Cover image: Female opium addict hides her face – Mazar-i-Sharif detox centre, photo from Flickr.
Warning: this article mentions details of addiction and sexual assault.
For over a decade, Sameera and her husband Nadim, whose names Afghan Witness (AW) has changed, served as doctors in Afghanistan. They specialised in the treatment of female drug addicts, scouring cemeteries and underpasses looking for the troubled women.
Since the Taliban’s return to power last year, Afghanistan’s healthcare sector has been described by the World Health Organisation (WHO) as being “on the brink of collapse”. Over the last two decades, the sector has been heavily reliant on foreign aid, much of which has been cut since the de facto rulers took over. Some healthcare workers have left the country, while those who remain describe higher workloads, less pay, and threats to the safety of themselves and their families.
Sameera and Nadim speak to Afghan Witness (AW) from Pakistan, where they have sought temporary refuge with their three children.
Sameera served as a doctor treating female drug addicts for nearly 13 years in one of Afghanistan’s northern provinces – AW will not specify the location for security reasons.
“There were times when I have gone under bridges and graveyards and have collected women drug addicts and have admitted them to the hospital myself,” she says.
Afghanistan is the world’s biggest opium producer, forming 85 per cent of opium production globally. Crystal methamphetamine production – created from the ephedra plant, which grows wild in the country – has also reportedly surged. The Taliban outlawed the cultivation of opium in early April this year, though there is scepticism over whether this will improve the situation.
Experts say that factors such as widespread destruction and displacement during the war, as well as foreign aid cuts and losses of local spending after the departure of foreign troops have left many destitute Afghans dependent on the narcotics trade for survival.
The frontlines of addiction
“Poppy Fields in Afghanistan” by United Nations Photo is licensed under CC BY-NC-ND 2.0.
A 2015 survey by the United Nations (UN) estimated that up to 2.3 million people in Afghanistan had used drugs that year – equivalent to around 5 per cent of the population at the time. An updated, reliable figure is not known, though Afghan doctors estimate numbers to have only increased.
The United Nations Office on Drugs and Crime (UNODC) notes that after decades of conflict, Afghanistan’s population has been left vulnerable to mental health problems such as anxiety, depression, and post-traumatic stress disorder (PTSD) – described as “common risk factors” for initiation of drug use and development of drug use disorders.
Sameera and Nadim explain that women in Afghanistan fall into addiction mainly as a result of hard labour, such as carpet weaving, which leads them to use drugs for pain relief. They say that women addicts often give drugs to their children, something reflected in UNODC statistics; in 2009, for example, nearly 80 per cent of women who had used opium also reported giving opium to their children. According to the two doctors, female addicts are known to use drugs to calm their children, either by feeding them liquid or smoking on their faces.
The couple tells AW that in their work, they saw women and teenage girls ubiquitously used as drug sellers, as male drug users were more eager to buy from females. They say that female addicts and sellers were often sexually abused and lived in poor conditions in graveyards and under bridges.
“There were girls of even 12 or 13 years old who became pregnant due to sexual assaults and rape, and we have the evidence and photos of them,” says Sameera.
The couple chose to focus on female addicts as they say some families sold their daughters and deliberately put them in the business to earn money.
“Lately, before the regime change in Afghanistan, a woman who was raped repeatedly in a graveyard where drug addicts [gathered] got pregnant and delivered her child there. Dr Sameera and her team members went to that woman and brought her and the child to the hospital and took care of her,” says Nadim.
Sameera and Nadim always feared the drug mafia in their area, who viewed them as disruptors of their business. They were also previously threatened by addicts who didn’t want their addiction disclosed to their families. Nevertheless, Sameera and Nadim worked tirelessly, not just treating patients but also advocating for them and resolving their family issues.
At first, the couple continued with their work even as Afghanistan fell to the Taliban, but a week into the takeover, they decided to quit their jobs – which had ties to the US – due to fear of reprisal.
“It is very unfortunate to hear that what we had worked for all collapsed,” Nadim tells AW.
Since the return of the Taliban, there have been reports of drug addicts being forced into a process of “painful withdrawal” in drug centres. Before the group’s return, Kabul police would sometimes arrest addicts and transfer them to centres, but since last August there have been increasing reports of raids on areas in the capital where addicts are known to gather.
“We hear horrible news about how drug addicts are now being treated and that there remains no more support for them,” Nadim adds. “I even heard that in some rehab facilities, the addicts eat grass, and some have turned to cannibalism.”
Insecurity and abductions
Sameera and Nadim thought that distancing themselves from their work was the safest option for their family and confined themselves to their home. However, they say that not long after quitting their jobs, their daughter was kidnapped on her way to school. They had sent her via hired taxi to attend an exam.
Doctors and their family members have long faced abduction in Afghanistan due to being considered wealthy. Sameera and Nadim were even more vulnerable due to their high-risk work treating addicts and their vocal campaigns against addiction. The couple, though distraught and helpless, say they were warned by the kidnappers not to notify the de-facto authorities.
“They [the kidnappers] told us not to try asking for help as they claimed they had people among the current authorities,” Nadim told AW.
Sameera and Nadim’s daughter; photo sent to AW.
After four days, Sameera and Nadim eventually released their only daughter from the kidnappers. They paid the ransom by selling jewellery and their car and borrowing from friends and relatives. The two doctors say that following their daughter’s release, the Taliban captured the kidnappers, although two of them were killed in the clashes, and three had fled to Iran.
After the incident, staying in Afghanistan was no longer an option for the family. However, their passports had expired, and with the country’s foreign embassy and consulate services largely suspended, leaving seemed impossible.
Having been granted medical visas to seek treatment – under the pretext that they would return – Sameera, Nadim and their three children went through an arduous journey and crossed the border to Pakistan on foot. Now six months after their arrival in Pakistan, they are still waiting to be evacuated to a safer country.
“We have been knocking on every door for help, but no one listens to us,” Nadim says.
Sameera and Nadim registered with the UN High Commission for Refugees (UNHCR) but are concerned about how long they will have to wait before they can leave Pakistan. Several months ago, AW also spoke to an Afghan activist seeking refuge in Pakistan, who described being “stuck” in the country due to delays with the processing of asylum cases.
“We have been receiving death threats and have been told by the [drug] mafia that they have our address in Pakistan,” Sameera says fearfully.
The family say they are currently renting a cramped house in Pakistan and have managed to enrol only their eldest son at school. They had lost all their savings after paying the ransom to their daughter’s kidnappers – their two younger children do not attend school because they cannot afford the fee.
Their daughter, still in shock and suffering trauma from the kidnapping, fears going out and meeting people.
“She wakes up in the middle of the night and shouts and cries,” Sameera tells AW.
“I served Afghanistan’s health sector for over a decade, and I am proud of it. But now we are here in Pakistan … facing uncertainty and poverty,” she adds.
“I wonder who on earth the international community sees as qualified for a rapid evacuation if not us?” Nadim says. “I do not know why they are not listening to us and postponing our case and asking us to wait … waiting is dangerous for us.”
Three days after the couple spoke with AW, Nadim shared screenshots of threats he had newly received from an unknown number, which claimed to know the family’s whereabouts in Pakistan. In the message, the sender said that they would come after the family.