Five thousand dead and counting: the Philippines’ bloody war on drugsBMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6177 (Published 28 November 2016) Cite this as: BMJ 2016;355:i6177
After being elected president of the Philippines in June this year, Rodrigo Duterte embarked on a violent campaign to end illicit drug use in the country. He offered bounties for the bodies of drug dealers and promised to protect police from prosecution for the killings.
Some 5000 people have been killed in police operations or by suspected vigilantes since Duterte promised “to fatten the fish in Manila Bay with the bodies of 100 000 criminals.”1
But the Philippines’ health minister, Paulyn Rosell-Ubial, told The BMJ in a recent interview that the aim of completely eliminating drug use from the Philippines is unrealistic. “That’s the goal, but I think it’s an impossible goal. It’s really to make drug use something that’s unacceptable [and] totally disliked by Philippine society,” she said.
“It is a social movement, to say: drugs are not acceptable. At the moment everyone is using drugs. There’s no outcry, it’s completely accepted behaviour. I think we should change this culture of drug use in the country.” But she would not comment on the brutal methods Duterte is using.
The killings have drawn widespread condemnation, including from the United Nations and international human rights groups.
“It’s just terrible,” said Chris Beyrer, professor of public health and human rights at Johns Hopkins Bloomberg School of Public Health in Baltimore and an expert on the health implications of drug policy.
He told The BMJ, “This is not the rule of law. People are being killed on the accusation or presumption that they are involved in the drug trade: that is a recipe for vigilante violence.
“We saw a similar policy in 2003 in Thailand, with then prime minister Thaksin Shinawatra’s war on drugs, with over 2400 extrajudicial executions, the youngest of whom was 9 months old. These crackdowns are popular because drug users are so vilified.
“They drive people underground and force people to share injecting equipment. In the Thai situation there was a marked increase in alcohol dependency as people tried to switch to something legal.
“Much of the anxiety in the Philippines is related to stimulant use, to methamphetamine, which is widely available in the region. This was also the case in Thailand.”
High methamphetamine use
In 2015 the Philippine Dangerous Drugs Board estimated the number of illegal drug users at 1.8 million, of the 100 million population.2 However, Duterte has said that the country has more than three million drug users.
Like other countries in the region the Philippines has seen a recent rise in the use of methamphetamines, known locally as “shabu,” in recent years. The UN Office on Drugs and Crime calls it “the top illicit drug threat in East and South-East Asia” and estimates an annual prevalence of use of about 2% of Filipinos.3 Another report by the UN office found that seizures of amphetamine type stimulants in the region quadrupled between 2008 and 2013, from 11 to 42 tons.4
Duterte’s “war on drugs” has led 800 000 people who use drugs to “surrender,” whereby they register with the authorities, hoping to receive immunity from the killings and treatment. Their only other option is to wait and see what the president’s war on drugs might bring.
The number of people surrendering has caught the government by surprise because it doesn’t have the infrastructure to help so many people with drug dependency, Rosell-Ubial said. “We have only 5000 beds for inpatient care for treatment and rehabilitation in the whole of the Philippines,” she said. “Because of this campaign of the president we’ve been caught flatfooted.”
The Philippines has fewer than 50 accredited rehabilitation facilities and lacks drug counsellors and doctors to properly assess patients’ needs. But Rosell-Ubial added that a 10 000 bed drug rehabilitation centre will open in November, funded by a Chinese philanthropist and located in a military camp north of the capital, Manila.
Mental health problem
In 2002 the government repealed the Dangerous Drugs Act of 1972 and enacted the Comprehensive Dangerous Drugs Act, which focused less on law and order and more on preventing drug use and rehabilitating people with drug dependency, in line with globally accepted approaches. However, while government officials maintain that drug use will be treated as a health problem, the country seems less than ready and willing.
“We’re approaching it as a mental health problem,” said Rosell-Ubial. “Therefore we’re rolling out a drug abuse treatment and rehabilitation program that looks at a spectrum of interventions, not only for the abusers but also to stop demand and to prevent young people, especially those in schools, taking up the habit. It’s now a programme in the health department.”
She said that reaching young people through schools and in the community was critical to tackle drug misuse.
Forced dance classes
Some people who have surrendered have been forced to take dance classes or have been released without offer of help, media reports have said.5
Good, evidence based treatments for methamphetamine dependency are lacking. “There is no gold standard,” Beyrer said. “People are detained and held, and often what they’re getting is cold turkey and then forced exercise, forced labour, and forced marching—and forced Zumba dancing—ridiculous approaches that have no evidence of efficacy. They achieve very little at great human cost. When you don’t have a good intervention, it’s not the time to introduce a mass intervention programme.”
People who surrender undergo an assessment of their drug use to determine whether they are eligible for inpatient or outpatient care. Of the 800 000 who have surrendered in the past four months, just 1% needed residential care, Rosell-Ubial said.
But while Rosell-Ubial said that community based and outpatient based treatment and rehabilitation programmes were being rolled out for people who were not “hardened users,” adequate provision of care remains to be seen.
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.
thebmj.com Observations Non-violent drug users should face no penalty—a call from the Global Commission on Drug Policy doi:10.1136/bmj.i5921; Editorial The war on drugs has failed: doctors should lead calls for drug policy reform doi: 10.1136/bmj.i6067