The CCTV footage showing the killing of senior ASP Anisul Karim at Mind Aid Psychiatry and De-Addiction Hospital on November 9 has created a renewed focus on the mostly unlicensed and unregulated private clinics that have cropped up across the city in recent years to cater to a "market" of patients who are easy to take advantage of because of the social stigma surrounding their ailment—drug addiction and related psychological or mental health issues.
In the chilling video that revealed the moments before Anisul's death, he is seen being wrestled to the ground by five to six people, who tie his hands behind his back and push him into a small room. During this attack, he becomes increasingly motionless; later, a woman in an apron performs CPR, but to no avail. It was revealed later that Mind Aid did not have the papers to operate a psychiatric clinic or rehab, nor did it have the full-time doctors, psychiatrists and trained nurses that a rehabilitation centre is meant to have, as outlined in a home ministry gazette from 2005. All the people who assaulted Anisul at Mind Aid were staffers, ward boys and cleaners—no medically trained personnel were present.
However, Mind Aid is hardly the only psychiatric/de-addiction "hospital" operating without permission, below capacity and with little to no technical expertise. Media reports suggest that while there are 351 registered residential rehabs across the country, the actual number could be around 1,200 if you include the unlicensed ones. In almost all of these places, we have no idea what sort of "treatment" is being given.
Yet these centres are handling patients who require utmost sensitivity and care—all over the world, there is a growing acknowledgment of drug addiction as a public health issue. According to the World Health Organization, "people with drug disorders deserve the same level of care as patients with any other health condition… For people suffering from drug dependence, health systems have to provide access to comprehensive treatment, including psychosocial support, pharmacotherapy (including opioid substitution therapy for people dependant on opioids) and the prevention and management of associated health problems such as HIV, tuberculosis, viral hepatitis, mental health disorders and drug overdose."
Almost none of the rehabilitation centres in the country are equipped to provide this kind of comprehensive treatment. In fact, in most of these places, the substance abusers are treated less like patients and more like incarcerated inmates. In a recent report in this daily, recovering addicts spoke about being beaten, starved, isolated and given sleeping pills as the sole treatment. Last year, this daily also reported on the prison-like conditions in certain rehabilitation centres, where patients spoke of being tortured, force-fed medication, confined and being given expired food and drugs.
In the last three years, at least 17 bodies have been recovered from rehabs across the country, according to police data, many of which had marks of injuries and torture—such as 30-year-old Jahangir Mia, who was tortured to death only hours after he arrived at a rehab in Savar in February, and 37-year-old Jalal Uddin, whose body was discovered in the parking lot of a rehabilitation centre in Moulvibazaar in 2018. All of these incidents point to a method of treatment where the recovering addict is disciplined into following the "right path" and punished if they cannot quit cold turkey, regardless of the very real physical impacts of substance withdrawal (especially in the case of opioids), rather than exploring the psychological, social and even economic conditions that could have led to the drug abuse in the first place.
Every time stories of abuse at rehabilitation centres surface, some immediate steps are taken, such as the arrest of the owners or the involved staff. After Anisul Karim's death at Mind Aid, the Department of Narcotics Control (DNC) raided and closed five unlicensed rehabs in Dhaka on November 18. However, the odd raid after a tragedy is a short-sighted solution that not only does little to deal with the unlicensed and underprepared rehabs mushrooming across the country and operating with very little regulation; it fails to tackle a crucial miscalculation in our national drug policy—almost all measures to deal with substance abuse are punitive, not rehabilitative, and fail to address the causes behind drug abuse.
This is reflected in the increasing number of drug users in Bangladesh despite our hardline policy towards drugs—according to a DNC report, an average of 114 patients per day sought treatment at public and private rehabilitation centres in 2019, up from an average of 104 in 2018, and 69 in 2017. And these are only the people who had the opportunity and the means to seek treatment in a society where drug users are shamed, excluded and ostracised. The DNC report suggested that only a little over 41,000 people sought treatment for substance abuse last year, but a 2017 report from the Association of Prohibiting Drug Abuse (MANAS) estimated that around 7.5 million people could be addicted to drugs in Bangladesh, which means that only 0.5 percent of substance abusers were able to reach out for help.
The criminalisation of drug abusers and dealers and a punitive drug policy only adds to this ostracisation. In 2018, 466 drug dealers were killed in incidents of "crossfire" as part of Bangladesh's "war on drugs", quite possibly the highest number of extrajudicial killings in the country's history, and the Narcotics Control Bill 2018 was passed, which introduced the death penalty for possessing as little as three tablespoons of heroin. However, examples from across the world show that a "war on drugs" is not one that can be won—in 2017, Cesar Gaviria, former president of Colombia and founding member of the Global Commission on Drug Policy (GCDP), wrote in the New York Times, "The war on drugs is essentially a war on people… a new approach is needed, one that strips out the profits that accompany drug sales while ensuring the basic human rights and public health of all citizens," adding that the "application of severe penalties and extrajudicial violence against drug consumers makes it almost impossible for people with drug addiction problems to find treatment."
According to the GCDP, there are five pathways to drug policies that actually work—putting people's health and safety first, ensuring access to essential medicines and pain control, ending the criminalisation and incarceration of people who use drugs, refocusing enforcement responses to drug trafficking and organised crime, and regulating drugs markets to put government in control. However, so far, Bangladesh's policy has been fixated on drugs and its relationship with crime, without an equal level of attention on public health, human rights and economic development.
Last month, the government announced the formation of an independent institution to carry out dope tests as a part of intensifying and strengthening narcotics control. This new "Bangladesh Drug Testing Institute" will be set up in 19 districts for an expanded dope testing project that will apply to all job sectors and educational institutes, and will cost the government Tk 62.83 crore in taxpayers' money. But what exactly will be done with all the "addicts" identified by these tests? Will people lose their jobs, and will students be expelled from educational institutions? Who will be responsible for rehabilitating these drug users and bringing them back to being useful members of society?
It has been made amply clear that mass arrests and killings of drug traffickers, especially the low-level actors, can do little to stem the widespread use of drugs, which were widely available in Bangladesh even during the lockdown. It is also clear that recovering addicts are not being given the medical and psychosocial care they need—they are being put into the same box as drug traffickers and locked away like criminals. As long as addicts continue to have their rights taken away, and we continue to stigmatise and discriminate against people who have become victims of drug abuse, we will not be able to deal with what is an urgent and fast growing social problem in our country.
On many occasions, economists have discussed how important it is to invest in human capital in a country with a population as large as ours. If we truly want to invest in people, we need to ensure that recovering addicts are also not left behind. We must invest in proper rehabilitation centres that focus on prevention, harm reduction and treatment, not on punishment, and we must collectively come together to support (not shame) recovering addicts so they can learn to live without drugs.
Shuprova Tasneem is a member of the editorial team at The Daily Star.
Her Twitter handle is @shuprovatasneem.