The number of specialist shisha bars in Birmingham has risen fivefold since the ban on smoking in pubs and clubs was introduced, the city council has revealed.
Health campaigners warned customers are putting their lives at risk because they assume smoking from a shisha is healthier than smoking traditional cigarettes.
But a spokesman for one popular Birmingham shisha bar said they provided an alternative to bars which sold alcohol, and customers were adults who smoked in moderation.
Birmingham City Council revealed in response to a Freedom of Information request that it knows of 15 shisha bars in the city – up from just three in 2007.
The bars are covered by the ban on smoking in enclosed places which came into effect in July 2007, in the same way as any other bar or cafe.
But they stay within the law, for example by allowing smoking only in exterior areas, which are often kept warm using patio heaters.
Customers may be charged around £9 to use a shisha pipe, an Arabic water-pipe in which fruit-scented tobacco, or shisha, is burnt using coal.
The smoke passes through a bowl of water, cooling it down, and is inhaled through a hose.
Tobacco may come in a wide range of flavours, such as strawberry, cherry, grape or mint.
Shisha bars also typically serve coffee or cold drinks, and food such as Mediterranean and Middle Eastern snacks known as meze.
The smoking ban is enforced by council inspectors, and action has been taken when it is believed the law is being broken.
Last year, Moon Shisha Lounge, in Adelaide Street, Digbeth, was fined £1,500 and ordered to pay £844 prosecution costs after Birmingham Magistrates’ Court ruled that a marquee where smoking was allowed counted as an enclosed space.
But shisha bars are legal as long as they take care to ensure smoking areas are less than 50 per cent enclosed.
Mike Knapton, associate medical director at the British Heart Foundation, said: “Anecdotally, we’re hearing that shisha smoking is on the rise. The problem is that too many people wrongly think it’s healthier than smoking cigarettes.
“The reality is that the water doesn’t filter out all the toxins and chemicals and you’re just as much at risk of developing heart disease or cancer.”
Kiran Chavda, manager at Exhale Sheeshateria Ltd, which runs Exhale Sheeshateria, in Digbeth, said: “It is a social thing. You have a couple of drags. You don’t sit there smoking constantly.
“And the idea is to enjoy the flavour. You are not supposed to inhale, as you would with a cigarette.
“I’d say our customers range from 18 to 55 or so, but most are in their 20s or 30s. They can make their own decisions.
“We get a large Asian crowd and a large Arabic crowd and then some Chinese people and European or white people.
“I love it when we get a really mixed crowd on some nights.
“We don’t serve alcohol. It’s an alternative to drinking. It’s a chilled place to relax and talk with a coffee or milkshake.”
A spokeswoman for Birmingham City Council said inspectors enforced the smoking ban when the law was broken but shisha bars were operating legally.
A paper published by the World Health Organisation in 2006, called Tobacco: Deadly in any form or disguise, warned: “Serious lung disease, cancer and other adverse health effects have been documented and linked to waterpipe smoking.
"However, information on patterns of use, content and health effects are more limited than for cigarettes.
“Nonetheless, waterpipe smoking is tobacco smoking, and a growing body of evidence confirms that the health effects are largely those expected from tobacco smoke exposure, including lung disease, cardiovascular disease and cancer.”