‘Narghile:’ Thank You for Smoking

By Alexander Whitcomb and Rekar Aziz

ERBIL, Kurdistan Region – It has become a fixture in Erbil’s café culture.  Customers puff flavored tobacco out of charcoal-heated glass water pipes. The practice is popular despite knowledge it poses some health risks, yet few know the full extent of its dangers.

“I don’t like it,” grumbles one passerby. “It’s not Kurdish.”

Indeed it is not -- although it arrived in Kurdistan centuries ago. Some attribute the invention of the water pipes to Hakim Abul Fath, a Persian physician at the court of Mughal Emperor Akbar (1556-1605).  When European tobacco became wildly popular amongst the Indian nobility, the physician devised a solution to their corresponding health problems. “Smoke should be first passed through a receptacle of water so that it can be rendered harmless,” he wrote, planting a myth that has survived until today.

The commonly used “narghile,” meaning coconut in Persian (and derived from Sanskrit), alludes to the original construction of the pipe using a coconut shell.  Smoking narghile spread to Kurdistan through the Persian Safavid Empire and became even more widespread under the Ottomans, who brought it to much of the Middle East, North Arica, and Southern Europe.
  

Narghile offers a smoother and more accessible form of smoking to people who don’t care for cigarettes.  The tobacco is soaked in flavored molasses, and cafes typically offer a wide range of options, such as apple, lemon-mint, or bubblegum. The water cools the smoke and makes it feel cleaner -- more like steam than something toxic. According to the World Health Organization (WHO), narghile is also more “female friendly”: the practice is consistently more gender balanced than cigarettes in countries where society frowns upon women smoking.

Smoking can be fun, as greater volumes of thick smoke can be used to blow smoke rings. There is also an image factor.  In a survey of your typical café, you see young men perfecting the pasha look, lazing into their chairs and meditatively puffing at their personal glass. At around $10 a glass, the narghile projects the power of a cigar. without the offensive smell. 

Users usually acknowledge that there is a negative health effect, but few understand how unhealthy it really is. 

“When people say narghile is harmless, they are communicating a dangerous message and misleading the public,” says Doctor Khalis Qadir of the Kurdistan Regional Government Health Ministry. “Narghile is more dangerous than (cigarette) smoking by far.”

Smoking narghile involves inhaling through a hose, which creates a vacuum in the bowl and pulls the charcoal combustion through the tobacco, producing aerosol.  This bubbles through the water and into the smoker’s lungs. No matter what Dr. Hakim Abul Fath told the Mughal court, the water only removes some of the nicotine and tar. The remaining smoke contains high levels of carbon monoxide, cancer causing chemicals and heavy metals.

Ironically, the lower level of nicotine delays the sense of nausea so that a smoker can expose herself to much higher quantities of carcinogens and toxins.  According to a WHO study, if a cigarette smoker takes 8-12 puffs of 40-75mL of smoke, a narghile smoker typically takes 50-200 puffs of 0.15-1 liter of smoke. That means a one-hour narghile session involves as much smoke as burning through 100-200 cigarettes. 

Rekan Arif, 23, has been smoking it since 2007. “I have heard of doctors when they say smoking Narghile one time is equal to smoking an entire packet of cigarettes. But I still have the desire to smoke when I see my friends are doing it.”

Habitual users become hooked as they end up consuming just as much nicotine, if not more. Hassan Muhammad Abdulla, a merchant from Baghdad, smokes early one morning in a shop in the Eskan district of Erbil.

“I have been smoking narghile for 30 years and I know it’s not good for me. It’s a notorious kind of smoke, yes, and has side effects. It badly affects the blood, eyes, head and everything,” he recognizes.  As an attendant supplies him with fresh coals, he admits he smokes “because I’m addicted to it like any other people who are addicted to cigarettes or alcohol.”

Shop owner Hikmat Kareem, brings several glasses to a table of customers and fires up their pipes, taking down deep draws until the glasses are ready. “I will have headache and will look tired if I don’t smoke narghile everyday,” he says.

Because café workers warm up dozens of glasses for customers, they suffer from an acute form of second-hand smoke unique to narghile.

Pipe smoke can also lead to more diseases than smoking cigarettes.

Dr. Yadgar Mirza Mahmoud, a lung and chest specialist at Erbil’s Rizgari Hospital, emphasizes that bacteria can find their way inside narghile tubes, even if you use replaceable plastic caps.

Unless pipes and hoses are thoroughly cleaned with hot water and antibacterial liquids after each use -- something you would be hard-pressed to find in the cleanest cafés -- there is a risk that pipes carry communicable diseases like tuberculosis or hepatitis. Shop owners Rudaw spoke to consistently believe brushing the hoses and changing the water is hygienic.

“There are big numbers of patients visiting our department with bacterial infections from smoking narghile,” the doctor says. “They tend to cough a lot, breathe hard and produce thick saliva. I also have many patients suffering from COPD (chronic obstructive pulmonary disease) as a result of smoking narghile, cigarettes, or both.”

“Ninety-nine percent of our lung cancer patients are smoking,” he continues. “The other one percent are either working at coal mines or have been exposed to other poisons.”