For more than a decade, most parts of Somalia have not been under the control of any type of government. This “failure of state” is complete in the central and southern regions and most apparent in Mogadishu, which had been for a long period in the hands of warlords deploying their private militias in a battle for resources. In contrast, the northern part of Somalia has had relatively stable control under regional administrations, which are, however, not internationally recognized. The present study provides information about drug abuse among active security personnel and militia with an emphasis on regional differences in relation to the lack of central governmental control—to our knowledge the first account on this topic.
Methods and Findings
Trained local interviewers conducted a total of 8,723 interviews of armed personnel in seven convenience samples in different regions of Somalia; 587 (6.3%) respondents discontinued the interview and 12 (0.001%) were excluded for other reasons. We assessed basic sociodemographic information, self-reported khat use, and how respondents perceived the use of khat, cannabis (which includes both hashish and marijuana), psychoactive tablets (e.g., benzodiazepines), alcohol, solvents, and hemp seeds in their units. The cautious interpretation of our data suggest that sociodemographic characteristics and drug use among military personnel differ substantially between northern and southern/central Somalia. In total, 36.4% (99% confidence interval [CI] 19.3%–57.7%) of respondents reported khat use in the week before the interview, whereas in some regions of southern/central Somalia khat use, especially excessive use, was reported more frequently. Self-reported khat use differed substantially from the perceived use in units. According to the perception of respondents, the most frequent form of drug use is khat chewing (on average, 70.1% in previous week, 99% CI 63.6%–76.5%), followed by smoking cannabis (10.7%, 99% CI 0%–30.4%), ingesting psychoactive tablets (8.5%, 99% CI 0%–24.4%), drinking alcohol (5.3%, 99% CI 0%–13.8%), inhaling solvents (1.8%, 99% CI 0%–5.1%), and eating hemp seeds (0.6%, 99% CI 0%–2.0%). Perceived use of khat differs little between northern and southern Somalia, but perceived use of other drugs reaches alarmingly high levels in some regions of the south, especially related to smoking cannabis and using psychoactive tablets.
Our data suggest that drug use has quantitatively and qualitatively changed over the course of conflicts in southern Somalia, as current patterns are in contrast to traditional use. Although future studies using random sampling methods need to confirm our results, we hypothesize that drug-related problems of armed staff and other vulnerable groups in southern Somalia has reached proportions formerly unknown to the country, especially as we believe that any biases in our data would lead to an underestimation of actual drug use. We recommend that future disarmament, demobilization, and reintegration (DDR) programs need to be prepared to deal with significant drug-related problems in Somalia.
Having interviewed military personnel in Somali, Michael Odenwald and colleagues conclude that drug-related problems, mainly relating to the use of khat, have reached proportions formerly unknown to the country.
Somalia—a country in eastern Africa—has been torn apart by civil war over the past few decades. Fighting among clans and warlords has caused the near-complete breakdown of state control in the central and southern regions of the country (including the capital, Mogadishu) although independent administrations provide some governmental control in the northern regions of Somaliland and Puntland. Efforts to establish a transitional federal government have largely failed and, to date, it has been impossible to initiate a nationwide disarmament, demobilization, and reintegration (DDR) program in Somalia for ex-combatants, a key step in the transition from war to peace. As in other war-torn countries, the social and economic reintegration of ex-combatants into civil society in Somalia is likely to be difficult. However, without effective reintegration, ex-combatants may take up arms again because they have no means of economic support or become disaffected and seek to destabilize the peace.
Why Was This Study Done?
One risk factor for poor adjustment to civilian life among ex-combatants is substance abuse. Many ex-combatants use drugs to help them deal with traumatic war-related memories, but unrecognized drug abuse can hinder reintegration, increase criminality, and threaten the peace-building process. Most studies on substance abuse and treatment of drug-related problems of former combatants have been done in Western countries. Very little is known about how many ex-combatants abuse drugs and the types of drugs they abuse in postconflict regions in Africa. This information is needed if DDR programs are to be effective. In this study, therefore, the researchers have investigated drug use among “convenience” samples of combatants in seven regions of Somalia. Convenience samples are groups of people chosen to participate in a study because they were available rather than groups chosen randomly from the whole population.
What Did the Researchers Do and Find?
Trained interviewers asked more than 8,000 military personnel about their own recent use of khat (chewing khat leaves releases an amphetamine-like stimulant), a legally traded drug in Somalia, where its use has long been commonplace. The interviewers also asked the respondents how much they thought others in their military personnel unit used khat and other drugs such as cannabis, psychoactive drugs (tranquilizers and other drugs that change mood, behavior, and thinking), solvents, alcohol, and hemp seeds. (Note that the researchers relied on perceived drug use; alcohol is illegal in Somalia, which is a Muslim country, and the use of drugs other than khat is not generally acknowledged.) Over the whole of Somalia, one-third of respondents said they had used khat recently. The highest levels of self-reported use were in southern/central Somalia, where up to two-thirds of combatants used it. More respondents in southern/central Somalia reported using an excessive amount of khat (more than two “bundles” of khat per day for one week) and having sleepless nights (a side-effect of khat) than in northern Somalia. The overall perceived use of khat (two-thirds of combatants) was higher than the self-reported use but similar in northern and southern/central regions. Finally, the perceived use of other drugs was highest in the southern/central regions.
What Do These Findings Mean?
The use of convenience samples (which may not be representative of the whole population) and other aspects of this study mean that the numerical values of these findings may be inaccurate. For example, the levels of self-reported khat use may be underestimates because drug-using combatants may have been undersampled or not all combatants may have responded honestly. Nevertheless, these findings confirm that khat is the most commonly consumed drug among combatants and reveal a large increase in the number of people using it in southern/central Somalia since the conflict began (only one in five adult males used khat in these regions in 1980). They also reveal that more khat is being consumed by some individuals than previously, particularly in the southern/central regions, and uncover a worrying increase in the perceived use of other drugs, again mainly in the southern/central regions. These changes in the traditional patterns of drug use in Somalia, if confirmed in studies that use random sampling methods, suggest that future DDR programs in Somalia will need to be prepared to deal with major drug-related problems and that drug use among the general population might have reached dimensions formerly unknown to the country.
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0040341.
Information about Somalia is available from the US Department of State, the United Nations, and Swiss Peace, a peace research institute
The US Council on Foreign Relations, the Beyond Intractability Knowledge Base Project (based at the University of Colorado), and the UN DDR Resource Centre provide general information on DDR programs
The Multi-Country Demobilization and Reintegration program provides additional information about ongoing DDR programs in other parts of Africa (in English and French)
DrugScope (a UK charity) provides information about khat
The US National Drug Intelligence Center provides information about khat in the US
The UK Advisory Council on the Misuse of Drugs provides an assessment of the risk of khat to individuals and communities in the UK
The Vivo Foundation supports programs that relieve the trauma of stress, including PTSD