As in any democratically functioning society people today continue to exercise freedom of choice — be it in the jobs they apply for, food they eat or what they smoke. The youth have taken this opportunity to indulge in shisha smoking to the extent that a water pipe can be seen in nearly every café and has become an accessory to places of social gatherings. Not surprisingly, this has also evolved into a thriving business, with customers belonging to specific age brackets maintaining a high demand, and shisha café owners generating revenue from this increasingly profitable business.

Given the harmful effects shisha smoking is said to have on human health, the Sindh government, following a resolution passed by the provincial assembly, ‘enforced’ a ban on shisha smoking last year. Having never come into effect in practice, in theory it aimed to penalise all those who served and consumed shisha after a specified date. But cafés continued to sell it. People continued to smoke it. And no one was reprimanded. Was this a half hearted attempt by the government? An idealistic ‘solution’ to something rarely thought of by many as a genuine problem? An encroachment of personal choice?

In any case the fact remains that this ban was, to say the least, ineffective. At best, it revived the ‘shisha versus cigarettes’ debate.

The ban aimed to halt the trend of shisha smoking which is believed to be “hazardous” to the health of young people. It aimed to eradicate shisha being served at cafés; however, the implementation of this ban was far too weak. In Sindh no concrete action was taken. Cafés continued to serve shisha and did not face a decline in customers during the time this ban was supposedly in place. In Punjab — particularly in Lahore — however, a lot more ground had been covered. Special teams had been established to oversee this plan.

On June 11, District Coordination Officer Noorul Amin Mengal announced that these teams had successfully raided 35 cafés, shut down 12 of them and confiscated 200 water pipes. One of the reasons this province was far more successful than its southern neighbour was perhaps due to the step-by-step tactful approach taken by the provincial government. Long before these café raids began, awareness campaigns were launched regarding the hazards of smoking shisha, and the managers of these cafés were given “sufficient time” to either shut down their cafés or discontinue serving shisha.

The Sindh Assembly passed the resolution on the ban without any prior notice to the café owners to arrange for alternatives and did not launch any formal awareness campaign. In Punjab however, the DCO made it clear that persistent efforts are still underway to eliminate shisha from the cafés.

Were the health benefits justification enough for banning shisha smoking altogether? Perhaps one major reason the shisha trend has become so widespread is its social acceptability amongst younger age groups as compared to cigarettes. However, in terms of the medical facts, shisha has been known to be more harmful than cigarettes according to some specialists. One session of shisha smoking is said to be the equivalent of inhaling 100 to 200 times the volume of cigarettes. While gauging the harm caused by shisha various sources give varying figures ranging from being equivalent to 60 to 70 cigarettes, or 80 drags on a cigarette, or 50 cigarettes.

What ever the numerical value may be, it is true that shisha does have harmful long term effects. “Shisha contains many other chemicals in much higher doses,” says cardiologist Dr Aamir Hameed Khan. “Since people start it at an early age, exposure time increases as does the intensity of its side effects.” It has a high content of carbon monoxide which depletes the blood’s oxygen carrying capacity and has also been linked to tuberculosis outbreaks in the Middle East along with oral infections due to sharing a mouthpiece.

However, it is important to keep in mind the composition of shisha when considering its effects. Not all cafés serve tobacco infused shisha.

Due to this, some of the shisha smoked lacks nicotine which does not make shisha addictive. “It really isn’t addictive,” says 18-year-old Babar Ali. “I think it’s just a pastime, leisure-activity which people could grow out of and it doesn’t need an effort to quit”. The statement ‘shisha is equivalent to 100 cigarettes’ takes into consideration one person smoking it until the flavour burns out. But due to the cost — relatively high compared to cigarettes — shisha is not as readily available to many; it is often shared amongst groups of friends and considered ‘finished’ once the flavour burns out.

Whether or not shisha is more harmful than cigarettes is still an ongoing debate but the fact of the matter remains that shisha smoking does entail health risks. The various government sectors involved with healthcare have a duty to create awareness regarding the harmful effects of shisha. Confining shisha smoking to certain portions of cafés and banning it in public places are the measures that need to be taken, not all-out bans which would only encourage its illegal consumption. Levying higher taxes on shisha and its ingredients can also help serve this purpose; such measures are feasible and much easier to implement as compared to sudden bans. To tackle this issue a step-by- step approach needs to be taken to discourage the youth, not restrict them.