Every morning for years, Moustafa Yareen coughed uncontrollably. His chest hurt and he hacked into the bathroom sink. For him, the best medicine was a cigarette. Mr Yareen lives in Aleppo, Syria, with his wife and six children. He started smoking when he was 12, and for decades supported a 75 cigarette-a-day habit. Today, at 47, he has smoked nearly one million cigarettes. Recently, his breathing became so laboured he responded to a get-help ad in the newspaper. He called the Syrian Centre for Tobacco Studies, an organisation dedicated to raising awareness about the dangers of smoking. "I heard those who are smoking can die," Mr Yareen said. "My wife always said I spend money to burn my life, and that is true. "But after two months of quitting I returned to the cigarette. I felt I had failed, as usual, so I quickly ran to the centre." Founded in 2002, the clinic consists of three rooms jammed with medical equipment. Patients smoke water pipes while doctors monitor their vital signs. It is here Mr Yareen receives counselling for his addiction. But this personal battle is part of a much greater war to end Syria's love affair with smoking. And the world has noticed. Through research, health campaigns and collaborations with hospitals in Jordan, Lebanon, Egypt and the United States, the centre has been recognised with the Hamdan Award for best medical institute in the Arab world. From this small office, researchers have worked with the American University in Beirut to study the harmful effects of water pipe smoking; Jordan University to investigate smoking among youth; John Hopkins University in the United States to research Arab children's exposure to second-hand smoke; and the University of Newcastle in the United Kingdom to study the determinants of women's health in poor cities in Syria. The centre is supported by a five-year grant from the US National Institutes of Health. Abdulla bin Souqat, the director of the Hamdan Awards, said the Syrian Centre is a rallying force that works to dispel strong misconceptions associated with smoking. "For many, smoking is like prestige," he said. "That is how I feel. When we were young, we saw smoking as becoming a man. An effort to study smoking and raise public concerns about it is an amazing thing in this part of the world. The centre in Syria has shown exceptional initiative. This was not an easy effort." The Hamdan Award is sponsored by Sheikh Hamdan bin Rashid Al Maktoum, the deputy ruler of Dubai. The objective of the prize is to provide an incentive for the development of research and health education in the Arab world. According to the Syrian Centre, smoking in Syria has reached "epidemic" proportions. It is estimated about 60 per cent of males and 23 per cent of females smoke. Meanwhile, "nargilleh", or water pipe smoking, remains an ingrained fixture of daily life in outdoor cafes. Dr Wasim Maziak is the director of the Syrian centre and an associate professor of health sciences at the University of Memphis in the United States. He said the water pipe was quickly becoming a more pressing issue than cigarettes, and believed it had eclipsed cigarettes as the most popular form of smoking in the region. In 2005, his work resulted in the first health advisory for the water pipe by the World Health Organisation. "It is rapidly spreading among youths all over the world," he said. "And this is because of a misconception of reduced harm and addictive potential, due to the assumed filtering effect of water." In a study just released by the University of Memphis, researchers found the amount of smoke inhaled in a single water pipe session can equal that of 100 cigarettes or more. Dr Maziak said the effects of water pipe smoking are made worse by its explosion in popularity, as the centuries-old tradition has discovered a modern reawakening among youth. According to Dr Maziak, this surge has coincided with the mass production of flavoured tobacco - apple, grape, peach and mint - that has appealed more broadly to a younger generation of smokers. A recent survey of 90,000 students between the ages of 13 and 15 from 20 Middle Eastern countries found 15.6 per cent of boys and 9.9 per cent of girls smoked water pipes. Meanwhile, 6.7 per cent of boys and 3.2 per cent of girls smoked cigarettes. Dr Fouad M Fouad, a general surgeon and the intervention co-ordinator at the Syrian centre, admits he was also fooled by the water pipe. "At one time I thought like many others that smoking water pipe was a sort of fun," he said. "I know now the importance of making people aware of reality." Dr Fouad has worked with countless Syrians who come to the centre seeking help for their addiction, including Mr Yareen, who has not smoked in six months. Dr Fouad worries this achievement may be only temporary. While the Syrian government has recently taken steps to ban smoking in government buildings, he believes the overwhelming presence of cigarettes and water pipe smoking in public will be too tempting for Mr Yareen. He said the Syrian government, and other countries in the Arab world, need to take action against the smoking "epidemic" in public areas. What Mr Yareen needs, he said, is for Syrians to change the way they think about smoking. Mr Fouad hopes the Hamdan Award may bring them one step closer. "We have regulations and we have laws, but they are not enforced," Dr Fouad said. "We need more awareness. Mr Yareen is why you need to ban smoking in public places. Seeing smoke and smelling smoke changes the brain. It triggers your desire." jtodd@thenational.ae
