Lebanon, Beirut (CNN) — In Lebanon, you’re never far from the whiff of cigarette smoke.
In restaurants and cafes, on the streets, in the airport and even in elevators, Lebanese delight in lighting up. The World Health Organization (WHO) says Lebanon has one of the highest smoking rates in the world.
"We are a tobacco-friendly society," says cardiologist Dr. Georges Saade, a former WHO official who now heads the Tobacco Control Project at Lebanon’s Ministry of Public Health.
Saade is a committed anti-smoking campaigner and for years he’s fought an uphill battle for funding to increase awareness of the risks of smoking.
The ministry estimates that if attitudes towards smoking don’t change, this small nation of 4 million will experience at least 3,000 tobacco-related deaths each year.
–Tony, a Lebanese smoker in his early 30s
On a cool autumn night, Saade, his wife and their 5-year-old son walk through the streets Beirut’s renovated downtown; the intermittent odors of cigarette and water-pipe smoke wafting through the air.
Water-pipe — also known as hookah, shisha or nargileh – is a popular form of social smoking.
Saade says they’ve seen a steady increase of hookah smoking among young females — mainly because of a widespread misconception that water-pipes are not as harmful as cigarettes.
Various studies, including research by the American University of Beirut, indicate smoking water-pipe is at least as harmful if not more harmful than cigarette smoke, leading to higher risks of mouth, throat, and stomach cancer.
"If I want go out with my son," says Saade, "I cannot take him to any cafe here in Lebanon, to any indoor place unfortunately, because somebody is always smoking."
He says he and his wife spent most of her nine-month pregnancy at home because public places provided no protection from second-hand smoke.
The WHO estimates that about half of Lebanese adults smoke, and the ministry estimates that the figure is higher. There is, however, an even more alarming statistic.
A 2001 Global Youth Survey found that Lebanon had the highest rate of smoking among school children in all of the Middle East.
The ministry estimates that around 65 percent of Lebanese boys aged 13-15 consume tobacco regularly — either by smoking cigarettes or water-pipe.
These statistics marry up with Saade’s experiences in practice. The patients he sees who suffer from tobacco-related heart disease are getting younger and younger — and it inspires his passion for change.
Now he’s getting a chance to try to clear the air.
After years of applying and being turned down, the ministry has finally received a grant from New York-based organization, Bloomberg Initiative to Reduce Tobacco Use.
On November 1, a shock media campaign featuring the message "Smoking is eating your loved ones alive," was put up on 500 billboards countrywide and featured in newspapers, magazines and on TV spots.
A draft law submitted by the Ministry of Public Health and various NGOs to curtail smoking in public places has been decaying in the parliament’s proverbial drawer since 2003.
Saade hopes the national awareness campaign will mobilize Lebanese people to put pressure on their fractious political leadership to re-consider.
He is particularly compelled by the thought that in a decade most of his son’s high school colleagues are likely to be smokers.
"This is why I’m doing something," he says. "But I think in 10 years few of the colleagues of my son will be smoking."
Realistic? Or a pipedream?
Cigarettes are cheap in Lebanon and health warnings are not currently required on packs. In addition, the media is heavily bombarded with tobacco advertising.
Even worse, there is not even a minimum age to buy cigarettes. And then there’s a culture that defies regulation — perhaps a lingering side-effect of the lawlessness of the nation’s devastating 15-year civil war that ended in 1990.
Law enforcement officers rarely intervene, even when people blatantly break rules. Which may explain why it’s so common to see people smoking literally underneath a no-smoking sign.
Gemmayzeh, is a Beirut neighborhood famous for its active night life. In the bars and restaurants there, smoking is considered a symbol of freedom.
Tony, a smoker in his early 30s says Lebanese people would not react well if the government banned smoking in bars.
"Rage, anarchy. That’s what will happen.
"It’s not a smoking culture. This is freedom culture. You can do whatever you want," he told CNN.
Many other Middle Eastern countries have laws restricting tobacco advertising and smoking in public places.
Syria banned smoking in public places in October. Jordan is trying to go smoke-free in the coming months. Israel, Egypt, most Gulf countries — even Iraq — have some restrictions on tobacco use, although degrees of enforcement vary.
Smokers in Lebanon say any attempt to ban smoking won’t work here.
"Most likely people won’t accept it and will continue on smoking," says Raoul, a shaven-headed Lebanese in his mid-30s, puffing on a cigarette in a popular bar.
Raoul says even if the law passed, it would last a week and be forgotten.
"Unfortunately [the Lebanese] don’t like laws," he continues. "Because of the history of Lebanon and what happened here, they’re used to it, they’re not into laws, they don’t like to respect laws and most of them think that laws are against them."
But, for health advocates, there are some signs of promise in the very bars that are usually thick with tobacco smoke.
One Beirut bar called Godot opted to implement "smoke-free Wednesdays" about a year ago. The managers say that although they initially lost a few customers, Wednesday is now one of their busiest nights, catering to a non-smoking clientele.
The entire Gemmayzeh area, with the support of anti-tobacco NGOs, has had two completely smoke-free nights over the last year.
So for Saade and his tireless — some may say Quixotic — campaign, it seems there is hope.
