Hilda Ajrab peers warily out her front door and down the Via Dolorosa in Jerusalem’s Old City. It is from this street – the street down which Christ carried his cross – that narcotics first entered her home and consumed her world.

Mrs. Ajrab steps back into the house, checks her watch and asks her husband, Emil, “Shouldn’t he have called by now?”

The couple are waiting for their regular Friday afternoon call from their son, Johnny, a heroin addict who is spending a year as an inpatient at a rehabilitation center.

It is the only chance they get to speak to him these days.

Johnny is one of the few addicts to have the opportunity to try to get clean in a place far away from the drug playground the Old City has become in recent years.

A study of drug abuse among Palestinians in Jerusalem has found what Mrs. Ajrab and the community at large have long known – drug abuse is rising precipitously.

While hashish has been readily available in Jerusalem’s Arab population centers since before 1980, the far more addictive heroin (here known as “coke”) has become an easily obtained drug of choice in the last 20 years.

Many blame this uptick in drug abuse on a society weakened by years of conflict with Israel.

The strains of these past three years – since the start of the current Palestinian intifada – have caused fissures in family and community structures and resulted in a lack of educational, professional and recreational opportunities for Palestinians. Making matters worse are the limited resources to combat drug abuse in the Holy Land, though some efforts are finding success in East Jerusalem.

A recent study by the Arab Thought Forum is the only in-depth examination of drug abuse among Arabs in Jerusalem. The study finds that in 1999 some 5,000 Palestinians in Jerusalem (2.4 percent of the city’s Arab population) were addicts and 10,500 (5.5 percent) had used illegal drugs.

These numbers represent a large percentage of the population, considering the stigma in Arab culture surrounding the use of alcohol and drugs. Jerusalem’s Palestinian population, in fact, is more afflicted by drugs than Palestinian refugees in other Middle Eastern countries.

No thorough study of drug abuse has been conducted in the West Bank and Gaza. Researchers estimate that in each of those regions – far larger than East Jerusalem – there are roughly as many addicts, some 5,000 in each area. The rate of drug use among Arabs in Jerusalem is also higher than that of Jewish Israelis.

Most people familiar with drug use in Jerusalem agree abuse is substantially higher among the city’s Christians than its Muslims, probably because the Christian community permits the drinking of alcohol, while the Muslim community forbids use of all inebriating substances.

The nature of Arab society makes measuring drug abuse among women virtually impossible. Estimates are that some 800 women in the area abuse drugs.

A lack of data has made it impossible to pinpoint the rate of increase of drug abuse, says sociologist Michel Sayegh, who conducted the study for the Arab Thought Forum. He is certain, however, the rate is climbing.

Almost as troubling, says Mr. Sayegh, is the declining age of typical drug users. “What we see now is the number of youths using drugs is increasing and the average age of the user is decreasing,” he says. “We used to talk about 18 as the age when young people began to use drugs. We can now talk about the age 15 or 16.”

Of Arab Jerusalem’s 5,000 users, 23 percent are between 20 and 22 years old.

Family under siege. Johnny Ajrab is only a somewhat typical addict. In his research, Mr. Sayegh found that the family – the foundation of Arab society – is at the heart of drug abuse in myriad ways. He concluded that the most common thread in the backgrounds of the city’s drug users was a family broken by misunderstanding or divorce.

Johnny comes from one of the city’s oldest and largest Christian families, a relatively stable one without problems of divorce or, apparently, abuse.

Johnny’s family does mirror other drug-afflicted families in some ways. Mr. Ajrab was once gainfully employed as a tour guide with one of the city’s largest tour companies. Since the drastic decline in tourism to the Holy Land, he no longer has any work. “I used to be in the upper social class,” says Mr. Ajrab, looking depressed, deep lines in his cheeks framing his mouth. “Now I’m not even working.”

Johnny, like most Palestinian youths, reached young adulthood as the current Palestinian intifada was taking root. With the uprising came a slump across the Palestinian economy leading to a lack of employment and educational opportunities, which has left young men like Johnny little of substance to work toward.

Johnny’s call from the Israeli-operated Zuhareim rehabilitation center finally arrives in the late afternoon. He says he is doing well. Mrs. Ajrab is relieved, but concern over Johnny is not even the greatest trouble faced by Mrs. Ajrab. She knows Johnny is being looked after and is working to beat his addiction.

She is far more preoccupied these days with another tragic feature of this trend toward drug abuse in Arab Jerusalem. Mr. Sayegh found that more than half of drug abusers first begin with the help of a family member. Mrs. Ajrab has two other heroin addicts in her family, her brother and son-in-law.

While the Ajrabs awaited Johnny’s call, Mrs. Ajrab’s heroin-addicted brother, Henry, stumbled into the serenity of the family home. Affable with an infectious smile, this 50-something man nags his family and their guests for money he claims is for cigarettes.

Mrs. Ajrab has neither the heart nor the money and refuses. Shaking her head dejectedly, she turns her attention back to her son. “We hope that God can make a miracle with Johnny.”

Mr. Ajrab puts a positive spin on things: “This exact area of the Old City where we live was a center of drugs. There are still five or six addicts on this street alone, but now the man who was responsible for that is clean. So we’re hoping for a change.”

Switching sides. Just down the Via Dolorosa from the Ajrab residence lives “the King,” the man Mr. Ajrab spoke about. Or that’s how Robert Ghazzawi used to be known. “I was like a flag for drugs,” he recalls, sitting in his clean, spartan house, the very place he says was once a crowded drug den.

“I had everything. I was also like a doctor because I was so good at helping people inject heroin.” After beginning to use drugs at age 14 to escape the pain of an abusive father, Mr. Ghazzawi watched countless friends die of overdoses, many of whom he had supplied with drugs.

“I didn’t care. I was sad for just one minute and then I’d forget them. I knew I’d be like them someday.” But, after 25 years of drug abuse – 14 in prison – he has managed to turn his life around.

He is now an outreach worker with the Old City Counseling Center, which receives support from Caritas Jerusalem. He tackles his work at the center with a sense of mission, driven by his need to help people turn their lives around.

Mr. Ghazzawi spends the middle of each day making rounds in and around the Old City. Lying in the shade cast by the hulking walls surrounding the Old City or milling about listlessly in its narrow streets, dozens of drug addicts – many his former customers – greet him. Their gaunt, often dirty faces become more lifelike as he addresses them.

His approach is always the same: “How are you doing? When did you last score? When will we see you at the center? It’s time to clean up.” Mr. Ghazzawi even runs a 12-step group and invites those who have begun recovery to this weekly meeting at his home.

Getting addicts into the center, however, is not an easy task. Many say they will come, but few do.

Mr. Ghazzawi may be fighting a losing battle. The price of drugs has decreased dramatically in recent years, making heroin a more affordable option. A gram of pure heroin cost $100 just three years ago. The same amount is available today for less than half that price, with even less expensive options for a less pure product.

The drugs are moved through the city, says Mr. Sayegh, by Palestinians and Israelis alike. “The delivery and selling and pushing of drugs is the single best example of cooperation between Israelis and Palestinians,” says the sociologist dryly. “If the politicians could learn from the drug dealers, maybe we could all benefit.”

Not only is there a lack of will on the part of drug addicts to seek help, there is also a dearth of recovery services in the Palestinian community. The Old City Counseling Center is a welcome exception.

The center takes a holistic approach to lessening the impact of drugs on the lives of individuals and the community. The center provides psychosocial counseling for drug addicts and their families, works to improve the living conditions of families of drug addicts, offers group therapy for those in recovery, refers addicts to treatment centers and operates prevention and educational programs in the community to deter drug use before it begins.

Much of this work begins with the outreach efforts of “the King.” Even when Mr. Ghazzawi succeeds at bringing an addict into recovery, it is only the beginning of a tenuous process. The center’s social workers care for the recovering addicts and monitor them closely, frequently stopping by their homes to check on their progress and commitment to staying clean.

Seemingly countless addicts in recovery populate the Old City and a walk with one of the center’s caseworkers exposes the depth of the problem.

Hussam Hijazi stands in the warm sunlight in a bright yellow shirt. He sells candy and juice from a wooden box outside his home in the Old City. His recovery from addiction began violently. On his first visit to the center, he ripped a cross from the wall and shattered a glass in a fit of drug-induced rage.

He has become one of the center’s latest success stories, but his personal recovery, social workers say, is still fragile because his home life remains difficult.

He lives in a tiny room – “a toilet,” he says – with little more than two metal-framed couches and a double bed.

Somehow he shares the space with seven other family members. His recovery is all the more at risk, explains the social worker, because he lives with his brother, who is an addict.

A little help for friends. In the Palestinian town of Bethany in the outskirts of East Jerusalem, a group of men sits quietly on folding chairs in a circle. Some smoke, some stare into the distance and others listen attentively. All are quiet and respectful of the drug addict who is talking.

The men are inpatients at Al Sadiq Al Taieb or the Good Friend. Remarkably, the Good Friend is the only inpatient drug treatment facility intended for the estimated 15,000 to 17,000 Palestinian drug addicts across Jerusalem, the West Bank and Gaza. Its capacity? A mere 27 beds.

For Majed Alloush, director of the center, just seeing the men talking openly in this group therapy session is an achievement.

“We have a society obsessed with shame,” says Mr. Alloush. “Problems are kept under the table. It’s an Eastern family tradition, but now people are beginning to talk about their problems and seek outside help.”

When Mr. Alloush launched the counseling portion of the Good Friend’s work, he did not imagine that addicts would be willing to speak openly about family problems and other issues. But they have been and this community of men has become the foundation of support for one another’s recovery.

Each day, addicts follow a rigid schedule that includes three hours of group therapy, meetings with social workers and time for exercise and meals. The inpatient approach offers many recovering addicts the opportunity to escape a neglectful or abusive family environment, which often led them to seek solace in drugs.

It also gives the men a reprieve from what many, including Mr. Alloush, deem to be the other most important cause of drug addiction among Palestinians: “The whole political outlook for the last 10 years,” says Mr. Alloush.

“The peace process, the intifada, the lack of work, the curfews. These things cause a lot of problems for the people and they cannot solve them. So they run away from this through drugs or alcohol.”

The facility faces constant budget crises and collects the majority of its operating funds from international donors. While humble in appearance, the Good Friend is staffed by a medical doctor and nurse, a physiotherapist, social workers and a psychologist. The most important staff members at the facility, Mr. Alloush says, are two former addicts because “no one can really understand an addict better than an addict.”

If a Palestinian lives in Jerusalem and can afford treatment, he may enter an Israeli government rehabilitation center – space permitting. These are actually a somewhat cheaper option than the Good Friend, which costs inpatients $550 a month, because they are largely subsidized by the Israeli government.

For the thousands of addicts living outside Jerusalem, the Good Friend – and its 27 beds – is their only option for inpatient care.

The Good Friend takes a family approach to recovery. When a new addict arrives, he stops using drugs and immediately enters the extreme psychological and physical suffering of withdrawal.

The newcomer must have another resident – his “shadow” in Good Friend parlance – with him at all times during withdrawal. This approach ensures that the addict does not leave or hurt himself. It also gives the “shadow,” always an addict who is further along in his recovery, a chance to gauge his own progress.

Addicts typically stay at the facility for as little as three months, or more often, upward of a year.

Mr. Alloush is proud of the center’s success rate for graduating addicts who stay clean. That rate – a seemingly small 22 percent – is actually quite high, Mr. Alloush explains, comparing it to a success rate of 4 percent in the United States and 17 percent in Israel. He boasts also that the facility has had tremendous success with extended families, managing to keep them together about 80 percent of the time.

While, in the face of an overwhelming physical addiction, recovery from drugs seems to be a more critical issue than working on the strength of a marriage, service providers say they understand the importance of doing both. After all, many of Jerusalem’s addicts fell into drugs in the first place due, in part, to broken family structures.

And without a strong family to return to, an addict may soon be back in the shadows of the Old City walls.

Ben Cramer, a journalist and radio producer living in New York City, is a frequent contributor.