The country, a key transit point on international trafficking routes, used to have low rates of drug abuse – until now

The setting sun reflects off the corrugated iron shacks that make up most of the homes in Mafalala, a poor neighbourhood in Mozambique’s capital city, Maputo. Mothers call their children inside after a day of play and, by 6pm, the streets have transformed, revealing a dark underworld.

Young men gather in groups, blasting Portuguese rap music: many of them are heroin addicts who come to Mafalala to buy from local dealers. After injecting, they slump on the sidewalks in a stupor.

In Mafalala, “everyone’s using,” said Munir Covas, a 42-year-old recovering addict. Most of his old acquaintances have died because of drugs. “Of my friends, only two of us are left,” he said.

Mozambique has been a key transit point on the international drug route for the last 25 years but it has had historically low rates of drug usage compared to its northern neighbours, Kenya and Tanzania. Now, this appears to be changing and both drug users and those working in drug recovery report an increase in the number of people using heroin across the country. Aid agencies and the government are scrambling to stem the rising tide of addiction.

Experts estimate that between 10 and 40 tons of heroin move through Mozambique on dhows each year, and more comes through the country’s ports. With an export value of approximately USD $20 million per ton, making heroin one of Mozambique’s largest exports.

The drug trade has well-established links to government officials in Frelimo, the country’s ruling party. It’s estimated that more than USD $2 million per ton of heroin stays in Mozambique in the form of bribes and payments to senior Mozambicans.

“If the government wanted to end this, they would,” one former drug user told The Telegraph. Bairro Militar, a neighbourhood in Maputo where a military headquarters is stationed, is also one of the city’s most notorious drug hot spots. Here, drug dealers have operated with impunity for decades. Rather than preventing drug deals from taking place, police often extract bribes from dealers and users, several sources said.

Mozambique’s anti-drug government agency, the Gabinete Central De Prevenção E Combate A Drogas, did not respond to multiple requests for comment about government involvement.

Until recently, the government’s tight grip on the illicit drug industry appeared to have prevented wars between influential drug trading families and kept most of the heroin out of local markets. But this grip has loosened in recent years, and as a result heroin and other hard drugs have flooded onto Mozambique’s streets.

Those working on the front line agreed that drug use was becoming more widespread, while users are getting younger.

“The consumption of drugs has increased a lot…in the past three years,” said Pastor Dario Vitor Braga Rito, a former drug addict who has been clean for 18 years and who now runs the Mozambican branch of Remar, a Christian organization helping drug users get back on their feet.

Rito said that while most drug users Remar helped used to be anywhere from 20 to 40 years old, in the past few years, the organisation has begun to see more 14-to-16-year-olds asking for help as drug dealers have started targeting schools to expand their user base.

Other sources told The Telegraph that dealers are sprinkling “brown dust” – heroin – on the marijuana students normally buy to get them hooked on the stronger narcotic, and that these dealers are reaching students as young as 12.

Jose Carlos Santos began using drugs in his late teens but more than two decades of smoking heroin caused his lung to collapse and he was rushed to the hospital.

“The doctor couldn’t believe I was alive. He asked to repeat the test because he couldn’t see one of my lungs,” said Santos. “It was a miracle.”

Santos has been in and out of prison in South Africa and Mozambique; he has stolen money and betrayed his family members. He was a self-described “diabolical” drug addict.

When Santos’ lung collapsed, he hit rock bottom. He was released from hospital after one month and went straight to Costa do Sol, a neighborhood outside Maputo which houses Remar’s all-male inpatient rehabilitation facility. Located on a farm, Costa do Sol uses prayer and good old-fashioned manual labour to bring drug users back from the brink.

The men in the facility go “cold turkey”, enduring the excruciating opiate detoxification process without the help of medication. Afterwards, they stay for a period of months, or even years, working in the lush gardens, attending listening circles and Bible study and maintaining a strict schedule with limited visits from family and friends.

The facility is run entirely by recovering addicts like Pastor Dario himself, and each new entrant has a mentor who shadows him and keeps an eye on his behaviour. As of last April, Costa do Sol had 75 men in treatment, with another 40 on the waiting list.

“No one knows a drug user better than an ex-drug user. So, when a drug user is thinking about doing something, we are two steps ahead,” said Pastor Dario.

On Santos’ arm is an old prison tattoo shaped like a rising sun with the number 2000 – symbolizing the year he expected the world to end – and the letter S for Santos. Today, he tells people that the 2000 signifies the number of lives he has been gifted from God, and that S stands for Sandra, the woman he loves and married in July of last year.

But for many drug users, an abstinence-only Christian methodology doesn’t work.

“In Remar, I felt like I was in prison. I always had a shadow,” said Munir Covas, the recovering addict from Mafalala.

Medical and public health professionals are now calling for harm reduction programmes, similar to those implemented in Europe and the US, as an alternative to abstinence-only initiatives.

These include needle and syringe exchanges, which allow injecting drug users to drop off contaminated used needles and pick up clean ones at no cost, as well as free, widespread testing and counseling for injecting drug users.

Such initiatives are relatively new in Africa and have met some resistance.

“I think the main challenge is… some leaders think that harm reduction might encourage drug use,” said Cynthia Semá Baltazar, a researcher at the Mozambican government’s National Health Institute. “[I]t’s in our society. I think historically the main strategy addressing drug use in our society has been punishment. But it’s important that we shift from a criminal justice to a public health approach.”

In 2018 the charity Medecins sans Frontieres opened Mozambique’s first harm reduction programme in Malfalala. MSF had to work closely with the community, including religious leaders, elders and even the drug dealers themselves, in order to create enough buy-in to safely open their doors.

The programme has already saved lives. 24-year-old Rukeya, rail-thin after years of heroin use, began using drugs at the age of 17, after her mother was diagnosed with cancer and her brother was sent to prison. Rukeya watched her mother die in front of her eyes while her brother listened on the phone.

“I am powerful now, but it was difficult because he was my support,” she said, her hoarse voice cracking as she began to cry. “He was my everything. And then when I lost my mother, I felt like no one liked me. So, I started to use drugs. And I started to sleep on the street.”

Rukeya sold cigarettes and marijuana to fund her own drug habit, wasting away until she couldn’t recognise herself in the mirror.

“I [thought] that I have to change. I started to come here to the centre. I came and disappeared, came and disappeared,” she remembered. “I saw my friends who looked beautiful. And I looked emaciated. And I said, ‘why? I need to go home’.”

Rukeya finally committed herself fully to the programmes at the drop-in centre. “This is my new family,” she said.

She became a peer counsellor and is also trained in the use of Naloxone, a medication that has recently become available in Mozambique to rapidly reverse opioid overdose. MSF has trained users, community members and even dealers on how to use it.

One of the most important aspects of Rukeya’s recovery is methadone maintenance therapy. MSF, in collaboration with the Government of Mozambique, opened the country’s first methadone clinic in one of Maputo’s primary healthcare centers.

MSF ran the drop-in centre and the methadone clinic from 2018 to 2020. This year, with the support of other partners, the programme was successfully turned over to Mozambique’s Ministry of Health which hopes to roll it out to other parts of the country.

Ana Gabriela Gutierrez Zamudio, MSF’s medical coordinator in Maputo, says the handover “required a lot of willingness from the government, which was present,” said Zamudio. “For us it was a big relief.”

She hopes that a firm footing will help more people like Rukeya, who has been on methadone for three months and is taking it one day at a time.

“Many people are dying. Many people are dying now. If people die, people throw them away into a container,” she said. “I don’t want to die like that. For people to say, ‘that girl was beautiful.’”