Hookah, also known as shisha, is a single or multi-stemmed water pipe, mostly glass-based, used for smoking. It originated in the north western provinces of India along the border of Pakistan nearly a thousand years ago.

These hookahs were originally used to smoke opium and hashish. From there, it made its way through the Persian Kingdom, which included Pakistan, Afghanistan, much of Middle Asia and Arab parts of Northern Africa.

Today, it is a global phenomenon, as readily found in the streets of HCMC as it is in Sydney or London.

The pipe utilizes water and indirect heat for smoking fruit-flavored, sweet-scented tobacco and can be shared by one or several people.

Hookah smoking has gained widespread acceptance in the Middle East, Europe and America for the popular misconception that it doesn’t result in addiction or disease. But recent studies have found that it is just as damaging to health as regular smoking tobacco.

Hookah smokers in Vietnam are mostly young professionals, college students, teenagers and foreign tourists who gather for the heady buzz the flavored tobacco delivers.

“I sometimes go here for smoking shisha,” a Hanoian insurance employee said at a bar. “Shisha smells good and the feeling is amazing.”

One described his first experience with shisha as making him feel: “strange, dizzy, like when you got high from smoking pipe tobacco.”

Some bars in Hanoi and Ho Chi Minh City have already cottoned on to the popularity of the pipe. Spaces have been created by savvy bar owners, complete with Persian rugs, tables and curtains to create a Middle Eastern feel for their customers.

A bottle of shisha is served from VND100,000 to VND160,000 (US$5.84 - $ 9.35), a waitress who wished to be unnamed said at a bar in Hanoi.

“You can replace the water with milk or wine for a stronger impact”, she said, adding that the bar is always packed with hookah smokers at night.

Young smokers said they were introduced to shisha by their friends and took a liking to a social pastime that is not stigmatized by an association with drug use.

"Cigarettes are for nervous people, competitive people and people on the run. When you smoke a hookah, you have time to think,” said Ismet Ertep, on a website devoted to the practice.

“It teaches you patience and tolerance, and gives you an appreciation of good company. Shisha smokers have a much more balanced approach to life than cigarette smokers.”

If the sales figures are any indication, then many in Vietnam are in agreement with Ertep. It has become so widespread that Shisha of unknown origin is now on sale online by local traders.

Quang Anh, an online seller from Hanoi, said he sends dozens of shipments to HCMC every month.

Each 250 gram package of tobacco is sold for VND300,000 ($17.53), according to a shisha seller, who wished to be unnamed. A smoking session requires only two pieces of hookah charcoal to be used. One hundred pieces of charcoal are sold for VND200,000 ($11.69).

But the effects on human health have become a hot topic of debate in recent years.

The World Health Organization has advised that there is no evidence that the use of hookah pipes is safe. Sharing hookah pipes can lead to the transmission of diseases such as tuberculosis, viral hepatitis and oral herpes infection.

Heavy hookah smokers are also subjected to the risks of lung cancer, emphysema and cardiovascular diseases associated with smoking tobacco.

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