By Michael Woldeyes, LLM student International Human Rights Law, m.mengistu student.rug.nl

Khat, known as Chat in Ethiopia, is a flowering plant native to Ethiopia that usually grows as a bush or a small tree.[1] Khat leaves have been chewed for recreational purposes for centuries both in Ethiopia and the Horn of Africa, as “its young buds and tender leaves contain amphetamine-like psycho active substances, which produce euphoria and stimulation.”[2] However, research has shown that khat chewing results in adverse health effects. For instance, khat use results in acute myocardial infarction,[3] elevation of blood pressure and pulse rate,[4] heart failure,[5] and depression.[6] Research also shows that khat serves as a gateway to tobacco use.[7] Ethiopian children are particularly vulnerable to the physical and mental health effects of the drug because there is no legislation that regulates the trade of khat to and its use by them.[8]

Ethiopia is State party to the Convention on the Rights of the Child (hereafter CRC) and, by virtue of article 24 of this convention, it is expected to respect the right to health of the child. This blogpost argues that informing children about the health effects of khat use is one of the State’s obligations to fulfill this right.

Khat and Ethiopian children

The habit of khat chewing is highly associated with tradition and religion in Ethiopia.[9] Yet, its reputation divides society. Khat has a special place in some communities while others see it as a social evil.[10] For instance, in the eastern part of Ethiopia khat is used to cheer up social gatherings and celebrations.[11] This part of society tolerates and even encourages the habit of khat chewing among children and adolescents.[12] In other parts of the country the chewing of khat is frowned upon. Nonetheless, children and adolescents pick up the habit from their peers.[13]

The lack of regulations that limit the exposure of children to the drug have made khat use rampant among, especially, adolescents. A review study found out that khat chewing had a 14.6% prevalence rate among high school students across Ethiopia.[14] However, by virtue of article 24 (1) of the CRC children have the right to the highest attainable standard of health. This means that Ethiopia needs to take measures that limit the exposure of children to khat. I believe that one of the most important measures that should be implemented by the State is informing children about the health effects of khat. This is due to the fact that, as it is discussed below, information plays an indispensable role in the health of the child by affecting his/her physical and social development. Informing the child about khat is not just a measure; it is an obligation that the State is required to fulfill under article 13 of the CRC which grants the child the right to receive and impart information.

How is disseminating information on Khat related to the right to health of the child?

The right to health is a holistic right that needs the identification of risks and protective factors to the health of the child and the implementation of informed interventions that address the social determinants of health.[15] A child may adopt unhealthy lifestyles such as drug addictions or unhealthy diets due to environmental or cultural surroundings. This vulnerability of children is significantly seen during adolescence, defined as the age between 10 years and 18 years.[16] As the Committee on the Rights of the Child (hereafter CteeRC) puts it “adolescence is a life stage characterized by growing opportunities, capacities, aspirations, energy, and creativity but also significant vulnerability.”[17] The health of an adolescent is “predominantly [linked to] social and economic determinants and structural inequalities, mediated by behavior and activity, at the individual, peer, family, school, community and societal levels.”[18] Hence, States are required to create an environment that will enable children and adolescents to acquire health-seeking behavior instead of a risky behavior.[19] One of the ways to achieve this goal is through disseminating appropriate information.

The child’s right to information is an important component of the child’s right to health and development because “information affects the physical, emotional, cognitive and social development of the child. The way in which a child learns to walk and talk, and how he plays and communicates with others is also due to the information he has received.”[20] To this regard, the CRC declares that the child has the right to receive and impart information.[21] Without access to information children will not get the chance to have an impact on their future life and development.[22] And the CteeRC indicates that children who do not get proper information and guidance on health related issues are at high risk.[23] For example, when it comes to HIV/AIDS, “States Parties are reminded that children require relevant, appropriate and timely information which recognizes the differences in levels of understanding among them, [and] is tailored appropriately to age level and capacity … in order to protect themselves from HIV infection.”[24] By the same token, the State is required to disseminate appropriate information on khat in a manner that is tailored to children’s age and capacity so that they will protect themselves from the adverse health effects of khat. This could be done simply. For starters, the State is encouraged to use all media platforms, including social networks, to reach children and adolescents with information that are helpful for their development and health.[25] In addition, school clubs and mini-media can be used to deliver the message to children.

In conclusion, the availability or not of appropriate information affects the health and development of children. Fulfilling the right of the child to health entails the fulfillment of his/her right to information. As a result, since Khat would negatively affect the development of children to become competent adults, Ethiopia is obliged to guide children to a healthy lifestyle by providing them with the right information about khat.

[1] Ayman El-Menyar, Ahammed Mekkodathil, Hassan Al-Thani and Ahmed Al-Motarreb, “Khat use: History and Heart Failure” [2015] 30 (2) Oman Medical Journal, 77.

[2] Ibid.

[3] Al-Motarreb, M Al-Kebsi, B Al-Adhi, and K J Broadley, “Khat Chewing and Acute Myocardial Infarction” <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767022/> accessed on 13 December 2020.

[4] Ethiopia Ministry of Health and Ethiopia NCDI Commission, “Addressing the Impact of Non-Communicable Diseases and Injuries in Ethiopia: Findings and Recommendations from the Non-Communicable Diseases and Injuries (NCDI) Commission of Ethiopia” (2018), 35.

[5] Ayman El-Menyar, Ahammed Mekkodathil, Hassan Al-Thani and Ahmed Al-Motarreb (n1), 81.

[6] Depressive symptoms are seen at the end of use. See Tekalign Damena, Andualem Mossie, and Markos Tesfaye, “Khat Chewing and Mental Distress: A Community Based Study, in Jimma City, Southwestern Ethiopia” [2011] 21 (1) Ethiopian Journal of Health Science, 44.

[7] Saba Kassim, Nikki Rogers, Kelly Leach, “The Likelihood of Khat Chewing Serving a Neglected and reverse

‘Gateway’ to tobacco use among UK Adult Male Khat Chewers: A Cross Sectional Study” [2014] 14 (448) BMC Public Health, 2.

[8] See Logan Cochrane and Dacin O’Regan, “Legal Harvest and Illegal Trade: Challenges and Options in Khat Production in Ethiopia”, [2016] 30 International Journal of Drug Policy, 29.

[9] Ezekiel Gebissa, “Khat: Is it More Like Coffee or Cocaine? Criminalizing a Commodity, Targeting a Community” [2012] 2 (2) Sociology Mind, 204.

[10] Clarke Brooke, “Khat (Catha Edulis): Its Production and Trade in the Middle East” [1960] 126 (1) The Geographical, 50.

[11] Ezekiel Gebissa (n 9) 205. See also Deutsche Welle, “Khat is Big Business in Ethiopia” <https://www.dw.com/en/khat-is-big-business-in-ethiopia/a-49523289> accessed on 15 December 2020.

[12] Yeraswork Admassie, The Khat Conundrum in Ethiopia: Socio-economic Impacts and Policy Directions, (2017) 52.

[13] Zerihun Girma Gudeta, Logan Cochrane, Gutema Imana, “An Assessment of Khat Consumption Habit and its Linkage to Household Economies and Work Culture: The Case of Harar City” [2019] 14 (11) PLoS One, 7.

[14] Wondale Getinet Alemu, TadeleAmare Zeleke, Wubet Worku Takele, and Shegaye Shumet Mekonnen, “Prevalence and Risk Factors for Khat Use among Youth Students in Ethiopia: Systematic Review and Meta-Analysis, 2018” [2020] 19 (16) Annals of General Psychiatry, 3.

[15] UN Committee on the Rights of the Child, “General Comment No. 15: On the Right of the Child to the Enjoyment of the Highest Attainable Standard of Health” (17 April 2013) CRC/C/GC/15 para 16.

[16] UN Committee on the Rights of the Child, “General Comment No. 20 on the Implementation of the Rights of the Child during Adolescence” (6 December 2016) CRC/C/GC/20 para 5.

[17] Ibid para 2.

[18] Ibid para 57.

[19] UN CteeRC “General Comment No. 15” (n 15) para 67.

[20] Marian Koren, “The Right to Information: A Human Right of Children” [1997] 23 IFLA Journal, 58.

[21] UN General Assembly, Convention on the Rights of the Child (adopted 20 November 1989, entered into force 2 September 1990) 1577 UNTS 3 article 13 (1).

[22] Herdis Thorgeirsdottir, A Commentary on the United Nations Convention on the Rights of the Child: The Right to Freedom of Expression – Article 13, (2006) 2.

[23] UN Committee on the Rights of the Child “General Comment No. 3: HIV/AIDS and the Right of the Child” (2003) CRC/GC/2003/3 para 2.

[24] Ibid para 16. See also UN Committee on the Rights of the Child, “General Comment No. 4: Adolescent Health and Development in the Context of the Convention on the Rights of the Child” (1 July 2003) CRC/GC/2003/4 para 28.

[25] UN CteeRC “General Comment No. 20” (n 16) para 47.