Much attention has been paid to the supply of illicit drugs in the Middle East and war-torn Syria, but little has been focused on the patterns and implications of drug consumption in the region. However, a recent MedGlobal report reveals insightful data about Syria’s emerging addiction crisis. The report notes that drug consumption has increased 300% since the outbreak of Syria’s civil war, with high addiction rates associated with illicit substances, including captagon, crystal meth, heroin, cannabis, and other volatile substances. In this episode of the Contours podcast, the New Lines Institute’s Caroline Rose and Senior Non-Resident Fellow Dr. Karam Shaar discuss the report’s findings with MedGlobal President Dr. Zaher Sahloul and talk about the future of drug demand in Syria and beyond.
Caroline Rose:
Hello everyone and welcome to this New Lines Institute Contours podcast. My name is Caroline Rose, and I am the director of the Captagon Trade Project at the New Lines Institute. The Captagon Trade Project is an initiative that is sought to generate intelligence-driven research and analysis on amphetamine flows in the Middle East and beyond. I’m very pleased to be joined today by our project Senior Non-Resident Fellow Dr. Karam Shaar, who will be co-hosting this discussion with me, and our guest, Dr. Zaher Sahloul. Dr. Sahloul is president of MedGlobal, a nonprofit organization committed to delivering crucial healthcare to populations affected by crisis and poverty worldwide. Dr. Sahloul is a former president of the Syrian American Medical Society and has led numerous medical missions to regions hit by natural and man-made disasters, including Syria, Ukraine, Colombia, Puerto Rico, Gaza, Yemen, and Bangladesh. Professionally, he’s a critical care specialist at Advocate Christ Medical Center in St. Anthony’s Hospital, and associate professor at the University of Illinois in Chicago. He’s recognized for his unwavering commitment to serving vulnerable populations and advancing medical care in resource-limited settings.
Our project is very excited to have Dr. Sahloul with us today to discuss a new report that was published at MedGlobal two weeks ago, “Under the Surface: A Decade of Conflict and the Drug Use Epidemic Inside Syria.” This report encompasses a study conducted in 2022 through a mixed methods approach combining qualitative and quantitative research methods. An online questionnaire was distributed to 478 participants, including Syrians both inside Syria and refugees in other countries, alongside interviews with 27 experts and key informants providing a comprehensive view of the crisis. The findings reveal a significant rise in substance use, especially in opposition-controlled areas and a growing concern about prescription medication dependence. Dr. Sahloul, can you walk us through some of the main findings of this MedGlobal report?
Dr. Zaher Sahloul:
Sure. So the survey and the study showed that there is significant increase in the drug addiction and substance abuse in all sectors of people who were surveyed, whether they are in opposition areas or government-controlled areas, or they are refugees. So in the opposition-controlled areas, the increase was from 2% before 2011 to 5% after 2011, which is an increase of about 150%, significant increase in the drug addiction. In the government-controlled areas from 1% before 2011 to 11% post-2011, which is about 1,000% increase. A huge number. But the sample in the government-controlled area is smaller, so I’m not sure how valid is percentage. Still, it’s very significant. And among the asylees, the refugees, it went up from 10% before 2011 to 20%. An increase about 100%. Which is still significant.
In general, the whole sample, the drug addiction substance abuse increased from 3% to 8%, which is about 150%. Young people are more affected than others, especially male population. Among young people age of 18 to 29, the increase was from 3% to 9%, which is 300% increase. So all of this indicates that substance abuse or drug addiction prevalence has increased significantly in all sectors, in all areas, especially among young males in government-controlled and opposition-controlled areas.
Caroline Rose:
So I want to start off by asking everyone what we think this report brings to the literature that exists on drug consumption in the region and in Syria specifically. We don’t see that much documented about drug consumption, let alone drug abuse. For example, both Karam and I have been working on the captagon file for years, and there’s been a lot of literature about the supply side of the coin when it comes to drug flows in the Middle East rather than the demand side of the coin. Dr. Sahloul, why do you think that is? And I would also like to pose this question to Dr. Shaar as well.
Dr. Zaher Sahloul:
Thank you Caroline for having me and especially discussing this important topic and report. And as you’ve mentioned, this is probably one of the few reports, if not the first, that highlights the extent of the drug addiction in Syria, in light of the conflict that started in 2011. And the previous reports, especially the ones that you led, focused on the captagon trade and the routes of trade and supplies and the economic impacts of that trade. But this is probably one of the few reports that highlights the impact of drug addiction, whether it’s captagon or other illegal drugs, and also prescribed drugs on the society and the communities inside Syria, whether they are in the opposition-controlled areas or government-controlled areas or even the Syrian refugees. So that’s why it’s important.
I think the perception, especially for people who are not familiar with Syria and they don’t go into Syria in the last few years, that drug addiction is probably limited to certain areas. That it is exported, it’s not consumed locally. Also, that there’s not much resources, which is true, to rehabilitate patients who are addicted to drugs. So this report basically through the survey, addresses the incidents and the prevalence of the drug addiction, which drugs that are used in Syria and what are the reasons that people, especially young men, are using these drugs, and the impact on the society and the policy recommendations.
Dr. Karam Shaar:
But I think the report also brings to the public is the ability to access populations that are very difficult to access, especially in conflict settings like in Syria. So it’s quite difficult to reach addicts and ask them about their addiction and what drugs they’re using and what frequency and so on. But doing that in a conflict setting is incredibly challenging. And the fact that you manage to actually do it in multiple control areas, which gives us now the ability to compare between those areas, I think is particularly helpful. So thank you and thanks to the team.
Dr. Zaher Sahloul:
I just returned recently from actually another conflict country, which is Colombia. And people may think that what’s the relationship between Colombia and Syria? We have a clinic in Colombia that provides healthcare to the migrants, especially Venezuelan migrants, and also host communities. And as we know, there is a large migrant crisis south of the [U.S.-Mexico] border that starts from Latin America and Central America and arrives into the border here in the U.S. And some of the triggers for this crisis is the fact that some of the countries that were in crisis or conflict, especially Colombia and Honduras, and now Ecuador unfortunately, are controlled by drug cartels and people are fleeing because of the violence related to drugs and drug networks.
So what I’m seeing in Syria, and I think your previous reports are providing the same thing, that we are now at the maybe the beginning of a crisis like this in Syria that start with captagon, but other drugs are implicated. And with time that going to create a regional problem, it’s already a regional problem, but going to create another wave of refugees probably to Europe and other places, not because of the current conflict, which has not ended yet, but because of the impact of the drug trade, the drug cartels, and the violence related to that.
Caroline Rose:
Absolutely. And I think that really we’ve heard so much about flows of amphetamine-type stimulants like captagon and methamphetamines in the Middle East. The one side of the coin that we keep hearing about is supply-side and all of the efforts that are being conducted such as interdictions, law enforcement exercises, raids, lab seizures, that all are really trying to tackle the supply side of this. But there really hasn’t been an effort like this to show just the scale of consumption and addiction, not only across the region, but specifically inside of Syria. We hear about Syria being such a huge production hub, but I think that this report puts many stories and even faces behind this addiction crisis. And I think that that’s so incredibly important, especially in a field and in this corner of the literature where some of the studies that were conducted, the most recent ones before this report was put out, were from perhaps the early 2000s and even the early 2010s.
So this really, I think, is filling in a gap in the literature and updating what we know about captagon and amphetamine-type stimulant and other illicit drugs, the consumption and abuse that surrounds that.
Dr. Zaher Sahloul:
Exactly. I think one of the issues that we face in the Middle East, the fact that mental health in general and drug addiction in particular are taboo. People don’t talk about them. And even if they have family members or friends who have mental illness or addicted to drugs, they don’t address these issues. They try to hide it. And this is part of the cultural heritage in some areas in the Middle East, especially in Syria. So it is important to address these issues and raise awareness and educate the communities, not only people who are afflicted by drug addiction, but also healthcare workers because there’s not much information about these issues among doctors and nurses and hospitals. There are not much resources to provide to patients who are addicted.
When I was in Syria last year, I asked about the rehabilitation centers that are available for drug addicts, and I was told that the best option is prison because there’s not much drug rehabilitation or awareness in the hospitals. There’s few private and even more rare NGOs run a drug rehabilitation center. One of them was run by MedGlobal in Azaz. And most people who want to go through withdrawal, they’re put in prisons for a few weeks and that’s the best option for them, which is of course is a very primitive way to deal with this issue.
Dr. Karam Shaar:
Exactly. Actually, before we dive into the stats presented in the report, I just wonder how confident are you in these stats? How difficult was it actually to access the respondents knowing that many of them are actually addicts, and how worried are you about the use of surveys as a tool for collecting information? One would expect, for example, someone who is particularly addicted to be incapable of responding to a survey. So this might some biases into the stats, but the question always methodologically is give me an alternative, what’s the alternative to surveys? So I just want to hear your thoughts on the methodology.
Dr. Zaher Sahloul:
I totally agree that this is not the best way to measure the extent of the crisis, but this is probably the only way available, especially if we want to address or to survey multiple areas. And so although we surveyed, and this study was done in partnership with the Dialogue Syrian Center, the social unit of the Dialogue Syrian Center. It was done in 2022, as you’ve mentioned. The survey was distributed to about 400 people in opposition-controlled areas, in government-controlled areas, and also some refugees in Lebanon in particular, and Turkey. The response rate was about 66% or 65%, which is pretty good. Two thirds of the people who received the survey responded to it. There was difficulty getting the survey distributed in government-controlled areas because of the laws and strict monitoring of online, and the reluctance of people to share the survey. They were fearful of the repercussions by the government. So most of the responses were from the opposition-controlled areas.
And also on top of the survey, which is not only directed to addicts, but also to family members or people who have friends who are addicts. So I would say people in general would not have volunteered this information if it is not true. It is not perfect, but this is the best way that we can delve into the extent of the crisis and get some prevalence of the drug addiction. And also because it compares the phenomena of drug addiction before 2011 and after 2011, I would say that the numbers are relatively true. And besides the survey, there were about 29 people who were interviewed in details. And some of them are experts, some of them have family members who are addicted, some of them are addicts themselves, and that added more light to the result of the survey.
Caroline Rose:
Hopefully this report will help inspire clinics and facilities across the region to conduct studies like this, or at least start to generate more research and studies into consumption and abuse of illicit substances, particularly amongst affected individuals. And I think that the more research that is generated, the more inspiration that facilities and health clinics will have in trying to pioneer more research.
I want to dive a bit more into captagon specifically over at New lines. We run a project specifically on the captagon trade, and we’re broadening some of our to look at amphetamine-type stimulants more broadly in the region. But I want to talk and chat a bit about the health effects of captagon in particular. We’ve heard so many different stories, some exaggerated, for example, captagon has been termed the poor man’s cocaine. It’s been termed a zombie drug. There have been so many different names and nicknames that have been pinned on this illicit substance. Dr. Sahloul, how would you characterize the implications of captagon consumption and addiction? How do we balance that spectrum of nicknames and characterizations, and what is the most accurate picture of captagon?
Dr. Zaher Sahloul:
Of course, you’re the expert in this field, but captagon is not a new drug, of course. It’s a stimulant, so it keeps people alert. It has been used for a long time, especially in the ’60s, for patients with ADHD to keep them alert and focused, but also it was used in Vietnam by American soldiers, also to keep them alert in the battlefield and focused. But the captagon that is produced in Syria is a little bit different than the older captagon. It’s a mix of methamphetamine and paracetamol and ephedrine. It is called in the Syrian language “abu hilalain,” which is the pill of the two crescents because there’s two crescents on the pill. But of course, there’s other substances and chemicals that are added to it in different places where it’s manufactured. It’s a stimulant, it keeps people alert. Was used by fighters originally and during the crisis, whether it’s in opposition areas or government-controlled areas, but then it became more common among young people.
In this study, about 50% of people who are addict are addicted to captagon. The medical impact of captagon… Of course, being alert is a good thing, but also it transform people into different reality. That’s the main reason that people are using them. It gives you a rush, which is… people use it because of that effect. And also it’s a gateway to other drugs. And that’s the most dangerous things about captagon because people who start with captagon, then they move to crystal meth, they move to heroin and other… and fentanyl maybe in the future. And that’s the danger of it because of the gateway to other drugs. It’s very addicting. It can cause some cardiac arrhythmias, irregular heartbeats. It can cause heart attacks, of course, but that’s a very minimal impact because most people who are abusing it are young. And of course, it has a lot of withdrawal symptoms, and that’s why it’s very difficult for people to get rid of this habit.
Dr. Karam Shaar:
Looking more into the stats, it’s quite interesting that two largest reasons for drug abuse cited by those surveyed were actually escaping reality and suffering, which I think is quite common. But it was actually followed by another factor, which is being unwillingly involved in drugs. The share of respondents who actually thought that this is one of the triggers of drug addiction in opposition-held areas, the share was 47%, in regime-held areas, it’s 55%. What do you think this is about? Are we talking about people being forced to use drugs initially, which gets them later on hooked?
Dr. Zaher Sahloul:
Yes. Well, yes and no. So first of all, escaping reality. And for people who are not maybe familiar with the Syrian crisis, nowadays, we’re all focused about what’s happening in Gaza and Lebanon and even Sudan. But as everyone knows, Syria went through rough times, most Syrians went through rough time in the last 13 years. There was a war. It started with demonstrations and then it was transformed into a civil war. Half of the population have been displaced; 6.5 million became refugees in the neighboring countries mostly. And also in Europe. Germany has 1 million Syrian refugees. Ninety percent of the people in Syria are below poverty line. There’s still about 7 million internally displaced people in Syria. Syria is divided into four areas. Each one of them has their own government militia or armed forces and economy and healthcare. There is no end in sight. Today I was looking at the news and we have multiple clinics in northern Syria and our team send us information and pictures and videos of a bombing near Idlib in one of the internally displaced camps that led to the killing of five people and injuring of 10 civilians.
So these things are still happening. There’s still war in Syria, there’s still bombing. There is no political solution. You have hyperinflation, you have uncertainty, you have continuation of displacement and violence. And because of that, people want to escape from reality. There is no jobs for young people, and if you graduate from college or university, most likely you will not have a job. So that’s why maybe the first reason for using drugs like captagon or others is to escape from this reality that is very dark. And actually, if you look more into the details, you will discover that most people who responded to the survey and they are addicted to drugs, are well-educated. And some of them are responsible for large number of dependents. So they have families to take care of. Themselves, they are displaced. 50 or more percent of the people who responded are displaced themselves. That means they are living either in tents or in camps or in places that was not their original cities. So this reality forces people to use certain drugs.
Then the second reason that you’ve mentioned, for fighters who started to use captagon and other stimulants, they thought that this is good for them because it keeps them focused and give them energy so they can fight and protect their homeland. But they did not know that these drugs are addicting. And that’s maybe the term unwillingly, the lack of knowledge that these stimulants that they are taking during the battle will lead to addiction. And maybe some of them were forced to take it during bombing campaigns or in the battlefield. And also young people who are taking these stimulants don’t know that they are addicting drugs because of the peer pressures and because of the availability of these drugs. People are using them and they don’t know that it will lead to addiction and destruction of their lives. That’s the meaning of the second reason for using these drugs.
Caroline Rose:
Looking to the future, I think it’s important to think about how some of these drugs are somewhat seen as gateways to other substances, other illicit substances. And, Dr. Sahloul, this report draws upon findings that were collected in a questionnaire conducted in 2022. How do we think the presented trends have shifted since then? Have we seen a surge in other substances such as crystal meth amongst users recently? And in which control areas?
Dr. Zaher Sahloul:
It’s very difficult to know the extent of this crisis in government-controlled areas because of lack of studies and lack of transparency, but in opposition-controlled areas. I was in Idlib earlier this year and talking to people, it looks like it’s becoming… Everyone knows someone who is addicted not only to Captagon, but to crystal meth. And I heard very painful stories about young people who killed family members or friends because they want to have money to buy the crystal meth. They call it [inaudible] in the local language. It’s more expensive than captagon. Captagon is I think $1, crystal meth is about $7. It’s quite expensive actually, knowing that most people earn less than $200 a month. So people go to crime and they steal from their family, they kill to buy their drugs. And also when I was speaking with the director of health in Idlib, he mentioned that several healthcare workers died because of drug overdose.
The phenomena is getting worse, not only from illicit drugs, but also from prescribed drugs, which we have not talked about. And the reason is because there’s lack of regulation on prescribed drugs, especially opioid and also relaxants. People when they are injured, especially, they get, of course, morphine and tramadol, and they become addicted to these medication which are more dangerous than captagon. Because of the severe withdrawal symptoms and because of the intoxication and the drug overdose, as we know here in this country, we have more than 100,000 people who died last year because of drug overdose mostly from opioid and fentanyl. So these medications that are prescribed without control in Syria are letting people become more addicted.
I’ve heard many stories about the patients who come and they beg the physician to write tramadol or Xanax or Librium or other medications like that or morphine. And pharmacists sometimes can give these medications without proper control. So what I’m worried about in the context of Syria, especially in light of the disintegration of the public healthcare system and lack of awareness and lack of resources for community leaders, for mosques, for churches, for organization to raise awareness about this phenomenon, that we will have more and more of illicit drugs and prescribed drugs addiction in Syria.
Dr. Karam Shaar:
Since I started working on this topic, I’ve been struggling to understand the socioeconomic cohort that actually uses drugs in different parts of the Middle East. Because if you look at, for example, captagon, the drug that we’ve focused on at the New Lines Institute, you see in Saudi Arabia people using it across the spectrum. You have partygoers who just want to have fun, and you have people who are driving trucks who would like to keep driving for 12 hours nonstop, students who want to study the night before the exam, and poor people. So if we look at the stats from the report actually, practically three fourths of addicts recorded live on a monthly income of less than $200. Does this indicate that income-insecure individuals in Syria are more likely to become addicted, or do you think this actually lines up quite well with the distribution of income in the country, knowing that, as you mentioned earlier, 90% of the population lives below the poverty line? Is there a way we could explain this higher rate amongst income-insecure population in Syria?
Dr. Zaher Sahloul:
That’s a good question, but I believe it’s related the fact that most people in Syria earn less than $200 a month. As I’ve mentioned, 90% are below poverty line in Syria. People when you are addicted, and we know it from people who are addicted to alcohol and also smoking, I’m a lung specialist, they would rather pay for their pack of cigarettes than to buy nutritional food. Of course, this is much worse if you’re addicted to captagon or crystal and meth. So people are ready to sacrifice their earnings, even that it is low, to continue this habit. And I think that’s the only explanation that I have for the fact that even if you are poor and have very low earnings, you continue to buy drugs that are quite expensive. $1 is a lot of money in Syria. In some areas the average salary for a government employee is $25 a month. It’s a terrible habit, and that’s why I think you have more crimes and violence because of that.
Caroline Rose:
Absolutely. And I think it becomes this never-ending cycle of addiction. And then that of course, while some substances could be used to stave hunger and get themselves through a second or third shift, ultimately this is not necessarily helping their economic condition either with the fact that they’re spending just so much to procure these illicit drugs.
I wanted to ask about one particular aspect related to substance abuse and also how many of the participants self-reported their likelihood of recovery. So the report records that only 41% are sure they’d like to recover from substance abuse, leaving a 59% unsure whether they would prefer to recover. What are the factors that contribute to this, and why are we seeing such a lack of hope when it comes to recovery possibilities?
Dr. Zaher Sahloul:
I think the main reason for the fact that the majority don’t want to recover is the fact that they don’t know that this is a disease that has treatment. So lack of awareness is the main reason. And if people are educated… like nicotine addiction, I have patients who don’t know that there are medications that will help them to get rid of their smoking habits. They don’t know that this is addiction that can cause a harm to their body. So I think awareness, awareness, awareness is the key, and education. Not only to the community and to the young people in schools and colleges and university, but also to community leaders, to influencers, to imams, to, of course, healthcare workers and so forth.
And also having these resources for rehabilitation and detoxification available not only in specialized medical centers, which I would say the minority of people will go to because of the stigma and the taboo. You don’t want to be labeled as an addict. So most people, even if you have drug rehabilitation center, they will not go there. But having these detoxification units available in usual hospitals, regular hospitals like what we have here in the U.S. In my hospital here in Chicago, we have a drug or substance rehabilitation unit within the hospital. So if you are a patient and you come to the hospital, no one knows that you have an addiction. The same thing should be incorporated in several hospitals or in medical centers in Syria so that way there is less reluctance among people who are addicts to go and seek treatment.
Dr. Karam Shaar:
Moving now on to the front of potential responses to this crisis, if I may call it that. The report raises a unique policy recommendation of a regional task force or coalition of sorts that can address the demand side of drug use in the Middle East. And as you mentioned in your previous response, you have this stigma among addicts, which I think is magnified by various religious and societal restrictions in the country that make me wonder how viable do you think this mechanism is, and have you actually taken any steps towards it? Is there any buy-in from countries in the region?
Dr. Zaher Sahloul:
I think the best part of the report, the policy recommendations and the how can we translate these recommendations into reality. With the work of Caroline on the captagon, there’s definitely more awareness in the policy circles within the U.S. government of the captagon trade, within the regional power in Syria, and there’s more readiness to combat the trade routes. So it is already a regional problem. I remember a quote of a Jordanian officer who said that we have to assume that every car or truck coming from Syria contains drug. Maybe every week or every couple of weeks, we will see in the news that Saudi Arabia or Kuwait or Italy or Iraq or other places discovered large amount of captagon hidden somewhere.
These drug smugglers become very smart, and they continue to supply these drugs, and the demand is getting higher and higher for the reasons that you’ve mentioned and mentioned in the report, not only in Syria, of course, but the whole region. A regional problem requires regional solutions, so that’s why we recommended a forum that includes the Mediterranean countries and the Gulf states should be established to combat this crisis before it gets out of hand.
Caroline Rose:
Absolutely. And I think, too, when we’re approaching this critical nexus in the region, particularly when tensions between Israel, Lebanon, Syria, Iran are at an all time high, I think that when we’re talking about these sorts of issues in the Middle East, there’s so much potential for positive policy change. This leads me to my next question, which is, and this is really for all of us, what role can the United States play in all of this? We’re having this discussion at such a critical time in the region. We’ve seen now unprecedented levels of escalation and increased U.S. disengagement on some fronts in the region the topic of drug consumption and abuse has fallen further and further on the agenda. But how can the United States and its partners get creative in forging responses to this issue? And I think as Dr. Sahloul just mentioned, there is that possibility, a coalition or mechanism or task force, whatever we can call it, but there are lots of regional collaborative efforts here that the United States can take lead on. Are there any other policy spaces that Washington can try and create momentum on?
Dr. Zaher Sahloul:
Caroline, maybe you can share with us what the U.S. government has done so far in term of combating the captagon trade in particular. Today I was looking at also, again, the news and there were a few members of the Syrian elite that were added to the sanction list because of their role in the captagon trade. And this happens every few months. Do you think that this is effective? And the reason I’m asking you this question, Caroline, because I believe that the way that we combat these issues always comes from health security perspective, that we don’t want this phenomena to spread beyond Syria and it affects the European countries or the Gulf states and so forth. And that’s why our government pushes for sharing information and more collaboration between law enforcement agencies and putting these members of the Syrian government and their allies on a sanction list.
But I believe that there should be also effort to build resiliency within the communities that we serve in Syria and other communities, Gaza, Lebanon, and other places so there is more awareness of this crisis, there’s more awareness about drugs, providing education and training to healthcare workers. Similar to what we do with mass casualties training and protection of healthcare and so forth that we do during crisis. I think there should be training on mental health impact of wars, including drug addictions. And providing more resources and funding for NGOs that are working in that field. But what do you think, what else can be done by the U.S. government? And why aren’t we addressing this issue from the building resiliency and mitigation perspective?
Caroline Rose:
I think that this is a great question because the United States has done a lot in terms of establishing an interagency strategy to combat the trafficking of captagon. But a lot of this has been very supply focused and the rounds of sanctions that we’ve seen, which have been I think very positive, and I think Dr. Shaar will also have some really great thoughts on this because he’s been really at the forefront of sanctions reform. But ultimately, these waves of sanctions, they’re positive, they’re promoting accountability, they’re also an intended message to these traffickers, to these producers. And the message is essentially the United States government is aware of these activities, they’re aware of who’s doing it, the companies that are being used, and the ability to impose sanctions and asset freezes.
But beyond that supply-heavy approach, I think that we’re approaching a very critical juncture in the region and in a lot of these demand markets where there needs to be an equal focus on rehabilitation, improving access to that rehabilitation, raising awareness about drug consumption and drug abuse, and also trying to pump funds and investment into research vehicles, research vehicles and projects that can really bring and shed light on how consumption trends are changing in the region, which is why I think this work does a really great job of trying to inspire a number of other research centers and clinics and the different actors on the ground that can build a better picture of what consumption and demand levels look like on the ground.
I think that Dr. Shaar might also have some thoughts on how we can build beyond the sanctions programs that have been implemented and what next, what other spaces are left for policy action?
Dr. Karam Shaar:
I think in response to Dr. Sahloul’s points, I feel sanctions are necessary but insufficient for reasons outlined by Caroline. So they’re important from a signaling point of view. Yeah, we’re here, we’re watching you. But to be honest, in terms of actual impact, I think their impact is pretty limited. We would want them to continue, but their impact is very limited. Now, if I think of this combination of supply and demand, as Caroline put it, you always have… and this is not peculiar Syria. In any other context when we’re talking about drugs, you have demand being much more stable. It always has its trends, ups and downs, but supply fluctuating around it. So supply is the one that is extremely volatile. That’s where you get the changes in prices in local markets.
Unfortunately, what we’re seeing from the U.S. is an approach that focuses heavily on supply, and this is emblematic of the U.S. approach to counter-narcotics at home as well. This has always been the approach. Just hit them, hit them hard, go after the producers and trafficking routes without actually investing enough on the demand side, where I think much, much more can be done. Much more sustainability can actually be gained from working on the demand side. In a region as volatile and unstable as the Middle East, if demand continues to hold steady, there will be supply. Supply will find its way to consumers. The issue is how do we press demand down? I think this is what the report covers very, very well in its recommendations. Yeah, that’s why issues like awareness raising I think would be much more of a priority for us in the long term than sanctions.
Dr. Zaher Sahloul:
I totally agree, Dr. Shaar. I think something that we did not mention in the report, and I think it’s in the mind of everyone who is familiar with the Syrian crisis and its impact on Syria and also the region and the world, I believe that the Syrian crisis have changed the whole world, but I am also Syrian-American, so maybe I’m prejudiced. Without political solution, we will continue to see Syria as a source of instability in the region, whether it’s refugees or displacement or another wave of people who are leaving Syria because of the economic deterioration or infighting or jihadis or terrorism or drugs. So a political solution based on the United Nations Security Council Resolution 2254 is a must, and that requires a leadership from this country, which we did not have for the past 13 years, a diplomatic leadership to make sure that all parties sit together and have a political compromise. But I don’t see that happening soon, unfortunately.
Promoting alternative livelihood because without livelihood, young people especially will continue to try to escape to different reality using drugs. So that’s important, providing livelihood, improving the economy. But how can you do that with Syria divided to four separate countries? Each one of them has their own government and economy. And public awareness, I’m very actually optimistic that with limited resources, Syrians and people in the region can do stuff for their own. So there was this drug awareness campaign in the northwest of Syria, “No to Drugs, Yes to Life.” They designated the June 21st as the anti-drug day. So these kind of awareness campaign that penetrates to the whole community using influencers and social media and imams and priests and so forth are very important. And of course, the rehabilitation and treatment, and also engaging the youth. Because if you look at the report, most of the people who are addicted are young people. So without their engagement and speaking a language that they understand and educating them in the schools and the colleges and the university, we will continue to have this problem.
Caroline Rose:
Absolutely. I think ultimately there is a huge stigma and taboo surrounding drug usage and abuse. And if the United States and its partners, if regional leaders really pioneer an effort in raising awareness not only about the implications of illicit drug consumption, but then also of course raise awareness about access to care, I think that that would do a lot of good in the region. I want to thank everyone for joining us, particularly Dr. Shaar, Dr. Sahloul, for their time today to discuss drug consumption in Syria and its implications.
For those interested in learning more about the crime-conflict nexus, please check out our work at the Captagon Trade Project at www.newlinesinstitute.org. And then of course, for those that are interested in reading this report, please do check out the report on MedGlobal’s website as well. Thank you so much to our listeners, and please do join us again soon for another Contours podcast. I wish you all a great rest of your day and a great week.
