The Darker Side of Paradise: Heroin Addiction in Zanzibar
The Lancet
August 31, 2019
Behind the beautiful touristic sand beaches, sober recovery houses provide safe havens for the thousands of people dealing with heroin addiction in Zanzibar. Amy Yee reports from Stone Town.
The sober house sits behind a wall on a dirt road lined with banana and palm trees. Chickens strut in the packed dirt front yard. About 20 men sit in a circle on plastic chairs inside the modest concrete building on the outskirts of Stone Town, Zanzibar (Tanzania).
Inspirational signs adorn the white walls. They read: “sometimes you win, sometimes you lose, but always you feel okay”; “no matter how long you stay clean, do your recovery by action”. On a humid day, a cat strolls into the men’s daily meeting.
The group listen intently as one man admits he doesn’t feel well. “I got stress. I want to smoke. How to overcome this feeling?”, he asks quietly.
This is one of eight sober houses in Zanzibar. This one, run by non-profit Zanzibar Youth Forum, has treated thousands of heroin addicts since 2009.
This large island off the coast of Tanzania is synonymous with a tropical paradise. Zanzibar’s idyllic white sand beaches and turquoise ocean are world-renowned. But most tourists are unaware that thousands of its 1·3 million inhabitants are struggling with heroin addiction. There are between 7000 and 12 000 people addicted to heroin in Zanzibar, according to the government’s drugs control unit.
Zanzibar’s island location makes it susceptible to the heroin trade from Afghanistan and Pakistan, which are located across the Indian Ocean from the east African coast.
A 2016 UN Office on Drugs and Crime (UNODC) report said that maritime forces in the Indian Ocean were seizing larger quantities of opiates sourced from Afghanistan, likely destined for ports in east Africa, especially in Kenya and Tanzania.
Zanzibar is also lax with punishing traffickers. However, the island’s government adopted a new drug control and enforcement act this June, which may help stem the problem.
Under the new act, “punishment is more severe for traffickers”, said Cassian Nyandindi, assistant commissioner for the Tanzania Drug Control and Enforcement Authority. “I’m sure this will make a very big difference.”
Tanzania’s mainland passed a similar act in 2015 and, as a result, heroin trafficking substantially decreased on the mainland, according to Nyandindi. Zanzibar is part of Tanzania, but it also has its own Government.
However, the new drug control act in Zanzibar is yet to be implemented and could be hard to enforce. The island’s porous coastline makes it difficult for authorities to patrol and stop smuggling. Meanwhile, as mainland Tanzania cracks down on drug trafficking, the trade is migrating south to neighboring Mozambique, and then to South Africa.
“Mozambique is a big new hub for drugs,” said Nyandindi. “Northern Mozambique is not very stable. From there, drugs are trafficked to South Africa.” He added that trilateral agreements between the three countries to fight the problem are being developed.
Trafficking via Zanzibar has historical roots. In the 1800s, the island’s strategic geography and ports made it a prime trade hub for spices, ivory, and slaves being shipped from Africa to the Middle East and beyond. It was so important that the Sultan of Oman moved the capital of his country from Muscat to Zanzibar in the 1830s.
In Zanzibar, a dose of heroin can cost as little US$0·50, and it is alarmingly accessible, especially in Zanzibar City, the island’s main urban centre. In one survey from 2003, 7% of people in Zanzibar who were polled had used heroin in the past 30 days, according to a WHO report.
Heroin use is not a new affliction in Zanzibar, but it seems to have worsened in recent years. Seizures by authorities suggest that it might be more common for Afghan heroin to be smuggled across the Indian Ocean into east and South Africa, according to the UNODC.
Now, traditional sail boats carry opiates from Afghanistan to Kenya and Tanzania. In 2014, authorities seized more than 2200 kg of heroin on the Indian Ocean, which is more than all heroin seizures in Africa between 2011 and 2013, according to the UNODC World Drug Report2015.
The heroin trade causes pain and suffering for addicts and their families and friends. Hamdani Abeid of Zanzibar Youth Forum works as a counsellor at this sober house. It is about a 20-min drive from the UNESCO world heritage-listed Stone Town, the historical section of Zanzibar City.
About 20 recovering men who are addicted to heroin live here for months at a time.
Mbarak Hamadi Simai (left) and Saad Saleh Misarak at a sober house in Zanzibar, Tanzania
Copyright ? 2019 Amy Yee/The Lancet
At the sober house, “sometimes they have major urge of using”, said Abeid. “They have to share. They feel lonely, so they have to share to live without feeling any stress.” Heroin addiction is difficult to break, and relapse is common among the residents. They can be clean for up to a year, but then they are highly susceptible to using heroin again.
“Being idle is a problem. That’s a factor for relapse”, said Maulid Suleiman, executive director of Zanzibar Youth Forum.
About 30% of the island’s population of 1·3 million people lived in poverty in 2015, according to a World Bank report. Unemployment among those aged 25–35 years was nearly 25% in 2014. For young people aged 15–24 years, it was far higher at 46%.
Saad Saleh Misarak, aged 44 years, volunteers at the sober house. He leads group meetings and mediates between residents when quotidian disputes arise. Misarak is also a recovering heroin addict and former resident of this sober house. He has been clean for 1 year. “I can get help here, help fellow addicts, and protect myself”, he says.
In Zanzibar, where education can be rudimentary and literacy low, some people do not know about the dangers of heroin.
Nassor Mkondo, aged 47 years, a former mechanic, started using heroin years ago in 1991. The first time he got high, he “felt joy. I thought I could stop any time”, he said in Swahili through a translator. When his girlfriend introduced him to the drug at the time, “I didn’t know it was dangerous”, he recalls.
Signs in this sober house in Zanzibar list rules and a daily schedule for residents
Copyright ? 2019 Amy Yee/The Lancet
Life eventually became unman-ageable and Mkondo lost his job. His breaking point came when he crashed a car while driving under the influence of the drug. A father and son died, and another boy’s injured arm was amputated. Mbarak Hamadi Simai, aged 28 years, the son of a member of parliament in Zanzibar, first used heroin when he was aged 17 years. “I knew it was dangerous, but I didn’t think I would get addicted”, he admits.
Simai’s life deteriorated, and he started stealing to fund his addiction. After he was caught robbing someone on the street, he checked into the sober house.
Here, Simai has made friends and talks about his addiction. “Now I know how to cope with how I feel. I can overcome stress.” He is looking forward to a job training programme to farm mushrooms and hopes it will keep him on track in the future.
More prevention programmes would help stem heroin addiction and the need for arduous recovery. To reduce heroin use in Tanzania, WHO recommended socioeconomic development in rural areas, awareness campaigns for teenagers, and discouraging use of alcohol, tobacco, and cannabis, which is associated with using other drugs. WHO also suggests more cooperation between substance-related agencies and breaking down links between drugs and crime.
This sober house uses the Narcotics Anonymous Step Working Guides, which were adapted from the Alcoholics Anonymous guidelines, to overcome alcohol addiction. The 12-step programme used by treatment centres worldwide, as well as medication assisted therapy, helps addicts to wean themselves off heroin.
A sign on the wall lists rules for living in the house. They include “Addict must accept to stay in house” and “No stealing, ‘F*ck off’ [swearing], climbing over wall”.
Residents can participate in sports, spiritual and stress-reduction sessions, gardening, and vocational training, such as breeding chickens. There is a daily session where they talk about their emotions.
Some schools in Zanzibar have started awareness programmes, said Suleiman of Zanzibar Youth Forum. But funds and resources are inadequate in Zanzibar and the road to recovery is full of hurdles. Far more support is needed, especially for HIV counselling and testing and programmes preventing relapse, which is very common.
Before his heroin addiction, Misarak had an administrative job in Zanzibar’s finance ministry. He had relapsed several times before volunteering at the sober house.
When he first starting smoking and snorting heroin in 1995, he did not know about its dangers. Misarak thought heroin was a “refreshment”, like “other enjoyments”, such as drinking or cigarettes.
Heroin made him feel “powerful, like Demolition Man. I feel good, more brave, no more stress”, he explains. “We repress our feeling[s] when we use drugs. We want to escape reality.”
That euphoria made him go to dangerous lengths to feed his heroin habit. “After being an addict, I know how to steal, lie, manipulate people”, he admits.
Now the thought of his son, aged 10 years, helps firm his resolve to stay clean. “I don’t want my son to become like me. I want to keep him safe.”
It’s a long road to recovery, but self-awareness and recognising addiction are part of the 12-step approach used at the sober house.
Misarak returned to volunteer at the sober house “not only to stop using drugs but to change my habit”, he says. “I want to become a good person.”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32001-X/fulltext