged 17-
40 years, in 2003.
Participants completed an anonymous self-
report questionnaire
of two parts; the first part of 13 questions relating to socio-
economic information, heal
th status and abusing unprescribed
substance, sources and reasons of abusing and the second part
of 5 questions for 8 substance categories. Results showed that
2.1% have ever used unprescribed substance over the past
twelve months; 11.7% abused tobacco (s
mokers) with significant
differences for male (21.4%) compared to (2.1%) for female,
1.2% abused alcohol with significant differences for male (2.1%)
compared to (0.2%) for female. The Study revealed no
significant differences of other substances; 0.79% a
bused
psycho-
stimulants, 1.09% abused sedatives, 0.30% abused
opiates, 0.99% abused cannabis, 0.70% abused inhalants, and
0.20% abused hallucinogenic. Pharmacies were the most
common source of narcotics and stimulants.
Arabpsynet e.Journal:
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Intervention of substance abuse
Comprehensive prevention programs do no
t exist in the
West Bank (United Nations, 1993) and Gaza Strip. The
Palestinian National Committee for Drug Prevention was
established in June, 1996. It has published leaflets (Palestinian
National, 1997) and is involved in preparing an academic
training
program aimed at educational moderators in the Ministry
of Education and social supervisors in UNRWA (United Nations
Relief and Works Agency) schools. The Ministry of Youth and
Sports is also involved in the domain, and has published leaflets
and pamphlets (Abu-
Afifah, 1997; Palestinian Ministry of Youth
and Sports, 1997).
Until 1990, the drug addicts were treated in private clinics
and Psychiatric hospitals in Gaza Strip (Al Naser Psychiatric
Hospital) and in West Bank (Bethlehem Psychiatric Hospital).
On
1990 in Gaza Strip, Gaza Community Mental Health
Progamme was established and treatment of heroin addicts was
done by regime included safe detoxification together with
psychological and social rehabilitation and family involvement
rather than the previous
Method of maintenance therapy, which included over-
prescription of benzodiazepine. The non-profit, Al-Sadig Al-
Taieb Association, which established its treatment center for
Palestinian drug addicts in May 1991, published a limited
descriptive study in
1993, comparing personality traits of addicts
in treatment, exaddicts and non-
users (Abdallah & Fasheh,
1993).
Potential obstacles to research in the field of substance abuse
There are several challenges to substance abuse research
in this area. The poss
ibility of individuals feeling uncomfortable
and unsafe about admitting alcohol or drug use may result in
reduced prevalence rates due to people disclosure also, moral
values, cultural issues, societal ties, and legal constraints due to
legislation on indi
viduals with regard to alcohol and drug use
may prevent some individuals from presenting fro treatment or
seeking treatment outside the Gaza Strip and West Bank, thus
prevalence rates from treating organizations and institutions
may not be fully representative of the problem.
Conclusions and recommendations
From previous review, a small body of literature, descriptive
in nature, has emerged that confirms the existence of substance
abuse problems among Palestinians in the West Bank and Gaza
Strip despite the existence of
Religious, legal, and cultural constraints that condemn and
prohibit such problem. Generally, the participants of these
studies were drawn from clinical populations, where heroin,
sedative, hypnotics, and hashish were the dominant drugs of
choice. There is a great need for establishing independent,
comprehensive, treatment and rehabilitation centers in Palestine
for dealing with drug abuse people in accordance with
international standards and Palestinian culture. Prevention
programs inclu
ding using media to show the harmful side of the
drugs targeting youth must be started. Also, training of
professionals working in the field of using culturally validating
instruments for monitoring and intervention such as the 8
th
and
16
th
steps of helpin
g alcohol and drug addicts (Obert, et all,
2002). Also, there is need for conducing more studies in the field
of drug addiction to find the risk and protective factors, and
applied research to evaluate types of intervention with such
target groups.
Refer
ence
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Abdeen, Z. (1997). Substance Abuse Among
Palestinian Youth in 1996 (East Jerusalem, Al-Quds University).
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Abdulla, T.,& Fashen, V. (1993) A Comparative Study
for Mental Health Across a Sample of Ex-
addicts, Addicts
(Under Treatment) and Non-addicts (
Never Used Drugs) and Its
Relationship to Self-
esteem, Life Satisfaction and Health Locus
of Control (East Jerusalem, Al-Sadiq Al-Tiaeb Association).
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Abu Afifah, T. (1997). Drugs and Death [in Arabic]
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Saleh, J et al (2007). Phenomena of drug addiction in
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1]1 [
، راو كاو جا ، أ
! ة#$ا %&' ()* ر'+,
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