KABUL, Afghanistan — The bed trembles in rhythm with Marzia’s body, which has been denied heroin for nine days.
At the age of 14, she married a drug smuggler working between their home country of Afghanistan and Iran.
“We were well off but I was always alone and I was tired of always worrying about my husband,” says the frail woman, whose gaze is alert, and curious, despite the abstinence-induced shivering.
The family lived in Iran for seven years. Drugs are easy to come by there and many Afghan refugees fall into addiction. Marzia’s friends introduced her to heroin as a way to calm her nerves while her husband ran drugs.
The 27-year-old mother of four returned to Afghanistan one year ago. Her husband has married a second wife and has threatened to leave her for good if she doesn’t kick her habit.
“It’s shameful to be addicted and shameful if he leaves me, that is why I am here,” she says.
It is the second time in a year she has come for help to the Sanga Amaj rehabilitation center in the capital. Two doctors and four nurses care for the 20 women receiving treatment at any one time. An additional six social workers go out into the community, caring for women in the home if they don’t want or don’t have their husband's permission to come to the shelter.
Since Sanga Amaj's spartan but clean center opened in 2007, more than 850 women have received treatment in the 45-day program.
It is primarily Afghans returning from Iran and Pakistan, where financial difficulties abound, who use drugs, said Muhammad Zafar, deputy minister of counter narcotics. Over 90 percent of the world’s opium and heroin comes from Afghanistan’s poppy fields, much of it transported through Pakistan and Iran into Europe via the Balkans, then traveling further west and north.
Zafar is honest about the difficulty in offering an alternative cash crop to impoverished farmers that is as lucrative as opium. Yet he remains hopeful the problem can be diminished. School textbooks now include information about drugs and addiction, where they didn’t two years ago. In addition to Sanga Amaj, the cities of Herat and Mazar-e-Sharif have treatment centers especially for women, many of whom are introduced to the drug by their husbands.
At Sanga Amaj, the chief doctor, Toor Paikay Zazai, estimates that about 20 to 25 percent of women relapse, despite her staff keeping in touch with women for two years after treatment.
There is no access to methadone. Her team tries to quieten the patients' agony as much they can the first few days with regular painkillers, then uses prayer, group therapy and education to keep the women away from opium, heroin, hash and glue. Zazai worked for seven years in Peshawar, Pakistan, where many downtrodden Afghan refugees are easy prey for drug pushers.
“The abstinence pains were worse than giving birth, I thought my bones would break from itching,” said Fawzia, 35, stroking her arms to show the extent of her suffering.
Fawzia didn’t understand the strength of the opium she gave her 2-year-old daughter to help her sleep. “When I came back, she was dead,” she said quietly.
Fawzia and her husband took the family back to Kabul and tried hiding their addiction from her parents. They failed and were thrown out of the home. Drugs are "haram," or forbidden, in Islam and addiction entails stigma, especially for women.
With nowhere else to go, they lived with their five children in an abandoned, bomb-damaged house without a roof, windows or doors. “We were ill all the time, it was a really hard life.”
She heard of Sanga Amaj two years ago during a visit to the mosque. When she told her parents that she was seeking help, they agreed to care for the children.
Like many other women, she had been introduced to drugs by her husband. They sought treatment together. “He was hesitant at first,” said Fawzia, “but I told him 'If I am strong enough to do it, so are you.'"
Her husband relapsed once but is now clean. Fawzia works as a cleaner at Sanga Amaj and finally feels hopeful about the future.
Suhaila, 20, also lost a child. Her daughter was born ill and weak from Suhaila's drug use and died three days later. “My daughter’s death is a big reason why I’m here,” said Suhaila, a pretty, wide-eyed young woman who unknowingly married a drug user at the age of 17.
"One day, about six months after we married, he looked at me and said 'Why are you hiding? This isn’t a bad thing,'" she recounted. The first time she smoked heroin she felt dizzy and slept for almost three days. But she liked how calm it made her feel.
Her parents don’t know she uses drugs and Suhaila declines to be photographed. Her 26-year-old husband is being treated at a different center. It is important they both pull through, because his parents won’t let them come home unless they defeat their addiction. “They’re ashamed of us,” she said.
On the other side of Sanga Amaj’s small, verdant courtyard, the center was able to add beds a year ago for the women’s children. About half of the children are also being treated for addiction, most after being subjected to second-hand smoke in the home.
Three young brothers and their slightly older sister sit together in the front row of a classroom. Their mother is being treated at home while their father is at a rehabilitation center for men. If one or both parents fail to keep away from the drugs, the entire family will be at risk again.
As the children happily participate in an Islamic studies class, with hands eagerly shooting into the air at each question, Shamila, 14, silently observes them from the doorway. She lives at the center, where she helps with the children. She misses them when they go home after the 45-day program that she herself went through.
It was even more difficult for Shamila than for the other patients to give up drugs, says Zazai, who looks at the young teenager with motherly affection. She takes Shamila with her to family parties occasionally and tries to give money to Shamila’s mother from time to time.
When Shamila’s father died seven years ago, her older brother forced her out onto the streets to beg. The pressure to bring home money was intense. When a cousin offered her hash she accepted.
She is angry with her brother for her own situation but also because he has now forced their 12-year old brother out on the streets.
“He never blames himself,” she said of her brother, who is still using drugs after a failed attempt at rehabilitation. “He can’t control himself.”