Organised by the Office of the United Nations High Commissioner for Human Rights with the support of Belgium, Czechia, Mexico, Paraguay, Switzerland, Uruguay, the World Health Organization, the Joint United Nations Programme on HIV/AIDS, the International Federation of Red Cross and Red Crescent Societies, the Agence Française de Développement, the Alliance for Public Health, the Centro de Estudios de Derecho, Justicia y Sociedad, the Centro de Estudios Legales y Sociales, the Eurasian Harm Reduction Association, Harm Reduction International, the International Drug Policy Consortium, the International Network of People who Use Drugs, the Open Society Foundations, the Skoun Lebanese Addictions Centre and Students for Sensible Drug Policy International

Monday 18th March 2024 – 09:10-10:00

Panellists:

Ganna Dovbakh – Eurasian Harm Reduction Association (EHRA)

Elie Aaraj – MIddle East North Africa Harm Reduction Association (MENAHRA)

Nele Van Tomme – Federal Ministry of Health, Belgium

Annette Verster – World Health Organisation (WHO)

Dr Lasha Goguadze – International Federation of Red Cross and Red Crescent Societies

Zaved Mahmoud: OHCHR

Chair: Tatyana Sleiman – SKOUN, Lebanese Addictions Center

 

Chair: Tatyana Sleiman – SKOUN, Lebanese Addictions Center: Good morning, everyone, and thank you for joining us. A warm welcome to our colleagues and all esteemed attendees. My name is Tatyana Sleiman, Executive Director of SKOUN, a Lebanon-based harm reduction centre. Today, I have the privilege of moderating a session that delves into the human rights challenges drug users face in humanitarian crises and other dire settings. This session is a collaborative effort with the Office of the High Commissioner on Human Rights and the International Drug Policy Consortium, and forms part of the CND side events spearheaded by the ECHR, drawing insights from its latest report on human rights and drug policy.  Through my work in Lebanon, amidst ongoing crises since 2019, and from various reports on humanitarian emergencies worldwide, a disturbing trend emerges: substance use spikes in crises, with services and responses dramatically constricted. Our discussion today centres on the humanitarian crisis’s impact on drug users, the response challenges, and gaps. With our distinguished panel, we aim to underscore the critical need to weave harm reduction services into humanitarian programming and to push for drug policy reform, ensuring no one is left behind.  In light of discussing humanitarian crises, let’s pause to extend our solidarity to the people of Lebanon, Hezbollah, and all those in occupied Palestine facing daily human rights violations. I’m also grateful to our event co-sponsors, OHS HR, and the French Development Agency for their support in making this event possible. A heartfelt thanks to the ITPC team for their incredible support and to our panellists for their valuable insights and participation.  Special thanks to my colleague, Michelle, for her exceptional effort in event logistics and timekeeping today. To our panellists, please keep an eye on Michelle for time cues.  Without further ado, let’s welcome our first speaker from OHCHR.

Zaved Mahmoud – OHCHR:  Thank you very much, Tatyana, and first, good morning to everyone. First of all, I’d like to thank all the organisers, as you can see on the banner, there’s a large number of entities, member states, and also civil society organisations supporting this. It shows the importance of these issues around the use of drugs in humanitarian settings. But before I delve into that discussion, I would like to mention where we are coming from, and why we are organising this event. Seizure has published a report last year on key human rights challenges with regard to drug policy or the world drug problem. The report was based on contributions by the member states as well as civil society organisations—quality contributions yielded a quality report. In this report, seven key challenges were identified. I already mentioned one challenge, that is,  drug use in humanitarian settings, but others include unequal access to treatment and harm reduction, the war on drugs and associated human rights violations, prison overcrowding due to drug offences, use of the death penalty for drug crimes, disproportionate impact on certain groups particularly youth, children, women, indigenous people, and people of African descent, and the right to a healthy and sustainable environment. The key objective of this side event we are organising is to look at all these issues in depth. The key objective of this side event is to review our findings, the associated recommendations, and how to discuss practical solutions and how we can support the members to implement these recommendations. Already, some innovative initiatives have been taken by the member states to promote the report or to implement the report’s recommendations. For example, I’d like to mention Colombia’s National Drug Policy, which was issued in March and in September last year, was informed by our report recommendations. The Czech Republic government and national drug coordinator organised a national event to launch the report and discuss its findings. Also, the European Union invited us to brief the European Union delegation on the report findings in CND, and the African delegation organised an event on the report and provided a briefing on the report. We encourage member states, civil society, and other UN partners to promote the report and discuss the report’s recommendations. This is one of the events where we would like to interact with discussion. Now, I’m sure that our panellists will reflect on our report’s findings and what needs to be done to address these challenges. It is really critical to discuss drug use in humanitarian settings and associated human rights challenges further, and we know that a few other side events will be happening around the same issues. So, maybe we can discuss and move forward on this particular issue.

Chair: Tatyana Sleiman – SKOUN, Lebanese Addictions Center: So now I’m very happy to introduce our first panellist Ganna Dovbakh the executive director of the Eurasian Harm Reduction Association. Ganna will be taking us through the Ukrainian context, mainly focusing on what has been the impact on people who use drugs, the impact on access to services for people who use drugs during the war, and other harm reduction services, the links to repressive drug policies, but also what were the gaps and challenges and the response and some of the successful models that have worked to ensure access to services.

Ganna Dovbakh – EHRA:Thank you very much, Tatyana, and good morning to everyone. Firstly, I must express our solidarity with the people in Ukraine, who are suffering daily due to Russian missile attacks and aggression. It’s profoundly distressing to witness such a conflict in the heart of Europe, which exacerbates vulnerabilities across society, particularly for marginalized groups including people who use drugs, those living with HIV, sex workers, and the LGBTQ community, by increasing problems and stigma. In any crisis, including curfews and the chaos of fleeing from attacks and occupation, as we’ve seen with the Russian Federation occupying parts of Ukrainian territory, these challenges intensify. It’s crucial to note the stark differences in drug policy between Ukraine and Russia, especially regarding access to and attitudes towards opioid agonist treatment and harm reduction. In all territories occupied, individuals using drugs face the cessation of opioid agonist treatments, barring a few heroic efforts from doctors in regions like Harrison from February to summer, which are, sadly, exceptions rather than the rule. On territories occupied by Russia, harm reduction is impossible, further stigmatizing and even criminalizing people who use drugs. Documenting these human rights violations is necessary, yet it also requires ensuring the safety of those who undertake this documentation. The crisis has stripped people, including those who use drugs and their families, of basic necessities: shelter, food, and has escalated trauma and gender-based violence. Despite these adversities, the Ukrainian state and public health authorities have shown remarkable flexibility and openness, making pivotal decisions like allowing 30-day take-home opioid substitution treatments and adapting services for the internally displaced in the western part of Ukraine. We are grateful to international partners, including the UN system and the Global Fund to Fight HIV, AIDS, and Malaria, for their emergency procurement of necessary drugs. Furthermore, European countries deserve our thanks for hosting refugees and lowering barriers to opioid substitution treatment, even though challenges remain in accessing these treatments in neighbouring countries. So, what does harm reduction look like in emergency settings? It transforms into providing shelter and basic necessities. Organizations must swiftly adapt to new roles, such as converting into shelters, as we’ve seen in the Poltava region where harm reduction organizations quickly opened five shelters for thousands fleeing the Hargrave region, including families and children. Specific facilities are also necessary for the LGBTQ+ community and people who use drugs, who may not integrate easily into general shelters. Moreover, it’s vital for regional organizations to disseminate information about available services to those in distress, ensuring they know where to find health facilities, food, and basic humanitarian support. From the second day of the invasion, the EU and neighbouring countries offered a system providing everything from psychological support to food and essential documents—a true sign of solidarity from European harm reductionists and the broader community. The key takeaway for me in this discussion is the importance of preparedness, flexibility, and the ability to adapt beyond job descriptions and protocols established in peacetime. The flexibility of harm reduction services, health facilities, and the responsiveness of state authorities are crucial in addressing the acute needs brought on by conflict. Thank you.

Chair: Tatyana Sleiman – SKOUN, Lebanese Addictions Center: Thank you so much, Ganna, for those amazing reflections. Moving forward, we’ll turn our attention to the Executive Director of the Middle East and North Africa Harm Reduction Association (MENAHRA). Drawing from the experience in the MENA region, and after listening to Hannah’s insights on the situation in Ukraine, particularly in the context of crisis situations, it would be invaluable to compare the impact on people who use drugs across these different parts of the world. MENAHRA has been notably focused on emergency preparedness, especially during the COVID era. With a specific look at Lebanon, could you discuss the challenges encountered, the responses initiated, and what could have been improved to facilitate better access? Please share your overview and experiences.

Elie Aaraj – MENAHRA: Thank you. Thank you, SKOUN and all the co-sponsors. I’m so happy to be here with you. I’ve been given five minutes to discuss a vast array of issues, but I’ll do my best. Despite the myriad struggles we’re facing in the region, including economic crises and wars, we must prioritize human rights. This is especially true for people who use drugs, people living with HIV, and other vulnerable populations, particularly when considering their right to access health services amidst crises like COVID or the Beirut blast in 2020, which specifically impacted these groups in the MENA region. As Tatyana highlighted, we developed an emergency preparedness plan during the pandemic for other disaster situations in six countries. We found that while these countries had their national emergency preparedness plans, none adequately addressed the specific needs of these key populations. This gap demonstrated a clear need to integrate these considerations into national plans. Looking at the current situations, for example, in Gaza and South Lebanon, and the influx of refugees from Syria into Lebanon, which now comprises about a third of Lebanon’s population, it’s evident that government and civil society organizations need support. We cannot tackle these challenges alone. The economic crisis nearly bankrupted the country, and two years ago, we faced a severe shortage of medications. This predicament underscores the indispensable role of civil society, with coalitions of harm reduction organizations led by SKOUN and supported by MENAHRA stepping in to fill the gap through international appeals, thus ensuring continued access to medications for those in need. There have been improvements in the region, such as the residential initiative to eradicate hepatitis in Egypt, with MENAHRA providing support to Lebanon, Syria, and Iraq, which recently faced significant issues with stimulant use. However, our efforts cannot be sustained without adequate support. A concerning development is the UNAIDS Regional Office’s closure in MENA, which was a significant loss as its presence bolstered civil society and aided in the implementation of national strategies. Moreover, the looming end of a significant grant from the Global Fund poses a critical challenge to resource availability while needs remain high. From these experiences, two key lessons emerge: Firstly, the integration of harm reduction services into primary health care centres is crucial, as harm reduction is fundamentally about providing low-threshold services. Secondly, emergency preparedness plans must explicitly consider the needs of people who use drugs to ensure the sustainability of opioid substitution therapy (OST) and broader harm reduction efforts. Lastly, there’s a dire need for continued support from the UN and international donors, especially for countries in crisis.

Chair: Tatyana Sleiman – SKOUN, Lebanese Addictions Center: Thank you so much, Elie. I want to take a moment to acknowledge our online attendees joining us for this hybrid event. It’s great to see both our virtual and physical rooms filled with participants. So, a heartfelt thank you to everyone for being here. Across different countries and crisis settings, we observe many similar trends and challenges. Equally, there are recurring recommendations on how to ensure a more timely and effective response. In light of this, I’m delighted that Annette Verster from the WHO office is with us today. Annette will guide us through the existing mechanisms for crisis response, focusing on how we can enact these responses more swiftly and effectively. In emergency situations, time is incredibly precious. We’ll explore whether through enhanced interagency coordination or perhaps more detailed guidelines addressing drug use in humanitarian settings and harm reduction, we can achieve a more prompt and efficient response. Our goal is to be better prepared for future crises, ensuring that our responses are not just reactive but proactive and well-considered. Thank you so much.

Annette Verster – World Health Organization (WHO): Thank you very much, Chair Tatyana, and thank you for this amazing report and these seven side events. It’s really incredible that this UN organization has been able to achieve this. So, a lot of things I wanted to say have been said, and maybe just to start with the fact that the World Health Organization, where I work, is responsible for providing guidelines and normative guidance on how to respond to public health crises or issues. And for us, this is not only around harm reduction but it’s also around access to controlled medicines for palliative care, for pain control…etcetera, so I want to highlight that point as well. And on the point of harm reduction. Recently, two years ago, we issued new guidelines where we defined harm reduction more simply than the 2007 and 2012 technical tools that were adopted also here at CND. And basically, the provision of sterile injecting equipment through needle syringe programs, opioid agonist maintenance therapy for the treatment of opioid dependence—and I want to highlight that this is a first-line treatment for opioid dependence and has added benefits of reducing transmission of blood-borne viruses such as viral hepatitis C and HIV. It’s been very much pushed through the infectious disease lens, but it really is a first-line treatment for opioid dependence. And the third component of harm reduction is the community distribution of naloxone to prevent or to manage opioid overdose. And this naloxone is not just available in hospitals or in ambulances, but with first responders so people could be present when overdose acute care. So, in order to, I think one of the important parts of this new guidance from 2022, is that we’re very much aware that it’s easy to say what is most effective and to say that these are the harm reduction services, or other important services to implement. But as long as structural barriers continue, then the services will be difficult to access for people who are tend to be criminalized and stigmatized. So in addition to just providing this health package for the first line, we also highlighted the importance of addressing structural barriers such as criminalization and recommend countries to review and revise punitive laws, and to work towards decriminalization of use and possession for personal use. Another area to look at which are unrelated to criminalization, of course, are stigma and discrimination particularly in the health sector, but also violence and to support the empowerment of communities. So this is the background and this goes to say and you may have heard our director general on Thursday morning, also saying we at CND to when discussing drug policy and drug policy reform, reform to balance a greater focus on public health versus criminal justice. So this is the background we during COVID I think this has helped us define what should go in come in. What should we prioritize which services should be prioritized in settings of humanitarian or other types of crises, and we managed to have harm reduction and access to essential controlled medicines as defined as essential services. We have OAT, NSPs, and Naloxone are essential services. I think having said this, it’s important that harm reduction in humanitarian settings of humanitarian crisis is already available because if it’s not there, I wouldn’t know how to scale up and assure continuation if or start something in such a difficult environment. So we have the example of course that Ghana described about Ukraine, where there was already a very good Harm Reduction programme implemented to assure a continuation and action for prescribing. It is important to root to also realize that I can think I’m only coming to your question here is to in settings. I think Ukraine was a good example. For the first few months, we had weekly calls with everybody and because when there’s a humanitarian crisis, everybody wants to come and help out. And sometimes this just is very difficult to manage on the ground. So it is really important that there is implementation and humanitarian agencies to really organize and decide who is responsible for what and who will take the lead on what and that of course with the background of the urgency that you mentioned. And in order to do so, I don’t think we can give a blueprint for how to do this. It depends on who is on the ground who already has an A country office, for example. Is it UNDP or is it WHO that can take the lead in this organization? But the urgency component, of course, is critical here. And I just want to quote a colleague from Ukraine, on the humanitarian response in Ukraine, that it has to be a mobile response, a digital one, an agile one, a relevant one, and an innovative one. And just to conclude the innovative one, for example, in Ukraine, the adoption of long-acting buprenorphine, where people don’t have to come every day to take their methadone but they can come once a month to get an injection could be hugely relevant and they’re supporting that with research to find out if it works as it is supposed to work. Thank you.

Chair: Tatyana Sleiman – SKOUN, Lebanese Addictions Center: Thank you for your valuable insights. To summarize, it’s evident that access to controlled medication is crucial, along with effective interagency coordination. There’s a clear need for a foundational baseline at the state level to mitigate barriers during emergencies. Your emphasis on access to controlled medication, both at the beginning and end of your remarks, serves as a valuable segue to our next panellist, Nele Van Tomme, the Drug Policy Officer from the Federal Ministry of Health in Belgium. Given Belgium’s advocacy for access to controlled medicines, and considering the risks of interruptions in crisis settings, particularly for people who use drugs, such as those experienced in Lebanon, where sudden interruptions led to dosage reductions, extensive withdrawals, and increased hospitalizations. How can we, as a collective, ensure continuous access to controlled medication during crises and beyond? How can we streamline regulations on export/import, procurement, and authorizations during emergencies to uphold the right to health?

Nele Van Tomme – Federal Ministry of Health, Belgium: Thank you very much for the opportunity to contribute to this discussion. I’d like to start by referencing a report where it’s emphasized that access to and availability of internationally controlled substances for various medical purposes, such as palliative care, cancer treatment, surgical anaesthesia, managing drug dependency, mental health disorders, and neurological conditions, is fundamental to our right to health. Belgium has been advocating for greater awareness and action in this regard for many years. Let’s recall the conventions because they serve as the foundation of drug policies. It’s explicitly stated in these conventions that narcotic drugs are essential for pain relief, and psychotropic substances are indispensable for medical and scientific purposes. However, globally, these commitments and obligations have not been adequately met. The statistics are striking; in low and middle-income countries, only 11% of the global quantity of internationally controlled opioids available for medical use are consumed by 85% of the world population. The lack of adequate treatment for moderate and severe pain among terminal cancer patients is alarming. The reasons behind this imbalance in access and availability are multifaceted, involving political, economic, social, and technical elements. Restrictions in the application of international conventions and regulations can hinder access to opioids. Government policies often reflect concerns about abuse, non-medical use, diversion, and illicit trafficking. Cultural barriers, stigma, and misconceptions among health professionals, caregivers, and patients further complicate matters. Additionally, insufficient data exacerbates the problem. Addressing these issues requires a thorough examination of context-specific barriers and enablers, along with tailored interventions. These challenges are particularly acute in emerging armed conflict settings, humanitarian crises, chronic conflicts, insecure regions, and geographically remote areas. However, access to essential medicines, including morphine, becomes even more critical in these situations. Belgium is actively working to raise awareness and persuade governments to address these challenges. We recently organized a high-level side event to review achievements and reaffirm our commitment to making significant progress by 2029. At this CND, we are introducing a resolution on access to controlled substances, in collaboration with Cote d’Ivoire, the EU, and its member states, to urge member states to assess, develop, and implement policies to improve access and availability. Key observations highlight the need for collective responsibility to ensure access to controlled substances, especially in emergency and crisis settings. Flexible and simplified procurement and dispensing processes are essential during critical situations. Additionally, there should be systematic inclusion of adequate formulations of morphine and other essential medicines for both adult and paediatric use in response packages. Furthermore, it’s crucial to enhance the understanding and expertise of healthcare providers delivering these medicines in humanitarian settings. Governments should establish emergency response mechanisms to ensure access to opioid agonists and other essential medicines. Special attention must be given to the needs of children, ensuring appropriate dosage formulas suitable for their age and development stage. In conclusion, it’s imperative that we work together to ensure that no patient is left behind. We must fulfil our common goal of improving access to and availability of controlled substances, particularly in times of crisis. Thank you.

Chair: Tatyana Sleiman – SKOUN, Lebanese Addictions Center: Thank you so much for your intervention. It’s important to emphasize the impact of repressive policies on individuals’ access to timely medication. It’s crucial to continue discussing flexibility and facilitating access, particularly in crisis response situations. Before we proceed to our closing remarks, and since we have some time, we’ll allocate about 10 minutes for a Q&A session. But first, I’d like to quickly invite Office of the Special Rapporteur on the Right to health and special mandate on the right to health to address us.  The floor is yours.

Office of the Special Rapporteur on the Right to Health: Thank you all very much. I represent the Office of the Special Rapporteur on the Right to Health, and although she couldn’t join us today, she sends her sincere regrets. We greatly appreciate the organization of this significant event. As some of you may know, the Special Rapporteur will present a report on harm reduction to the Human Rights Council in June this year. Her approach is firmly anti-colonial, anti-racist, and intersectional. In the lead-up to this report, she has been deeply engaged in developing harm reduction services for people who use drugs, emphasizing the need for such services and access to medicines for all. From a human rights perspective, access to medicines is inherently linked with principles of equality, non-discrimination, transparency, participation, and accountability. Additionally, the Special Rapporteur has tasked me with completing another report for the General Assembly in New York. This report will focus on harm reduction for sustainable peace and development, considering various issues, including those related to humanitarian and conflict settings. She has expressed her anticipation to continue engaging with the diverse stakeholders present here in the preparation of these upcoming reports. Thank you for your attention.

Chair: Tatyana Sleiman – SKOUN, Lebanese Addictions Center: Thank you very much. We eagerly anticipate the forthcoming report and welcome contributions. Now, let’s open the floor to questions. If anyone has any queries, please feel free to raise your hand, introduce yourself briefly, and ask away. Are there any questions from those present here, or perhaps from our online audience? It seems we’ve been exceptionally clear and on point, leaving no room for uncertainty.

Annette Verster – World Health Organisation (WHO):  I just noticed it in the chat but also gone. I mentioned it when we talk about humanitarian or other crises, not just to think of the country in crisis, but also when people are displaced and fleeing the neighbouring countries where they go to that we need these responses as well. so I think there’s a really important point to stress Thank you.

Chair: Tatyana Sleiman – SKOUN, Lebanese Addictions Center:  Absolutely. Thank you so much. And on that note, I would also like to highlight that UNHCR having a side event that’s particularly focused on humanitarian crisis and displaced populations, which we’ll be following of course, and see how we can bridge What were our discussions here and the discussions there because indeed the issue of displacement and the impact on displaced populations, especially when the policies from the country where they are to the country, where they go are different, it creates even more barriers. So thank you so much for highlighting that point.

Ganna Dovbakh – Eurasian Harm Reduction Association (EHRA):  I’d like to address two critical issues that add complexity to the problem at hand. Firstly, there’s the issue of gender-based violence and the urgent need to respond to the sexual and reproductive health needs of those fleeing conflict, such as in Ukraine. We’re witnessing numerous cases of gender-based violence, exemplified by the recent atrocities in Bucha. However, for marginalized and vulnerable groups like women who use drugs, sex workers, and LGBTQ individuals, the situation is even more dire. Access to essential services such as abortion, particularly in neighbouring countries like Poland, is a significant challenge for displaced individuals from Ukraine. This includes issues surrounding sexual and reproductive health rights. We must also focus on preventing and addressing gender-based violence within mental health facilities and shelters, providing training for social workers and medical caregivers to effectively handle these situations. Secondly, we must consider the plight of incarcerated individuals. During times of invasion, prisons often become inaccessible to outside aid, leaving inmates without food or medication. This problem is exacerbated in Russia, where the prison population has been deported, making it incredibly challenging to ensure their well-being. This highlights the consequences of criminalizing drug use, with individuals incarcerated for mere possession or use left in precarious situations. They are far more vulnerable than those who are free to move and seek assistance.

Chair: Tatyana Sleiman – SKOUN, Lebanese Addictions Center: Thank you very much, Ganna, for your insightful remarks. As you highlighted, the issue of addressing compounded vulnerabilities for people who use drugs during crises is paramount. Your insights shed valuable light on this complex issue. Now, let’s move to the question we have. Please, go ahead.

QUESTION: Thank you all for engaging in this crucial discussion during these challenging times. Before I proceed with my question, allow me to introduce myself. I represent a Brazilian civil society organization. I’m deeply concerned to inform you all that the Brazilian Senate has proposed a modification to our constitution, aiming to intensify drug prohibition by criminalizing the possession of any amount of drugs. This proposal is outrageous and alarming. It’s scheduled for discussion tomorrow, and it represents an attempt by the Brazilian Senate, which opposes our government, to further oppress the resilient Black and favela populations. This proposal perpetuates a form of apartheid that has existed since colonization, where the law’s punishment disproportionately affects these marginalized communities, leading to imprisonment, enslavement, and torture. I would like to invite the panel to comment on this issue, and I also have a petition against this proposal available. If any organization or country is interested in signing, I have the QR code here. Thank you.

Zaved Mahmoud: OHCHR: Thank you very much for bringing this important matter to our attention. Our human rights office is actively assessing how we can effectively communicate these concerns to the government. We appreciate your advocacy on this issue, and I will ensure to coordinate with your colleagues as well. Thank you.

Chair: Tatyana Sleiman – SKOUN, Lebanese Addictions Center: I will give the floor to Elie Aaraj.

Elie Aaraj – Middle East North Africa Harm Reduction Association (MENAHRA):  I would like to draw attention to a community that seems to be missing from our discussion today: people who are deprived of their liberty, those who are incarcerated. We haven’t addressed this group, but I want to share an example from Lebanon. Due to inflation and the inability to cover medication costs for prisoners, there’s a dire situation unfolding. Currently, a platform of civil society organizations, including ourselves, is pooling resources from our own pockets to ensure that prisoners have access to essential medication and lab tests. It’s heart breaking to witness individuals dying in prison not because of torture, but simply because we cannot afford to provide them with the necessary medicines. Once again, I urge everyone to prioritize this overlooked group. Thank you.

ONLINE QUESTION: Good morning, everyone. My name is Emmanuel, and I work with the Global Fund as the portfolio manager for the Middle East response grant. First and foremost, I want to commend and congratulate SKOUN, our UN partners, and collaborators on this initiative. It’s evident that punitive policies and structural barriers continue to hinder our initiatives. At the Global Fund, we’re increasing our investment in harm reduction initiatives and collaborations across countries. However, a significant challenge we often encounter, as Elie Aaraj mentioned, is financing. This raises the question of how we can mobilize and galvanize governments to address policy issues, especially in cases where punitive measures are in place due to criminalization. We need governments to make policies more friendly and enabling to ensure the delivery of integrated services, thus mainstreaming sustainability. This financing bottleneck is hindering effective programming, particularly in countries that have advanced harm reduction initiatives and innovations. I’m interested to hear if any of the panellists have experience or insights on how we can address this challenge. It’s an evolving conversation and area of innovation. Elie, your point about prisons resonates deeply, and we are continually advocating for expanding access to TB and HIV screening, diagnosis, and treatment within prison settings. From the Global Fund’s perspective, we’re actively pushing this agenda forward. Thank you.

Chair: Tatyana Sleiman – SKOUN, Lebanese Addictions Center: Thank you very much, Emmanuel, for your valuable contribution and for joining us for this session. Your points are well noted, and we truly appreciate your engagement. Unfortunately, due to time constraints, we won’t be able to delve into the issues you raised further today. However, they are certainly important, and we hope to address them in future discussions and forums. Moving forward, I’d like to pass the floor to Dr. Lasha Goguadze from the International Federation of Red Cross and Red Crescent Societies for his closing remarks and recommendations. Dr. Goguadze, we look forward to your summary of today’s discussion and any actionable recommendations you may have.

Dr Lasha Goguadze – International Federation of Red Cross and Red Crescent Societies: Thank you very much. I represent an organization that operates before, during, and after emergency situations. I believe it’s crucial to respond to the statements made and to express gratitude for organizing this challenging event, which has prompted valuable reflections for all of us. We’ve been discussing this topic for a long time, and there are lessons learned that we can apply in the future. To summarize, I’ll attempt to define key points over the next few hours, refining the wording as necessary due to the influx of new ideas. Firstly, it’s imperative to integrate the needs of people who use drugs and at-risk communities into humanitarian assistance planning, implementation, and funding allocation. This includes ensuring access to essential medicines, particularly opioid treatments and pain management, in emergency and crisis settings through relaxed control measures. Additionally, we must ensure uninterrupted opioid agonist treatment provision in crisis settings by establishing emergency response mechanisms. Meaningful engagement with harm reduction organizations and affected communities is vital in emergency and humanitarian response planning. It’s essential to have ongoing programs before emergencies or crises occur to make the system more resilient. We need to broaden responses to drug-related issues and involve all humanitarian agencies, enhancing collaboration and coordination. Policy reform is necessary, shifting away from punitive models towards drug policies based on health and human rights, which recognize and advance the rights of people who use drugs. We must address gaps in data and ensure access to health care in all settings, linking health initiatives, including harm reduction programs, within the context of universal health coverage. Equity must be a strong focus, addressing issues such as those related to prisons and gender inequity. These aspects should be included in recommendations. Lastly, I want to express gratitude for the invitation to share our experiences. It has been a privilege and a pleasure to summarize this important event.

Chair: Tatyana Sleiman – SKOUN, Lebanese Addictions Center: Thank you very much. This summary captures the essence of our discussion today. In these 15 minutes, we’ve merely scratched the surface. The purpose of this event is to initiate a conversation and shed light on this crucial and timely issue, especially given the global context of crises. Our aim is to move forward together, progressing from conversation to actionable recommendations, with everyone playing a role. I want to express my gratitude to all of you for attending and starting the CND week with us. Special thanks to our co-sponsors, as well as to Andrea and the IDPC team for their invaluable support and preparation. To the panellists, your contributions have been remarkable, and your messages were incredibly on point. Thank you for your engagement in the preparation process. As we move forward into the week ahead, filled with side events and plenaries, we will share the recording of this event and a summary of the recommendations with all attendees, both in person and online. We have collected your contact information for this purpose. Once again, thank you all, and please don’t hesitate to reach out if you need anything.