For the first time, two men have been sentenced to death for drug smuggling in Gaza. This comes amid an apparent rise in illegal opioid use in the territory, where access to legal pain relief and healthcare is limited by an ongoing Israeli siege.

On March 19, the two men were convicted of smuggling cannabis and 3,985 pills of opioid-medication tramadol from Egypt into the Palestinian territory of Gaza. One has been sentenced to be hanged, the other to be killed by firing squad, according to the Ministry of the Interior.

An estimated 400,000 tramadol pills have been seized in Gaza since the beginning of 2017.

Numerous people have been executed in Gaza since Hamas, the current ruling party, took power in 2007. However, this is the first instance in which individuals have been sentenced to death for drug offences; previously, the penalty had been reserved for those convicted of either murder or spying for Israel.

While drug offences are markedly different to espionage, Hamas suggests that the two are closely-linked. At a press conference on March 19, the Interior Ministry spokesperson, Iyad Bezm, alleged Israeli involvement with the trafficking of drugs into Palestine.

"[Israel's] aim is the destruction of Palestinian society", Bezm told a press conference following the conviction of the two men.

"[What Israel] failed to achieve through war and siege, it will not succeed to do through spreading drugs. […] Anyone who deals drugs, his crime is no less than those who spy for the [Israeli] occupation; their goal is the same: to destroy Palestinian society.”

While there is no evidence to suggest that Israeli authorities are complicit in the trafficking of drugs into Palestine, the rise of tramadol consumption in Gaza appears to be inextricably tied to the harms exacted by Israeli policy upon the territory.

Tramadol is an opioid medication which can be used to treat pain relief and post-traumatic stress disorder (PTSD). It is, therefore, unsurprising that it has gained popularity in a place that has been ravaged by conflict, and where access to legally prescribed medication is restricted by a decade-long Israeli siege.

Thousands of Palestinian civilians have been killed or wounded in Gaza during the past decade, primarily as a result of the Israeli Defence Forces’ (IDF) launching three devastating military operations – in 2008, 2012, and 2014 – in the densely-populated territory.

In an interview with Al-Monitor, a Palestinian pharmacist in Gaza claimed that around half a million pills of tramadol were being sold each day in the territory during the drug’s peak abundance - between 2012 and 2014.

The drug, he claimed, has become “a staple in every home” due to its low price, and its effectiveness at numbing the “overwhelming sense of distress” in Gaza.

He claimed that people with “addiction” to illegal tramadol "include young people, students, university graduates and people with families, including both men and women”, who, particularly during wartime “were feeling a sense of existential angst because of the various IDF military operations and the impossible economic duress”.

Indeed, a 2014 study in the Arab Journal of Psychology showed that a staggering 92 per cent of teenagers (aged 13-18) in Gaza showed symptoms of PTSD. To make matters worse, the unemployment rate in the territory is 42 per cent, and the youth unemployment rate is 58 per cent; some of the worst such rates in the world, according to the World Bank.

The incentive for Palestinians in Gaza to self-medicate with illegally-acquired tramadol is exacerbated by the lack of access to sufficient healthcare.

Mahmoud Daher, head of the World Health Organisation's Gaza office, told the Irish Times that hospitals in Gaza lack a third of essential medications and basic hospital supplies. The Israeli blockade on medical equipment and the Gaza government’s "lack of financial resources" are to blame, Daher described.

B'tselem, an Israeli human rights centre, also places significant blame on Israeli officials for Palestinians’ poor access to healthcare in Gaza.

“The flaws in the system are due, in part, to neglect over the nearly four decades of Israel’s direct occupation of the Gaza Strip”, it asserted in 2016, “and to the Israeli siege … [which] imposes restrictions on doctors traveling outside the Gaza Strip to pursue further medical training and specialisation”.

It is yet to be seen whether Hamas’ new hard-line approach towards people who sell drugs will have any tangible effect on the quantity being imported. Regardless, while countless people in Gaza continue to suffer from physical pain and PTSD without sufficient healthcare access, it is inevitable that the black market for tramadol will continue to exist.