By Martin Jelsma and Tom Kramer, Transnational Institute.

Winter is starting in Herat, a province in south-western Afghanistan, where we've come to look at the country's own drug problem. The city has one of the highest rates of heroin users in Afghanistan.

Back in 2005, Herat had some 11,000 heroin users, but everybody we meet tells us these numbers have increased. Treatment and other services for drug users are far from insufficient to meet this rising demand.

During visits to various places in Herat where heroin users hang out, we hear their dramatic life stories. The staff of the Shahamat Health and Rehabilitation organisation visit them every day to hand out clean needles, collect the dirty ones, advise about HIV/AIDS prevention and provide very basic emergency health care.

At the foot of the famous old minarets of Herat, we meet a group of twenty heroin users. After they receive clean needles from the outreach team, we wait to witness how this works. A thirty year-old man puts the heroin (called "crystal") in a syringe filled with sterile water. After shaking it for a while to dissolve the heroin, he ties a tourniquet around his arm and sticks the needle in. But he cannot find the vein, which is too damaged after several years of injecting. He asks a friend for help, who then injects it in a vein in his neck, a much more risky practice.

When we ask the men about their needs, they answer with one voice: a night shelter! "It gets very cold here at night, and twenty of my friends have already frozen to death, one of them while I was sitting next to him. I could be next. We have no place to stay," one of them tells us.

Crystal heroin is sold on the streets here for 50 Afghanis ($1) per package and most users need two or three of those a day. The quality is bad, mixed with pharmaceuticals, and the acid used in the processing causes urinal infections and hinders the healing of wounds caused by injecting.

Three quarters of injecting drug users in Herat are infected with hepatitis, but so far only ten cases of HIV have been detected among those living on the streets. No doubt there are more, but the active policy of needle exchange may have come just in time to prevent an HIV/AIDS epidemic.

Later that day we visit the Shahamat - or "Brave" - daytime drop-in centre. "For us this is like home, we can take a shower and wash our clothes," a man from the central Uruzgan province tells us. He fled to Iran with his family after fighting broke out in his hometown and started to use opium and later heroin while there.

"This is also a school for us", he says. "We learned about HIV and hepatitis, and safer injection methods. And I only use 30% compared to what I took before I came here. I feel much better". The drug users in the drop-in centre look remarkably cleaner and healthier than those living near the minarets. But they have to leave the centre at 4 pm every day. One of them says: "We need a place to go to at night and there is no centre for treatment". This seems to be the main concern of drugs users in the town.

All the stories we hear are similar. Most users started their drug habit in Iran, where they were arrested for drug use and deported back to Afghanistan by Iranian police. In many cases they left their family behind when they were removed. They want to go back, but it costs about $1,000 to be smuggled back across the border.

All those we speak with say they are ready for treatment, but earlier this year international funding for therapy dried up and the small existing centres were closed down. They had accumulated a waiting list of over 2,000 people. The only option for male users now are two private clinics, but they charge a 10,000 Afs ($200) fee, an unthinkable amount for those living on the streets earning their way by begging, doing simple jobs like garbage collection or petty crime.

The only remaining treatment centre in Herat is for women and children. We meet a ten-year old boy addicted to crystal heroin - a habit he got from his parents, who were also addicted. Most of the women we speak to say they started using drugs after their husbands did so too. As long as their husbands are not treated as well, they will face many difficulties returning home after their stay here.

Many also first used opium as self-medication for illness or trauma and later moved on to heroin. One woman tells us she started after both her sons were killed on the way to Iran smuggling drugs.

Clearly, Afghanistan's drug problem is not simply one of opium production. The lives of these drugs users can be improved significantly with some simple measures: night shelters, harm reduction services such as needle exchanges and treatment centres. Support for such programmes is urgently needed. When we say goodbye in the drop-in centre, one man says: "Thank you so much for showing interest in us. Our families do not want to speak to us anymore because of our habit."

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