Tramadol use no antidote to Israeli siege

*Tramadol pills have become dangerously popular in Gaza as an antidote to the stresses of Israeli occupation. Credit: Emad Badwan/IPS

GAZA CITY, Oct 21 2012 (IPS) – By Eva Bartlett

It’s being taken as an antidote to the stresses of Occupation. But the prevalence of the painkiller Tramadol in the Gaza Strip has more to do with its ease of availability than its singular effectiveness as a reality-numbing substance.

Under siege since early 2006, means of relaxation are scarce, and even some of the most resilient and educated people in the Strip have sought in Tramadol a break from the dire realities of trauma, manufactured poverty and continual stress.

A synthetic drug often prescribed for pain-related ailments, the innocuous pill comes in a second, more potent and potentially lethal variety: the illegal black market kind.

“Every week, we get three or four overdose cases, most of them young men,” says Abu Yousef, 34, a paramedic for over ten years. “Patients are sweaty, delirious, are vomiting, have abdominal pain, and may be hallucinating…it’s morphine after all, it has many side effects.”

Although never addicted, he himself took prescription Tramadol after his release from years in Israeli prisons. “I was taking tramadol for abdominal pain after I was released. But I stopped taking it, I take an analgic now,” he says.

But the vast majority of users these days are not taking the pill on doctors’ advice. “Some people feel it makes them strong, gives them power. Even some medics take it now and then, because they work long shifts. Tunnel workers are more prone to taking it regularly. But for them it’s about maintaining stamina, not about getting numb.”

Dr. Hossam Al Khatib, 28, specialises in addictions. In his work helping addicts break their habits, he sees a variety of backgrounds and reasons for taking the drug.

“Most want to forget their problems, and Tramadol helps with this, temporarily,” he says. “There is high unemployment among youths and adults in Gaza, so in the past six years, even more people have started using Tramadol, including recent university graduates who a year or years after graduating haven’t found work.”

Although he says there was a substantial increase in drug usage after the trauma of the 2008-2009 Israeli war on Gaza, Khatib cites the complete closure of the Gaza Strip as the primary reason for current high levels drug usage. “The siege causes all of the problems: high unemployment, hopelessness, stress, anxiety, depression. Even some youths 15 years and older, take it because their lives are so difficult.”

With the pills sold cheaply on the streets of Gaza, starting to take and becoming addicted to the pills is easier for Gaza’s youths than other more expensive, less available, hard drugs.

Khatib explians that drugs and marijuana have been present in Gaza since long before 2006 and the imposition of the Israeli-led siege on Gaza. “But people weren’t using Tramadol and drugs as an escape mechanism, not like now. It really is a product of the siege.”

The causes of usage are deeper than mere joblessness and frustration, Khatib says. “The situation in Gaza is causing a change in Palestinian society, leading to more problems in the family. For example, a son whose younger brother has work but he himself doesn’t. He feels ashamed at not being able to contribute to the family, or to provide for his own wife and children.”

Young men of marrying age who cannot afford the cost of a wedding and married life are also increasingly at risk of developing Tramadol or other addictions, as a temporary relief from their shame and misery, Dr. Khatib notes.

While he says some are merely casual users, in Khatib’s experience roughly 20 percent are chronic users. “Addicts,” he says.

Both Khatib and Abu Yousef say the majority of drugs enter via the tunnels from Egypt, the lifelines of Gaza which have brought in foods, livestock, agricultural and fishing needs, and virtually everything banned by Israel under its years-long closure of Gaza’s borders.

“Due to the widespread poverty in Egypt, many Egyptians make Tramadol at home, to sell. Some is a mix of morphine and mouse poison,” says Abu Yousef. “Poison is an excitant, it stimulates the brain to produce serotonin, as does Tramadol. The poison itself is not addictive, but in high doses or repeated usage it can kill.”

As with most addictions, the irony in Tramadol use is that it not only does not solve the root problems for which users seek it out, but actually compounds them, says Khatib.

“Normal after-effects and withdrawal symptoms are depression, anxiety, insomnia, hopelessness, and remorse at having taken the drug. With chronic addicts, there may be loss in coordination, sexual problems and even sterility.”

Recognising most Tramadol addicts as faultily seeking a solution to their psychological state, Khatib stresses the importance of counseling once users have stopped taking the pill. “We try to make them feel important and hopeful, and encourage them to socialize, not to remain withdrawn from friends and their community.”

Unemployment being one of the key initial stressors, Khatib’s clinic tries to help ex-addicts find work “and encourage them to be patient in their job search, not to give up or give in to despondence.”

The root problems do vary, he says, but as with many of Gaza’s current problems, the solution is painfully clear: “If the borders were opened, the siege lifted, work available again, people here wouldn’t feel hopeless, wouldn’t feel the need to take drugs like Tramadol,” says Dr. Khatib.


  1. What are the chances that someone(s) in Israel is happy about this or is actually supplying the drugs?
    “….there may be loss in coordination, sexual problems and even sterility.”
    Sterility of Gazans must be something some Israelis pray for.

  2. A well researched and thoughtful article about yet another insidious effect of the interminable siege.
    Forgive me for taking issue on one point. You write “Under siege since early 2006”. Amira Hass has always said that the closure began 20 years ago; it has been gradually and relentlessly tightened ever since. Mya Guarnieri fleshes out this statement with this article and points out the missed opportunity to correct Israeli lies that the closure was a response to the election of a Hamas government and the capture of Gilad Shalit.
    But restrictions began even earlier. At the start of the occupation in 1967 Gaza port was immediately closed as a trading port. I have seen little information on this imposition and have found just one clue: Salman Abu Sitta wrote [in a paper presented to the International Fact Finding Mission Initiated by Regional Council for Unrecognized Villages, Beer Sheba 11 July 2009] “Just before the first World War, Gaza port was crowded with vessels carrying wheat for export.” In contrast in the 45 years since 1967 Israel has allowed entry to Gaza by international vessels on just five occasions: all by the Free Gaza Movement.
    Sara Roy’s 1987 paper on the de-development of Gaza can be seen here

    In peace and solidarity,

  3. Thank you Richard. Agreed. For the sake of addressing the action taken immediately after Hamas was elected, I do refer to 2006. Many refer to mid 2007. When my article is more addressing the siege (this one didn’t leave me much space for the nuances of the siege), I do say that it has been a continuous state of closing down Gaza, and have cited Sara Roy and Amira Hass analogies in the past. []

    Other aspects that are traceable to around 2006 are:

    -virtually no exports have been allowed out of Gaza, which drastically impacts on the economy and (manufactured) poverty levels in Gaza
    -until about 2011, drastically few items were allowed into Gaza, including construction materials to re-build Gaza’s homes, schools, businesses, factories, hospitals and clinics…everything
    -in 2008 the Zionist forces drastically, illegally, and unilaterally reduced Palestinian fishers’ sea limits to 6 nautical miles, now to 3 (less than 3 in reality) and in 2009 increased the illegal, unilaterally imposed “no-go zone” (“buffer zone”) on Palestinian farmland to 300 metres along the Green Line, in reality shelling and shooting up to 2 km from the Green Line.

    But thanks for reminding people of this fact, that Gaza has long been being decimated by closures and restricted access and movement, and thanks for the links.

  4. Yeah, I think we are agreed people need to know this has been going on a lot, lot longer than is generally admitted and this needs to be told. But you’re there, walking the walk, living the life. Thanks for telling it like it is, because that is soooo important.


  5. I’d like to pop back on long enough to say that Raja Shehadeh”s latest book Occupation Diaries is fantastic.

  6. Thanks Richard. I think your comments need to be underscored. Yes, this manufactured poverty enforced on Gaza is not new. Accelearated, yes, in recent years. But you rightly hightlight that is stems from decades of closures of Gaza’s borders.

  7. I am a 47 year old U.S. citizen who did not know anything about this situation until 2 years ago when I found out about it from reading Chris Hedges’s articles and soon afterwards stuff by Norman Finkelstein.
    Can any of you recommend any books besides Norman’s and Raja Shehadeh’s that accuartely describe and discuss this occupation?
    Also, what other websites/new sources do you consider reasonably trustworthy?

  8. Hi Eva, I still enjoy reading In Gaza and the personal stories it tells about everyday life there. Glad to see you are safe and still active. Just wanted to give you a heads up on a potential story happening in Gaza…and maybe a chance to say hi again. On or about Nov. 6th, a group of over 20 doctors, nurses and a paramedic (me) will be coming from Canada to teach the standards of Advanced Cardiac Life Support (ACLS) to our colleagues there. It is the project of a remarkable Palestinian-Canadian physician that I work with. He knows who you are but not sure if you know him, unless you have met personally. He is typically low key and reluctant to say much about himself, as you can imagine, especially with the work he does and the scrutiny it brings.He was there for the month of August and I joined him for 5 days to do some preparatory work for the project. I hoped to contact you then but we were pretty busy and there for only a short time. Regardless, I think you would like meeting him and the group. Get back to me and I can give you more details if you wish. Looking forward to seeing you soon, Insh’Allah, jim Date: Sun, 21 Oct 2012 18:21:25 +0000 To:

  9. Books for Barry : “Occupied Voices” by Wendy Pearlman, “The Political Economy of Israel’s Occupation by Shir Hever” and a book written especially for young people by Elizabeth Laird : “A Little Piece of Ground”. If you have time to take a trip to Palestine, there are several possibilities
    offered by the Alternative Tourism Group (, The Israel Committee against House Demolitions ( or the Green Olive Tours (, among others.

  10. Hi Eva,
    It is a very interesting article. We would like to use or cite extracts of this article on a project about Human Rights. Is there a way we can get in contact to explain further?
    Thank you for your work.

  11. I’m a young Egyptian who used to take Tramadol 6 years ago when it was “original”, almost for the same reasons Gazans did it, unemployment. (And also for sexual proposes, as it makes men last much longer, maybe for an hour and that was good for me and my girlfriend!) However, now days I can assure you my friends that the real source of this dangerous fake Tramadol is in Israel. 6 years ago, Egyptian young guys who took it gave it a secret name and it was “apple”, (It’s why Israelis draw that “apple” on the fake one, and they wrote on it “U.S.A”, they thought we are stupid.
    By the way, the government in Egypt did put it as drugs and we couldn’t get it anymore, unless it’s doctor’s advise.

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