Nouakchott – Ifrah, 36, started smoking at just 13 years of age and never thought he would ever quit. Smoking was common in his home neighbourhood of Cansado in Nouadhibou, Mauritania, and he simply followed by example. “For me, smoking meant being trendy and mature. But that was just an illusion,” he says.

Over time, Ifrah realized that the use of tobacco was negatively affecting his health. "I knew that smoking was bad for me because I experienced breathing difficulties, especially shortness of breath. I tried to stop several times. I'd manage for a few hours, but the urge to smoke was too strong. I'd become anxious and irritable and then I'd relapse,” he says.

In Mauritania, World Health Organization’s STEPwise approach to surveillance (STEPS) 2008 survey revealed that 22.6% of the country’s adolescents aged between 13 and 15 use tobacco, the habit enabled by easy access to tobacco products for everyone, including children.

Today, however, legal steps to introduce graphic health warnings on tobacco packaging are changing the status quo. The 2021 Global Adult Tobacco Survey (GATS) shows that between 2012 and 2021, tobacco use in Mauritania has declined by 8%, from 18% to 10%.

The new legislation, implemented in 2018, aligns with WHO recommendations which stipulate that all tobacco products on sale in Mauritania must carry a health warning covering at least 70% of the surface area of both sides of the packaging.

The aim is to raise public awareness, especially among young people, about the dangers of tobacco use, which is the leading cause of death and noncommunicable diseases such as cancer, heart disease and chronic lung disease in the country.

"We have seen the law play a major role in the fight against tobacco use in our country," says Dr Abdallah Bouhabib, Deputy Director General of Public Health in the Mauritania Ministry of Health.  "Health warnings on tobacco packaging, particularly those combining text and images, have been one of the most cost-effective and efficient ways of raising public awareness of the serious health risks associated with smoking."

According to the survey, nearly 25% of smokers in Mauritania first noticed health warnings on cigarette packages, while 14% of smokers thought about quitting because of warning labels. "I stopped smoking when I realized the negative consequences for my health. It wasn't easy, but I made a firm decision to quit," says Ahmad Ahki, 41, who used tobacco for more than 10 years. "I was supported by my whole community. I think that's what allowed me to stay sane and give it up for good."

For Ifrah, the graphic warnings changed everything. "I saw an image of horror. I felt a heaviness in my chest and dark images of illness and death came to mind. That was the day I decided to stop,” he says. "Indeed, a lot of my friends had the same experience and, in our group, we all stopped smoking.”

The battle is far from over. The results of the Global Adult Tobacco Survey (GATS) indicate that around 34% of Mauritanians are still exposed to tobacco smoke in the workplace and that tobacco consumption among men is almost eight times higher than for women.

For WHO, tobacco use is an epidemic that demands an effective response. "The adoption of this law is a good thing because it has helped to reduce the prevalence of smoking in Mauritania.  We need to build on these achievements with a social and health approach to change attitudes and demystify the misconceptions surrounding tobacco consumption, especially among young people and adolescents," says Dr Charlotte Faty Ndiaye, WHO Representative in Mauritania.

"The disparities between genders and the high rate of exposure in the workplace, highlighted by the survey, underline the urgent need for robust health campaigns,” she says.

With WHO support, Mauritania’s Health Ministry has provided tobacco control training to 15 regional governors. Focal people have also been trained and assigned to government and regional departments. They are responsible for raising awareness and mobilizing community leaders, including religious leaders, in support of tobacco control activities. 

In addition to the legal interventions, the country is implementing other anti-smoking initiatives, such as awareness campaigns around the dangers of tobacco consumption, a ban on smoking in public places and the introduction of tobacco taxes, a portion of which funds efforts to combat tobacco-related diseases. 

"Quitting smoking is the best decision I've ever made for my health and I'm very proud of it," says Ifrah. "Giving up smoking is difficult, but not impossible. With willpower and determination, it can be done.”