No one knows for certain how widespread drug use and addiction is in Afghanistan. A United Nations survey of drug use across the country has been completed, but its numbers are being crunched and have not yet been released. Afghan officials and experts cite a figure of 60,000 drug users in the capital city of Kabul (estimated population 3,000,000), but while the common conception is that that number reflects the number of opium or heroin addicts, reality is a bit more complicated.
When pressed on the issue of Sinless Council symposium on the feasibility of licensed opium production, conceded that the 60,000 figure measured drug users, not drug addicts. The situation is further confused by the tendency here -- one of the ancestral homes of cannabis -- to consider it a "narcotic," a position that is neither medically nor scientifically defensible.
One of the world's poorest countries, decimated by a quarter-century of war and foreign invasion, and home to nearly 90% of the planet's illicit opium supply, Afghanistan is ill-prepared to deal with a rising tide of drug use. But despite all the obstacles it faces, including the weakness of the central government and limited support from the international community, the country is taking steps to confront drug use and help its citizens who fell into addiction and abuse.
By our definition of harm reduction, there is indeed currently only one such project. On the outskirts of Kabul, down a dusty side road, lies the NEJAT Center, the only harm reduction center in the capital city, and indeed, the whole country. [A note on semantics: DRCNet differentiates between "harm reduction" and "treatment and prevention." The latter term refers to activities such as getting drug users off drugs or stopping them from starting in the first place, while "harm reduction" refers to programs that attempt to work with active drug users, such as needle exchange, condom distribution, and safe injection sites.]
An outgrowth of a program begun across the border in Peshawar, Pakistan, in 1991 to deal with what would become millions of refugees fleeing factional violence in Afghanistan, NEJAT opened its Kabul facility in 2003. It still deals primarily with refugees -- this time Afghans returning home who developed serious opium and/or heroin habits as they rotted in Pakistani refugee camps for years waiting for political violence to subside in their homeland.
In NEJAT we lead a small team of doctors and social workers (many of them volunteers, some of the social workers graduates of his program) who bring addicts through a comprehensive rehabilitation program beginning with a one week detox followed by a second week of orientation and then a month-long rehabilitation program. During the program, clients are taught not only to resist the lure of opiates but also social and job skills, such as learning to weave carpets or make shoes, and some will even be able to get small loans to open small businesses. (Unsurprisingly, small businesses here often consist of a cardboard or wood shack, and whatever the product is, the overhead to open and operate a small business in Afghanistan is very small.) It's not just drug treatment. NEJAT also includes a harm reduction component, with an active needle exchange program, as well as condom distribution. With AIDS a rising problem, both are critical to the effort to get a grip on the epidemic. And while the inpatient treatment program is limited to men, the center's outreach programs also target women and children, a population typically neglected not only in drug treatment programs but by Afghan society as a whole. The silent, unseen part of the Afghan population, women are expected to be behind the walls of home and not out on the street.
AIDS has been like the tsunami for us, In addition to activities with injection drug users, we are also reaching out to sex workers in the Kharabat, Kabul. We have a team there consisting of doctors, social workers, and volunteers that do outreach there. AIDS is a big shame, and it's getting worse every day.
In the meantime, NEJAT programs do what they can with volunteers and a handful of ill-paid workers. Fortunately, NEJAT is generating them with its treatment and rehabilitation program.
One group of brothers and sisters in their late teens and early twenties, the Yaqubi family, is a sterling example. After the death of their mother in Iran, the family's father descended into heroin use, and the kids followed him. But as their money ran out, the Yaqubi children realized they needed help and turned to NEJAT. Now, eleven months later, the kids are not only clean, but helping at the center. That's the spirit. Despite the assistance of the international community -- and it is certainly deserved after the beating Afghanistan has taken from great power geopolitics -- the Afghan national will ultimately have to save itself. With drug treatment and prevention programs underway, with harm reduction programs gaining a toehold, and with the help of Afghan citizens like the Yaqubis, the country is taking the first steps.

Muhammad Qasim Zamani
Executive Director, NEJAT Center, Kabul