Khat (Catha edulis) use in the Horn of Africa is not simply a substance-use issue; it is a public health, household welfare, and political economy challenge. Its active compounds, cathinone and cathine, can enhance alertness and sociability, but regular and heavy use is associated with cardiovascular strain, sleep disruption, dependency, anxiety, and other mental health concerns. The policy question is therefore not whether khat is harmful or culturally embedded—it is both—but how to reduce harm without criminalizing a practice tied to social life, income, and regional trade.

Patterns of use differ across Somalia, Somaliland, Djibouti, and Ethiopia, so responses must be tailored. In Somalia and Somaliland, chewing is common among men in urban areas and is linked to conversation, business, and political exchange. Demand is reinforced by peer norms, underemployment, and limited alternatives. Public debate increasingly connects heavy use to youth unemployment, disrupted education, household strain, and mental health pressures, making khat a broader social issue rather than a private habit.

Djibouti presents a different challenge. Heavy reliance on imported khat and high urban consumption can divert household income from food, education, healthcare, and rent; public reporting has estimated that qat can........

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