Working in Shisha Bars: Slow Deaths?

4 min read

Across the Gulf states, shisha cafes are the most popular venues for socialising for both families and friends. It’s not a strange sight to see very young children, from babies in arms to young adults, patronising these cafes with the adults in charge of them.

Despite several campaigns, there’s little or no cognisance of the harmful secondhand smoking effects, especially on children.

Amongst those co-opted against their will to imbibe the toxic fumes are the largely migrant staff in these restaurants.

A 2016 study (see sidebar) reveals increased carbon monoxide (CO) concentration at the end of workers’ shift. CO, a deadly gas, is elevated in smokers as a by-product of combustion. While carbon monoxide levels vary from one person to another, a general benchmark might be that a person smoking one pack of cigarettes per day would have a CO level of 20, while someone smoking two packs per day might have a level of 40. The study found the average level at the end of a hookah bar shift was 49, or roughly equivalent to smoking 2.5 pack of cigarettes per day. Two of the 10 participants had post-shift levels of 90.

The discussions around shisha smoking rarely include the most vulnerable of the group, the workers exposed to the smoke for anywhere between 48 to 60 hours a week.

For some, their exposure is worse. While all staff are exposed to secondhand smoke, those who tend to the water pipes (who take the first drag to ensure the hubbly-bubbly is functioning properly) are compelled to inhale directly, as part of their job description. A job description they were likely unaware of before they arrived in the Gulf.

None of the workers MRRORS.org spoke to in different countries knew the nature of their job when they signed their contracts in their home countries. Most of them were non-smokers.

They do not have any special health insurance, nor are they subjected to more frequent medical checks to monitor any debilitating effects.

The Study

The study - Opens in new tab (published in the journal Tobacco Control) funded by the New York University and Abu Dhabi Public Health Research Institute examined workers in hookah (shisha) bars in New York City. The findings are troubling, to say the least.

Air samples were collected during the work shift of 10 workers. Some insights from the study:

The PM2.5 (gravimetric) and BC2.5 concentrations in indoor air varied greatly among the work shifts with mean levels of 363.8 mg/m3 and 2.2 mg/m3, respectively. The mean CO level was 12.9 ppm with a peak value of 22.5 ppm CO observed in one hookah bar. While heart rate was elevated by 6 bpm after occupational exposure, this change was not statistically significant. Levels of inflammatory cytokines in blood were all increased at post-shift compared to pre-shift testing with IFN-Υ increasing from 0.85 (0.13) to 1.6 (0.25). Exhaled CO levels were significantly elevated after the work shift with 2 of 10 workers having values >90 ppm exhaled CO.

These results demonstrate that hookah bars have elevated concentrations of indoor air pollutants that appear to cause adverse health effects in employees. These data indicate the need for further research and a marked need for better air quality monitoring and policies in such establishments to improve the indoor air quality for workers and patrons.

Workers excluded from widespread concerns

As Dr Ahmed Mohamed Al Mulla, head of the smoking cessation clinic at Qatar’s Hamad Medical Corporation points out, smoking shisha can be 10 times more harmful than cigarettes - Opens in new tab.

An NYU Abu Dhabi study showed - Opens in new tab that “CO levels in rooms where shisha was smoked were found to be five times higher than in rooms where cigarettes were smoked, while CO levels in rooms next to where shisha was smoked were nearly four times higher compared to rooms next to where cigarettes were smoked.”

Saudi has banned shisha in public places - Opens in new tab for many years but the implementation has been weak.

Earlier this year, Qatar’s municipal council demanded a ban on smoking shisha in closed spaces. “The council asked the Ministry of Economy and Commerce (MEC) to cancel the licences of all the closed rooms and cabins set apart for shisha at the cafes that offer tobacco products and its derivatives,” according to a local report - Opens in new tab.

A few years ago, Professor Tawfik A M Khoja, Director-General of the GCC’s Executive Board of Health Ministers’ Council called for policies - Opens in new tab banning the use of shisha in public places. “Shisha smoking is associated with many of the same serious life-threatening conditions as cigarette smoking, leading to lung cancer, respiratory illness and cardiovascular diseases [...] Users tend to smoke with friends in cafes and other public places, which is also a cause of second-hand smoking.”

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Working in Shisha Bars: Slow Deaths?

The Study

Workers excluded from widespread concerns

Have you had a similar experience?

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