|Arab residents of East Jerusalem and its suburbs are faced with lack of employment, poor education, high poverty levels and political instability - all of which contribute to the current level of drug use [GALLO/GETTY]
"I didn't think I would ever stop", Abu Salah tells the circle. "After 14 years of buying and selling, hashish, heroin and cocaine, I had lost control of my life. I had no job. I would never speak to my family."
His story, and the clinic we are sitting in, is an indication of how Palestine's drug problem is fast becoming a crisis. The towns in and around East Jerusalem have become breeding grounds for addiction, made vulnerable by poverty and a lack of security.
Unlike neighbouring Egypt and Lebanon, Palestine has no historic connection with the drugs trade. Its arrival has been sudden and spectacular, with heroin in particular spreading like wildfire. Al Quds University estimates there are over 6,000 addicts in East Jerusalem today, compared with 300 in 1986.
In the town of Al Ram, pressed up against Israel's Separation Barrier, degradation has set in. Once a lively suburb of Jerusalem, since 2006 it has been locked out by the Barrier, which surrounds it on three sides. The effect of this sudden disconnection from the city has been devastating.
One-third of all businesses have been forced to close, 75 per cent of youths under 24 are unemployed, and around half of the town's 62,000 residents have been denied the ID they require to enter Jerusalem.
Al Ram, like neighbouring Abu Dis and Al Ezzariya, has been left in limbo. It is now classified as a mixture of Area B and C, under the terms of the 1993 Oslo Accords, which stipulates Israeli security control with some Palestinian Authority administration. Palestinian police are forbidden from operating here without permission, so residents live with anarchy.
"There is no authority, no security and no police", says Dr Ajman Afghani of al Maqdese, a social development NGO. "It is easy to steal cars and rob houses, and it has become like a supermarket for drugs". Palestinian Authority Spokesman Ghassan Khatib acknowledges the problem; "these areas are suffering because we are not allowed to function, and is Israel is neglecting them as a policy."
Dr Afghani fears that Al Ram has become well known as a safe haven for dealers and users. He points to a small hole in the Barrier outside his window, which he claims is used to smuggle drugs. "Every night they bring heroin through here".
In the absence of an authority to address the trade, civil society institutions like Al Maqdese have stepped into the breach. They have a number of programmes tackling different strands of the drug problem; visiting schools to promote awareness, offering counselling to people who need it - they have trained psychiatrists - and a progressive harm-reduction scheme that distributes clean needles, straps, and condoms to addicts.
Harm-reduction seeks to contain the spread of deadly blood diseases. A 2010 study conducted by the World Health Organisation tested 199 injecting drug users for blood-borne infections affecting this group. The startling results showed that 45 per cent were infected with Hepatitis C. Were this ratio projected to cover all of East Jerusalem's addicts, the number of carriers would easily dwarf the rest of the Palestinian Territories combined.
The severity of the problem has forced a traditional, conservative community to accept the presence of drug-workers in their town. A generation ago, a programme to distribute syringes would have faced serious opposition.
This new atmosphere of tolerance has allowed Nihad Rajabi, a former heroin user, to found what he calls "the only rehab centre in Palestine" in one of Al Ram's most populous areas. It has been busy since it opened in 2007.
"Up to 23 people can stay here at a time", he says. "They stay for one to three months and they get clean. Sometimes their families bring them here, or they come themselves. Before, people (in Al Ram) were thinking that one who uses drugs cannot be saved; now they are pleased to have us here."
The centre uses an American-style 12-step programme to help recovering addicts, combined with an active routine that begins at 7am and includes three daily sessions of group therapy. The aim of these sessions is to encourage participants to shed introverted mindsets, recover their social skills and begin to build bridges again.
It is also cheap. Rajabi receives no funding from PA ministries and has been forced to support the centre from his own pocket. He would like to give tenants skills-training and quality treatment but is limited in what he can deliver.
"This is one per cent of what I want to do", he admits sadly, "but there are no resources."
The treatment is no-frills. For the first four days, addicts are kept confined to the building, after which they are free to go outside. During this first shock of cold turkey, what Rajabi calls "the dangerous time", there have been several suicide attempts.
One patient, Iyad Rahman, has been staying at the centre for one month now and has been clean for that time, but the lacerations across his wrists bear witness to the struggle. He tells us that he will endure anything to repay his family who have stood by him, but that he does not truly believe he can beat addiction.
Rajabi estimates the centre has a 40 per cent success rate, and that the rest will return to addiction. He cites the lack of employment opportunities and constant presence of dealers, ready to prey on any weakness, as factors leading to relapse.
The chances are better when the patient has a Jerusalem ID and can be referred for follow-up care. The centre has an informal partnership with a better-resourced NGO in the city, the Al Sadeq Al Taleb Association, which often treats Rajabi's patients when they have exhausted the maximum three-month stay in his facility.
The Association is led by another man for whom business is personal.
Director and founder Majed Alloush has watched two of his brothers die from their addictions and describes his ambition succinctly - "to save lives". He has worked in the field for 25 years and in that time has turned Al Sadeq Al Taleb into a respected campaign with major international backing. His group initiated East Jerusalem's first harm-reduction programmes and extended outreach to young women for the first time.
Despite the progress, Alloush is frustrated at a lack of meaningful support from authorities.
"We have had big problems with the Ministry of Education. Before they would not allow us to work in their schools. They think you can solve drug problems with paperwork".
That has changed in recent years. Since the 2010 WHO report, the Ministry has asked them to double their school visits. Alloush feels drugs have been allowed to thrive thanks to a cosy, self-serving relationship between donor bodies and the PA.
"They are paid to do nothing", he says of the government. "We report to the UNODC [United Nations Office of Drugs and Crime] what we find and they give money to the Ministry of Health. A year later we will be waiting to see any action. This is normal; they get money and it just goes. I told the UNODC this is a shared corruption."
He has always been suspicious of foreign donors, suggesting the "4,000 NGOs" in Palestine do not support genuine development. "They are funny. They want people doing paperwork. They will pay for furniture but not counsellors. They want to work on six month projects and then leave. They don't understand Palestine."
For Alloush, understanding is critical. He feels that to tackle Palestine's drug problem, and the broader problems in Palestinian society of which it is both symptom and contributor, there must be a fundamental shift in approach. The current Palestinian law on narcotics is based on a Jordanian law from 1965, which still imprisons users. Coupled with the complete absence of state treatment facilities, the message is zero tolerance for drugs and users.
Civil society institutions have put forward an amendment to the law that would remove the threat of prison, and make provision for families who have suffered. The bill has passed the Legislative Council and is awaiting approval from President Abbas, who has delayed a decision for the past two years.
Alloush, who assisted with the draft bill, says the point is to "see addicts as sick people, not criminals". His words echo a growing international consensus that the 'war on drugs' cannot be won by punishing its victims.
In the United Kingdom's worst affected city, Brighton, the local authorities are now pushing a policy of treatment over punishment. Brighton's most senior police officer, Chief Inspector Graham Bartlett, recently announced his opinion that "the people who manufacture drugs and supply them should be jailed, but the people that use them need treatment."
Addressing the supply to Palestinians is problematic, given the lack of autonomy in and around Jerusalem. It is a widely held belief among Palestinians that the Israeli authorities encourage addiction in Arabs, in a conspiratorial effort to undermine their national aspirations.
While such a claim is impossible to prove, and likely exaggerated, there is little effort from Israeli police to halt the supply to Arabs. The same dealers can be seen in plain sight day after day.
Israel's COGAT (Coordinator of Government Activities in the Territories) recently made a statement to Ha'aretz denying their responsibility for towns like Al Ram, claiming; "By dint of agreements there are no routine enforcement activities of the Israel Police...except in cases where Israeli citizens are involved in the crimes."
Palestinians both sides of the Barrier tell me their appeals to Israeli authorities have fallen on deaf ears.
Hassan, a shopkeeper close to Damascus gate, reported a dealer operating close to his store. "They asked me if he was selling to Jews or Arabs", he says. "I told them 'Arabs' and they did nothing."
Dr Afghani agrees.
"If they wanted to stop us breathing, they could", he says.
Notwithstanding these conspiracies, Palestine is suffering from proximity to Israeli society that is suffering its own epidemic. The Israeli anti-drug authority estimated there are over 300,000 addicts in the country, including 70,000 teenagers, in a market worth around US $2 billion a year.
Consumption of hard drugs is growing, widely and efficiently distributed by mafias, commonly based in Jerusalem.
The growth of these mafias has become so serious that the US Embassy in Tel Aviv communicated in a leaked cable that "the growing reach and lethal methods of Israeli organised crime...is of great concern. It is not entirely clear to what extent OC elements have penetrated the Israeli establishment and corrupted public officials."
The cable went on to suggest that the US must guard against international expansion of these mafias.
A more legitimate Palestinian grievance is that Israel has weakened their communities, making them more vulnerable. Access restrictions around Jerusalem have negatively impacted on schooling, resulting in a situation of 5,000 Palestinian children not attending any school at all.
As a result, the NGOs are treating addicts as young as nine. The lack of qualifications inevitably haunt them even if they recover.
Access restrictions from the Separation Barrier lost thousands of Al Ram residents their jobs overnight. Construction work, previously a well-paid profession, has dried up and there is no equivalent labour market east of the Barrier.
It is becoming increasingly common for addictions to spread in families where the chief breadwinner has been laid off and instead spends their time at home abusing substances. This phenomenon is widely blamed for the rise in female users, and there are a number of documented cases of fathers selling their daughters into prostitution for their next fix.
There is an obvious link to a rise in petty theft, with users finding any way to fund their habits, often deepening their ties to suppliers in the process.
Majed Alloush acknowledges the role of conditions but wants his community to take responsibility. "We don't have all the power but in some way we are surrendering. If people learn to take the garbage off the streets, this is the way to winning back our self-esteem."
He is happy to save lives but knows that without the attitude shift from the street and from the authorities, he may be winning battles but losing the war.
Community activists have shown the leadership their official leaders have shied away from. At a critical time when physical and social diseases are expanding in the vacuum, a comprehensive, co-ordinated effort is needed to drag communities like Al Ram back from the point of no return.