“Bring me two cartons of cigarettes and I’ll give you 80 shekels.”
“Take two cartons and I’ll pay you 100.”
“Carry four cartons and I’ll throw in a kilo of double-apple shisha tobacco.”
All these offers—and more—were made to the reporter in December 2024 at the King Hussein Bridge bus station in Jordan as she headed back to Palestine (the West Bank).
According to an international study, “Tobacco Control in the State of Palestine During War,” the tobacco industry flourishes in times of crisis and chaos. In recent years, the industry has exploited conflicts in countries such as Ukraine and Sudan, yet the damage caused by tobacco use is often ignored in such settings, which is exactly what has happened in Palestine since the war began in 2023.
This investigation is part of the project on tobacco-company activities in conflict areas and is published for World No-Tobacco Day. Daraj’s four reports focus especially on Gaza and Sudan, exposing how big tobacco firms exploit dire humanitarian conditions to make profits at the expense of public health.
Cigarette Smuggling Increases After War Starts
Palestinian security sources who requested anonymity say cigarette and shisha smuggling is not new. It began when tobacco taxes and excise duties shot up in 2002, but the trade has escalated sharply since the 2023 war, partly because unemployment now stands at 51 percent and many people have turned to smuggling as a way to earn a living.
Smuggling Hubs
Smuggling revolves around two main hubs. The first and most prominent is King Hussein Bridge, where most of the contraband is produced by Philip Morris. The second is the town of Dhahiriya in the southern West Bank, next to the Bir al-Sabe’ crossing and close to the Sinai Desert; this route supplies Manchester cigarettes (JSS Tobacco Limited) brought by smugglers from Bir al-Sabe’ to Dhahiriya.
The Occupation Bans the Entry of Security Personnel to the Smuggling Hubs
The main obstacle local Palestinian authorities have faced in combating smuggling since the war began is that the Israeli occupation has halted security coordination allowing Palestinian security forces to enter Area C zones. Security personnel are barred from these areas unless coordination with Israel is granted. One example is the road near the village of al-ʿAuja, northeast of Jericho—a drop-off point for goods smuggled across the King Hussein Bridge to the Israeli checkpoint. From there, Israeli-licensed taxis carry the contraband past the Palestinian checkpoint at the Jericho Rest House for a fee of 20 shekels per carton. Al-ʿEizariya, east of Jerusalem, is another such drop-off zone; it too lies in Area C. The same pattern applies to the smuggling of Manchester cigarettes through Dhahiriya: Israel has suspended coordination that once allowed Palestinian agencies, especially customs police, to enter Area C, which has been under full Israeli security control since the war. No Palestinian security body can now access these zones, depriving the Palestinian Authority of any effective control over smuggling operations and compounding their consequences.
A Semi-Organized Crime and the Exploitation of Children
Security information obtained for this report indicates that tobacco smuggling across the crossings and borders linking the West Bank, the Gaza Strip, Israel, and Jordan is not considered fully organized crime. Rather, it is a semi-organized operation carried out by a group of major traders in the sector, aided by a large network of smugglers who exploit ordinary citizens—including children—by having them carry contraband cigarettes in their luggage, toys, and other belongings.
It is important to note that the occupation authorities have granted these smugglers “wide latitude”: they inspect every bag and every person, know that cigarettes are being smuggled, yet, since the war began, show little interest in stopping them. All the information gathered for this article confirms that the phenomenon has recently intensified.
Palestine: Highest Smoking Rate in the Middle East
These findings come as the Palestinian Ministry of Health has sounded the alarm, announcing that Palestine now has the region’s highest proportion of smokers, about 34 percent.
In a press release issued in May 2023 for World No-Tobacco Day, the ministry warned that smoking is widespread across all segments of society. Its 2022 STEPwise survey on chronic diseases showed that 33.5 percent of Palestinians aged 18-69 smoke one or more tobacco products commonly available in the country.
The survey revealed that nearly two-thirds of citizens (64 percent) are exposed to second-hand smoke inside their homes, 66 percent while using public transport, and 58 percent at work.
Overall, 55.1 percent of men and 12.1 percent of women are smokers, and more than one-third of all smokers are young adults aged 18-29, who make up 40 percent of the total smoking population.
Poor Mental Health Leads to More Smoking
Psychological studies indicate that mental-health disorders double the likelihood of smoking, which means the previously cited figures have steeply increased since the war began. In Gaza, Palestinians face soaring rates of depression and post-traumatic stress as they endure genocide, starvation, and displacement since October 2023. Conditions in the West Bank are hardly better: siege, roughly 900 checkpoints and gates, the demolition and emptying of northern camps, and thousands of displaced people who have lost relatives and homes. Ultimately, all of this pushes residents toward tobacco.
Although the Ministry of Health has not issued a recent survey of smoking prevalence, Dr Nancy Al-Fallah, coordinator of the ministry’s anti-smoking programme, says that in counselling sessions, the first excuse many smokers give is psychological stress caused by the general situation, so they “take it out on cigarettes,” ignoring the harm to themselves and those around them.
Increased Smoking, Increased Diseases
A study on smoking-related illness in the Eastern Mediterranean Region shows that tobacco use accounts for 14.5 percent of all deaths and 23.2 percent of risk-factor deaths, making it a major driver of the heavy burden of non-communicable diseases that afflicts two-thirds of elderly Palestinians.
A Health Ministry press release notes that cancer is the third leading cause of death in Palestine, with 5,320 new cases recorded in 2021. That year, the overall incidence rate was 108.1 per 100,000 people: 3,368 new cases in the West Bank and 1,952 in Gaza, an annual increase of 5.5 percent compared with 2020.
Less Healthcare Services
As smoking-linked cancers—especially lung cancer, the third-most common tumor in Palestine—and other chronic illnesses rise, the share of adults (18+) with at least one chronic disease climbed from 18 percent in 2010 to about 20 percent in 2021.
Illness increases with age: 2021 data show that more than two-thirds of seniors have at least one chronic condition. This means it has affected 66 percent of men and 76 percent of women. The Health Ministry admits its current resources cannot cover this burden, whether in hospital beds, treatment or even basic medication, and says it is struggling to provide equitable services within its limited financial and human means.
Dr Al-Fallah notes, for example, that keeping in mind that diabetes is the most connected disease to smoking, diabetic patients can no longer find many types of insulin, due to Israel blocking imports and local manufacture since the war. Some patients travel to Jordan to buy insulin at their own expense because the ministry cannot supply it.
“The number of people insured through the ministry has risen sharply since the war, adding yet more pressure to an already strained system in both the West Bank and Gaza.” She adds that “the impact of chronic disease has worsened because checkpoints ring West-Bank areas, preventing patients from reaching clinics or hospitals for treatment and medication, while staff shortages—caused by the financial crisis and unpaid salaries—have curtailed ministry working hours, leaving many without care.”
At the start of 2025, Deputy Health Minister Dr Wael al-Sheikh announced that “the health sector is facing severe shortages of drugs and medical supplies and that ministry debt has reached nearly three billion shekels, which amounts to about US $800 million.” In a televised interview he said stocks of 120 medicines (including 20 cancer drugs) and 420 medical consumables—170 of them for heart and eye care—were at zero in ministry warehouses.
In Gaza, the collapse of the health system, barriers to reaching hospitals, the lack of medicines and supplies, the difficulty of lab testing, and the breakdown of preventive and palliative programmes have placed immense strain on patients with non-communicable diseases. Even before the war, more than 350,000 people in Gaza suffered from cardiovascular disease, hypertension, cancers, chronic respiratory diseases (COPD and asthma) and diabetes, which were the main causes of death and disability in the Strip prior to the genocide.
Lack of Anti-smoking Legislation
Palestine has not updated its tobacco-control laws since 2011 and has yet to implement the World Health Organization’s recommendations in full. Dr Nancy Al-Fallah notes that, although Tobacco Control Law No. 25 of 2005 was enacted, it was never followed by executive regulations, “so it is useless in combating smoking.” She says the Ministry of Health has repeatedly called for bylaws and implementing decrees, but “no real progress has been made.”
Israel introduced plain cigarette packs five years ago and routinely obliges the Palestinian Authority(PA) to adopt many Israeli regulations, yet in this case, it merely gave the PA permission to do so, fully aware that Palestinian legislation cannot be amended to mandate plain packaging.
Addiction Treatment: Costly and Unavailable
On treating nicotine dependence, Al-Falah explains that the ministry tried to obtain the necessary medications, “but they are extremely expensive and not on the essential-drugs list, so tobacco-cessation therapy cannot be provided at present.”
In Gaza, nicotine-addiction treatment was already rare; now it is almost non-existent. Clinics have been destroyed, many health-care workers killed, including Dr Aya Farwana, who had hoped to establish Palestine’s first tobacco-cessation programme. Dr Farwana was killed together with most of her family in an Israeli air-strike in October 2023.
Thus Palestinians face ideal conditions for smoking to flourish: smuggling, poor mental health, war and conflict, unemployment, the absence of effective laws, social and economic crises, and inadequate health services—all combining to create yet another cause of death in their occupied land.
The Tobacco Control Research Group at the University of Bath supported Daraj’s work on these investigations; the collection, interpretation, and presentation of information remain solely the responsibility of Daraj.
