In Gaza, Hospital Procedures without Anaesthetics Prompted Screams, Prayershttps://english.aawsat.com/features/4659581-gaza-hospital-procedures-without-anaesthetics-prompted-screams-prayers
In Gaza, Hospital Procedures without Anaesthetics Prompted Screams, Prayers
A wounded Palestinian man lies on a bed in Shifa hospital in Gaza City May 17, 2021. REUTERS/Mohammed Salem Acquire Licensing Rights
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In Gaza, Hospital Procedures without Anaesthetics Prompted Screams, Prayers
A wounded Palestinian man lies on a bed in Shifa hospital in Gaza City May 17, 2021. REUTERS/Mohammed Salem Acquire Licensing Rights
The little girl was weeping in pain and screaming "Mummy, Mummy" while the nurse stitched up her head wound without using any anaesthetic, because none was available at the time at Al Shifa Hospital in Gaza City.
That was one of the worst moments nurse Abu Emad Hassanein could recall as he described the struggle to deal with an unprecedented influx of wounded people and a dearth of pain relief medication since the war in Gaza started a month ago.
"Sometimes we give some of them sterile gauze (to bite on) to reduce the pain," said Hassanein.
"We know that the pain they feel is more than someone would imagine, beyond what someone their age would stand," he said, referring to children like the girl with the head wound.
Arriving at Al Shifa to have the dressing changed and disinfectant applied to a wound on his back caused by an air strike, Nemer Abu Thair, a middle-aged man, said that he was given no pain relief when the wound was originally stitched up.
"I kept reciting the Quran until they finished," The Associated Press quoted him saying.
The war started on Oct. 7 when Hamas fighters burst through the Gaza Strip's border fence with southern Israel. Israel says Hamas killed 1,400 people and abducted 240, in the worst day of carnage in Israel's history.
Israel responded with an air, sea and ground assault on the densely populated Gaza strip which health officials say has killed more than 10,800 Palestinians.
Mohammad Abu Selmeyah, the director of Al Shifa Hospital, said that when very large numbers of injured people have been brought in at the same time, there has been no choice but to deal with them on the floor, without adequate pain relief.
He gave as an example the immediate aftermath of an explosion at the Al Ahli Arab Hospital on Oct. 17, when he said some 250 injured people arrived at Al Shifa, which has only 12 operating theaters.
"If we had waited to operate on them one by one, we would have lost many of the wounded," said Abu Selmeyah.
"We were forced to operate on the ground and without anaesthesia, or using simple anaesthesia or weak pain killers to save lives," he said.
Procedures that have been performed by staff at Al Shifa under such circumstances have included amputating limbs and fingers, stitching up serious wounds, and treating serious burns, said Abu Selmeyah, without elaborating.
"It is painful for the medical team. It is not simple. It is either the patient suffers pain or loses his life," he said.
At Nasser Hospital in Khan Younis, in the south of the Gaza Strip, director Dr Mohammad Zaqout said there had been a period early on in the war when anaesthetic supplies ran out completely, until aid trucks were allowed in.
"Some procedures were carried out without anaesthesia, including Caesarian sections on women, and we were also forced to operate on some burns that way too," said Zaqout.
He said that staff did their best to alleviate patients' pain with other, weaker medications, but this was inadequate.
"This is not the ideal solution for a patient inside an operating theatre, who we want to operate on with full anaesthesia," he said.
For the first 12 days of the war, no aid was allowed into Gaza. On Oct. 21, a first convoy of aid trucks came in through the Rafah Crossing on the strip's border with Egypt. Since then, several convoys have entered, but the United Nations and international aid groups say the aid provided is nowhere near the scale needed to mitigate a humanitarian catastrophe.
Zaqout added that while the shortage of anaesthesia had been eased at his own hospital thanks to aid deliveries, there were still severe shortages at Al Shifa and at the Indonesian Hospital, both of which are in the heavily bombarded north of the strip.
Makeshift Captagon Labs Emerge in Syria from Rubble of Assad’s Narcotics Tradehttps://english.aawsat.com/features/5130508-makeshift-captagon-labs-emerge-syria-rubble-assad%E2%80%99s-narcotics-trade
Syria's new authorities burn hundreds of tons of Captagon pills and bags of hashish at the headquarters of the Fourth Division in Damascus. (EPA)
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Makeshift Captagon Labs Emerge in Syria from Rubble of Assad’s Narcotics Trade
Syria's new authorities burn hundreds of tons of Captagon pills and bags of hashish at the headquarters of the Fourth Division in Damascus. (EPA)
Ahmed el-Jouri
Syria has not only endured a war that shattered its cities, but also a quieter conflict—one that devours lives long before bodies fall. Amid the charred ruins of burned-out neighborhoods, an entire generation has grown up under the grip of a cheap pill originally intended for export but now flooding the local market.
The story began when the former Syrian regime transformed Captagon—a synthetic stimulant made from amphetamine and theophylline—into a lucrative war currency.
Once a controlled substance, it soon became a torrent surging through the country's alleys and streets, robbing youths of their futures and turning dreams into nightmares.
By 2020, the crisis had deepened. The price of a single Captagon pill plummeted from $1.50 to just five cents—cheaper than a cup of tea.
The drop reflected a cascade of events: the enforcement of the Caesar Act sanctions, sweeping sanctions targeting the Assad government, Lebanon's economic and banking collapse in late 2019, restrictions on dollar transactions and withdrawals from Lebanon, and tighter control over land borders that slightly curbed smuggling.
This Asharq Al-Awsat investigation, drawing on field visits to areas of post-Assad Syria and interviews with pharmacists and doctors in Amman and Erbil, retraces the production pipeline of Captagon.
It also features testimonies from addicts and their families, painting a stark portrait of a drug that fuels despair in a nation already exhausted by war.
A member of the Syrian security forces at a Captagon factory in Douma near Damascus on December 13. (AP)
In the shadows: Captagon addiction grips Syria's youth
In the crumbling streets of Damascus, where tangled electric wires dangle like specters above weary passersby, a toxic trade thrives under innocent names—“energy pills”, “happiness tablets” and others depending on the dealer. But behind the playful labels lies a systematic crisis. Syria's youth are not falling to addiction by chance—they are being consumed by design.
According to the International Labor Organization, 39.2% of working-age Syrians (15 and older) were unemployed in 2023. But statistics say little about how people like Ahmed, 19, spend their days.
Slumped on a crumbling curb in Damascus' Rukn al-Din district, Ahmed stares at his tattered shoes as a nearby dealer leans in: “This pill will make you a man... you'll work like a horse without feeling tired.”
Ahmed didn't know that the “man” he was promised would become enslaved to a handful of blue pills. The long hours at a bombed-out workshop turned into a nightmare only numbed by more doses.
His story is far from unique. It echoes across Syria like a shared curse in a land battered by war and poverty. In this darkness, Captagon glimmers like a false shooting star. Sources recount how the pill knocks down young people one after another, like dominoes—girls included.
Even the dream of escape has become part of the tragedy. Some sell family land to fund a risky boat journey out of the country. One man made it only as far as a Turkish prison—addicted, penniless, landless, and with no future.
This investigation collected over a dozen testimonies from across Syria—either directly from addicts or their families—offering a window into a drug crisis that has taken a darker turn since the fall of Assad's regime.
What was once a tightly controlled trade, reliant on pharmaceutical infrastructure and exports while feeding a growing domestic market, has devolved into a chaotic, deadly business claiming more lives through overdoses and despair.
Yasser, 17, from Aleppo, was kicked out of his family home and now lives in a basement room owned by his uncle-in-law.
“My friends used to laugh when they took the pills,” Yasser told Asharq Al-Awsat.
“They told me it felt like being the hero in a video game. I tried them to prove I was brave like them. Now, I wander the streets like a ghost. I hear my mother's voice haunting me. On cold nights, I sneak back to our house, touch the locked door and imagine a shell falling on me... maybe death would offer me a forgiveness I don't deserve,” he added.
In the northeastern city of Hasaka, Ali, 22, from Deir Ezzor, spoke after a grueling day of physical labor. “One day, I carried sacks of flour on my back for 10 straight hours,” he recalled.
“My boss was watching, then tossed me a pill and said, 'Take this—it'll make your back like iron.' Now, my back carries more than weight... the heaviest burden is what I see in my children's eyes. When I get home, I pretend to sleep so they won't come near me. I hear them whisper, 'Papa sleeps like he's dead.'”
Mohammad Abu Youssef, 45, rubs his cracked hands and gazes at a photo of his eldest son.
“I sold my health, worked myself to the bone just to pay his school fees. But Captagon stole him from me,” he said.
“When I found him trembling like a leaf in the corner, I screamed, 'Why didn't you die in the bombing?!' I tried sending him to Europe with smugglers, but he fled the truck halfway and returned months later—his eyes are just two black voids. Now, I've locked him in the house. I buy the pills for him myself and pray every night that God takes him.”
Captagon pills concealed in fake fruit found inside a factory in Douma east of Damascus. (EPA)
No rehab, no way out: Syria's addicts face slow death
In a country ravaged by war and addiction, the absence of rehabilitation centers is proving fatal for many. Without treatment options, a growing number of Syrians are left to spiral deeper into dependency—with no support, no shelter, and no escape.
Dr. Rawan al-Hussein, who requested using an alias for safety reasons, works with a branch of the health directorate and also consults for a non-governmental organization focused on addiction cases. Each day, she sifts through piles of case files, trying to salvage what's left of shattered lives.
“Just last week, a frail young man came to me carrying his infant daughter,” she recalled.
“He said, 'Take her before I sell her for pills. I don't even have a bed to put her in.'”
With rehab facilities scarce or nonexistent in many areas, stories like his are becoming tragically common—leaving medical workers overwhelmed and addicts trapped in a slow-motion collapse.
Al-Hussein exhaled deeply as she gathers water-damaged papers from her desk.
“International organizations send us boxes of medicine without assessing our needs,” she said. “Our youth are dying because the toxins are already in their blood. What are we supposed to do with bandages for wounds no one can see?”
The real tragedy, she explained, lies not just in the spread of addiction, but in the absence of mental health and rehabilitation services.
Staff working in Syria with the UNHCR and the World Health Organization told Asharq Al-Awsat that as of February 2025, there were no more than 10 specialized rehabilitation centers across the country, while the need is estimated at over 150.
With more than 70% of health facilities damaged or destroyed by war, accessing emergency care or psychiatric treatment has become nearly impossible.
“Even the programs that do exist are struggling,” al-Hussein added. “They rely heavily on volunteers and lack basic psychiatric medications.”
But the crisis runs deeper than infrastructure. Stigma, too, is a powerful barrier. “In Daraa, for example, residents rejected plans to open a rehab center out of fear it would tarnish the area's reputation,” a local organization told Asharq Al-Awsat.
Caught between a crumbling healthcare system and a society that shuns them, Syria's addicts are left to fight a silent war with little hope of rescue.
Captagon after Assad: Makeshift labs and a generation being wiped out by doses
The fall of the Assad regime did not mark the end of Syria's suffering—instead, it ignited a new phase of chaos, more fragmented and deadly.
As state institutions collapsed during years of war, young people became easy prey to a cheap addiction. Now, the regime's toxic legacy is playing out in the shadows through a deadlier, more decentralized Captagon industry.
While the new authorities dismantled public-facing drug labs in the wake of Assad's downfall, they failed to anticipate what would come next: the splintering of production into informal workshops run by former smugglers and recovering addicts navigating a shattered economy.
The once-affordable pill that had flooded the streets is now scarcer—and more expensive—driving many addicts to work inside the very workshops that sustain their addiction.
These makeshift labs operate with no safety standards, mixing dangerous chemicals by hand, without protective gear, and relying on improvised recipes that often push the drug's potency to lethal extremes.
In this post-Assad vacuum, Syria's Captagon trade has not disappeared—it has mutated, dragging a generation deeper into a cycle of desperation, exploitation, and overdose.
In the immediate aftermath of Assad's fall, Syria's new leadership launched a sweeping military and security campaign aimed at dismantling the country's Captagon empire—a key source of funding for the ousted regime.
The crackdown succeeded in destroying dozens of large-scale production facilities in the rural outskirts of Homs and Damascus. But what seemed like a victory soon spiraled into a deeper crisis.
With the collapse of organized production, the price of a single Captagon pill soared—from just five cents to more than $1.50, according to pharmacists and users interviewed by Asharq Al-Awsat.
Primitive material used to manufacture Captagon in the village of Hawik. (Asharq Al-Awsat)
The price surge has pushed many addicts into a state of desperation, willing to pay or do anything for a fix. It's a Russian doll of catastrophe: inside every crisis, a smaller one waits. The fall of Assad did not dismantle the machinery of death—it merely scattered it into thousands of dangerous fragments.
The addicts once hooked on the “cheap high” of mass-produced Captagon are now trapped in a darker spiral: counterfeit pills from unregulated workshops, mixed with unknown chemicals, sold on the black market.
To stave off withdrawal, users are turning to theft or joining smuggling rings. Families who once believed that regime change would bring their sons and daughters back from the brink have instead watched as they became statistics—new entries in the growing toll of addiction and overdose.
What began as a crackdown has, for many Syrians, morphed into a new chapter of the same tragedy—only now, it's less visible and harder to stop.
Captagon under Assad: A state-engineered drug empire disguised as pharma
Under the Assad regime, Captagon production was far from a rogue operation. It was a state-run enterprise cloaked in the legitimacy of Syria's once-thriving pharmaceutical sector.
Before the war, Syria boasted one of the most advanced pharmaceutical industries in the Middle East. The regime exploited that infrastructure to manufacture synthetic drugs on a large scale.
Licensed factories in Aleppo and Damascus—equipped with modern technology—became the backbone of a sophisticated narcotics operation. Inside, chemists and pharmacists engineered carefully calibrated formulas designed to hook users without causing immediate deaths.
Three former pharmacists who worked in separate Syrian pharmaceutical firms told Asharq Al-Awsat that official state laboratories were covertly used to develop these drug blends.
At times, authorities would shut down or confiscate equipment from legitimate factories under false pretenses—creating space for Captagon experts to refine new chemical compositions.
A chemical engineer who worked in a factory in Al-Kiswah, south of Damascus, said the effort was supported by foreign expertise.
“Iranian and Indian specialists were brought in to help perfect the formula,” the source revealed.
“There were strict protocols in place. The regime wanted addictive pills without scandals. That's why Syrian Captagon became the most sought-after on the market.”
Lighter versions of the drug were even rebranded and sold as “party pills”, offering users a temporary high and masking the addiction beneath.
Assad's narcotics machine wasn't just a revenue stream. It was a calculated instrument of control, designed to addict both domestic users and foreign buyers while preserving plausible deniability.
