FREETOWN, Sierra Leone (AP) — At a vast landfill in Sierra Leone 's capital of Freetown, smoke billows over decades of decomposing waste. Zainab sits there, squinting through the soot. It is her usual spot for buying kush, a cheap synthetic drug ravaging young people in the country.
“This kush is so addictive," she said. "If I don’t smoke, I feel sick.”
Her current home, a shack of corrugated iron, contains only a tattered mattress where she brings her clients as a sex worker. She uses her income to sustain her drug addiction.
She is one of many women in Sierra Leone who, as a result of social factors that include living conditions and stigma, have not benefited from intervention efforts after the government a year ago declared a public health emergency over rampant kush abuse. The declaration was meant to enforce criminal, public health and prevention measures to reverse the trend in Sierra Leone, as kush spreads to other parts of West Africa. The drug has been seized in Gambia, Senegal and Guinea.
Public health emergency over kush
While officials say kush has become scarcer on the streets in Sierra Leone, critics say programs are still underfunded and inadequate.
Despite new criminal, public health and prevention measures, only about 300 people have gone through the country’s official rehab program, according to available data. Most have been men.
Women have been less visible in the crisis. Rights groups say they are historically left out.
Only one in 18 women with drug use disorders receive treatment compared to one in seven men, according to the United Nations Office on Drugs and Crime. The agency said women are usually more vulnerable to gender-based violence, economic discrimination and human rights violations.
Fewer women receive help
The situation is not so different in Sierra Leone where various advocacy groups spoke about how women are not as visible as men in coming forward to receive support and often do not get adequate help. Far more men, though, use drugs compared to women, experts say.
Zainab said five years of smoking Kush has brought shame and isolation. She said no one has helped her, and spoke about days she gets so high that “I did not know what was happening around me.”
But she wants to stop for her children. One night while at work, flames engulfed their home with the two infants inside. They survived, but she entrusted them to an orphanage, haunted by the fire.
“I would love to hear my children call me mummy again,” she said, her scarred face breaking into a smile.
Kush is a depressant. Its short, intense effect often leaves users senseless. Symptoms of addiction range from sores to psychosis. Liver, kidney and respiratory problems are common.
Kush is difficult to combat
The drug's evolving composition, low cost and widespread availability make it difficult to combat in Sierra Leone, one of the world’s poorest countries. A recent report from the Global Initiative Against Transnational Organized Crime earlier this year found that nearly half of kush samples tested contained opioids up to 25 times stronger than fentanyl. The drug's content were largely unknown before now, hindering response efforts, experts noted.
Kadiatu Koroma with the local Women for Women Foundation nonprofit said her organization has seen a rise in drug use among women and girls in recent years.
“When they are very drowsy … men will just come and take advantage,” she said. Left vulnerable after using the drug, the women “are impregnated and they don’t even know the men who did it.”
25 strains of the drug
At Sierra Leone's Kissy Psychiatric Hospital, health workers described encountering 25 different strains of the drug in the wider Freetown area.
In one of two female wards, nurse Kadiatu Dumbuya said 90% of kush addicts she has attended to during her six years in the hospital have "sold their body” to feed the habit.
And yet, among the 50 people — majority of whom are kush users — who filed into one of Sierra Leone’s two government-run rehab centers on a recent day, only three were women.
Only 300 people have accessed the seven-week program at the Hasting Military Center since it opened in February 2024, guarded by the military and surrounded by barbed wire. Just 40 of the beneficiaries are women.
Officials say the program is gender-sensitive, with men and women separated by a fence. However, staff said stigma and family pressure mean women often deny their addictions and refrain from seeking support.
A drop in the ocean
“In most cases, we have 10% of girls that come to our attention. That doesn’t mean the girls aren’t addicts … they feel shy in their communities,” said Ansu Konneh, who works with the Sierra Leone's Ministry of Social Welfare.
“It is a drop in the ocean,” he says.
Due to funding challenges, an ‘ambassador’ program for recovered addicts from the center has stalled, and admissions were halted for five months. When it resumed, some of the parents on the 2,000 person-long waiting list said their children had died.
Among those desperate for help was Melda Lansana, who said she visited the ministry several times to secure a rehab spot for her 18-year-old daughter, Khadija.
“When I was taking it, I couldn’t wash, I couldn’t take care of myself,” Khadija said, recalling the relief of the days spent in the center last August.
Without money for school, she struggles to get her life on track. Due to family tensions, she has chosen to live “on the streets” with her boyfriend.
She vows she’s clean. Her mother suspects she’s still using.
Funding challenges slow progress
Progress against kush is slow, much like other parts of the world where the fight against synthetic drugs is often difficult.
Officials acknowledge the government has struggled to provide livelihood or business support to ease reintegration, particularly for beneficiaries without formal education - a step advocates say would help women.
Last year's emergency declaration, lauded by civil society, has helped shift the approach from punishment to care but the response is only "65% of what it should be,” said Habib Kamara, director of the Social Linkages For Youth Development And Child Link, a local nonprofit involved in the fight against drug use.
The organization is one of the few that have offered targeted support to female users, especially to vulnerable populations like sex workers, through community peer support, free family planning and beauty sessions to help build confidence.
“We have to meet the women where they are,” Kamara said.
Marie Kamara, 19, rejected kush for another drug - Tramadol, which experts have warned is also dangerous. She saw kush as too risky and was put off by her friends' stench and oozing sores.
One night, she said, she and her friend Yabu were chased by a kush dealer. Marie escaped. Yabu didn’t.
“They raped her … just because of kush,” Marie said.
Months later, Yabu died from the effects of the drug, Marie said — her second friend lost to kush.
“Let me not die like them," Marie said. "I pray.”
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Caitlin Kelly, The Associated Press
