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, 4 (12), e341

The Consumption of Khat and Other Drugs in Somali Combatants: A Cross-Sectional Study

The Consumption of Khat and Other Drugs in Somali Combatants: A Cross-Sectional Study

Michael Odenwald et al. PLoS Med.


Background: 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.

Conclusions: 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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.


Figure 1
Figure 1. Comparison of Information on Self-Report Information on Drug Use of 4,751 Respondents in Northern and 3,373 in Southern/Central Somalia
(A) Weighted estimates of proportions of khat users (week before the interview) and of respondents reporting signs of excessive use (> 2 bundles/d, > 1 sleepless night/wk, chewing alone); weights are based on sampling probability per region; error bars correspond to the 99% CIs. (B) Weighted estimates of average quantity of khat (bundles) consumed by 1,248 users in the north and 1,707 in the south and number of sleepless nights due to khat chewing in the week prior to the interview; weights are based on sampling probability per region; error bars correspond to 99% CIs.
Figure 2
Figure 2. Respondents' Perceptions of How Many of Their Unit Members Consumed Six Types of Drugs in the Past Week (Percentages), in Northern Somalia (Somaliland and Puntland) and Central and Southern Somalia (Hiran, Bay, Mogadishu, and Kismayo)
We report weighted estimates for proportions; weights are based on sampling probability per region; error bars correspond to the 99% CIs.

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