Agha Shahi had been using drugs for 10 years when his family decided it was time for rehab. In Uruzgan, an impoverished and often-neglected rural province in southern , there was only one place to go: the private home of a freelance treatment guru.
In the provincial capital, Tarin Kot, a hand-painted sign of an opium smoker points to Hamidullah Bawari’s drug “clinic”. In a small courtyard among well-tended flowerbeds, a handful of recovering addicts shuffle around with their feet in chains.
The treatment here is rudimentary, consisting of little more than cold turkey eased by painkillers. Even cigarettes are banned. In the first 72 hours, patients have their heads shaved and their ankles shackled.
“If we didn’t have chains on, we would escape like this,” Shahi says as he snaps his fingers.
Despite its basic amenities, facilities such as this fulfil an urgent need, even if it is the brainchild of an amateur drugs counsellor who buys his painkillers at the local bazaar.
A recent suggests that up to 11% of the Afghan population use drugs. The report, which is the first nationwide toxicological survey of drug use in Afghanistan, was based on saliva, urine and hair samples from more than 10,000 Afghans. Addiction, the report says, is particularly endemic in rural areas where about 39% of households tested positive.
Such estimates are notoriously tricky, particularly because Afghanistan’s last census was conducted in 1979. In earlier estimates, the UN put the number of at 1.6 million, or around 5% of the population.
Regardless of the exact number, health authorities are overpowered. Over the past decade, international donors have helped Afghanistan set up about 100 treatment centres across the country, offering space to over 30,000 addicts.
Tawab Saljuqi, a spokesperson for the Ministry of Public Health, said the government had achieved a lot with limited resources. “But the pool of addicted is increasing, and the resources are decreasing,” he said.
Bawari, the director of the Tarin Kot clinic, opened his home to addicts three year ago. Every day he saw addicts in the street, rummaging through rubbish to find sellable items for their next fix.
“I thought, ‘they have a family too. What would I do if I were in their place?” says Bawari, whose only training consists of a four-day course with the ministry of counter narcotics.
Bawari’s house can accommodate upto 40 patients, but rarely sees more than 20. A month’s treatment costs $100 (£65), a hefty expense for families.
“It’s very difficult for the family to bring a person here,” says Shahi.
Shahi, rail-thin with a thick black beard, started using when he was in his early 20s. Friends who had migrated to Iran returned with a drug habit, and he quickly got hooked on opium and heroin.
Even after treatment, many patients are doomed to live perpetually on the edge of addiction. Jobs are scarce and the abundance of poppy fields and drug smugglers in Uruzgan make a habit even harder to kick.
“If they leave this place and don’t find a job, they will start using again,” says Bawari.
Yet, a job is not always a safeguard against addiction. Jalil, 22, worked with the highway police, protecting lorries driving from Tarin Kot to Kandahar. His work, rife with corruption and close to drug routes, helped sustain a heroin habit he said cost him about £20 a day.
“When I brought my son here, he was very weak, almost dead,” says his father, Zafron. It took him five years to notice Jalil’s habit, and he is grateful to Bawari for his treatment. ”He gave a second life to my son.”
The clinic is men-only but plenty of women and children are addicted too. In the US survey, 11% of rural children tested positive for drugs, most of them exposed through second-hand smoke or from residue in rugs and pillows.
Until recently, Save the Children ran a drug clinic in Tarin Kot that was free of charge for both genders. But at the end of May, after treating more than 500 patients over two years, the organisation handed over the programme to the provincial health directorate of Uruzgan, which did not have the money to maintain it.
Jennifer El-Sibai, spokesperson for Save the Children, said the closure was an indirect consequence of aid cuts in Australia which funded the clinic.
“We were hopeful we might continue the programme in some form. However that has not happened,” she said.
Afghanistan’s drug crisis also illustrates a wholesale failure to eradicate opium. This year’s poppy harvest is expected to , surpassing last year’s unprecedented 224,000 hectares.
Since 2001 the US has spent $8.4bn on combating drugs in Afghanistan. On a recent visit to Kabul, William Brownfield, assistant secretary of the State Department’s bureau of international narcotics and law enforcement affairs, suggested that other countries should take more responsibility.
Brownfield told reporters in a briefing that in the US, “the amount of heroin consumed that is of Afghan origin is about 4% … There should be more nations and governments that are focusing their efforts and resources to this problem”.