Today we explore the rise of harm reduction across the Middle East and North Africa through the story of MENAHRA and the activists, healthcare workers, and organizations fighting stigma, HIV, and outdated drug policies. In regions where addiction and public health issues are often heavily stigmatized, harm reduction became more than healthcare — it became a movement for human rights and survival.
Transcription:
00:00 - 00:15
[SPEAKER_00]
Welcome to a new episode and a fresh perspective on GFN Insights on GFN TV. Today we're sitting down with Elias Al-Araj, looking at the origins, evolution and ongoing challenges of the Middle East and North Africa Harm Reduction Association.
00:15 - 00:26
[SPEAKER_02]
Eli, the Middle East and North Africa Harm Reduction Association. What's the story behind it and why was it created in the MENA region?
00:27 - 04:47
[SPEAKER_01]
First, in the mid-90s, we started the harm reduction services and outreach program in Lebanon with an association called SIDC that I founded in the late 80s. Then WHO and UNAIDS wanted to somehow scale up this kind of work because it was mainly the first organization working on this type of services. Especially that this type of service was against the law and it is not in the strategic, in the national strategic plan. And we were threatened to be taken to the jail because of distributing syringes. Anyway, WHO started in December 2006 in collaboration with HRI and the UNAIDS and other partners to organize a regional consultation. To talk about the risks and the harms that are facing people who use drugs, especially those who inject drugs, it ended up by some recommendations. One of them was that we need to have a kind of network in the region on harm reduction. So this is how they designed the project. We started by having three sub-regional knowledge hubs, one in Iran, one in Morocco, and the other one in Lebanon, hosted by SIDC. Then the regional secretariat was also hosted by SIDC until 2010. nine when we decided to register SIDC because the initial budget coming to an end and we had to apply for global fund grant. So, MINARA was registered in Lebanon as an international NGO and it is covering currently 20 countries in the region. We don't have anymore the knowledge hubs, but we are managing the capacity building and technical assistance from the Secretariat as MINARA. So this is it. And the main issue of Menara also was to strengthening the civil society organization's capacity in terms of harm reduction, but also to enabling environment to the governments to accept the harm reduction strategies. This is why we conducted many, many advocacy work. We are conducting many studies to show some evidence from the region. And also we have a group of law enforcement judges and prosecutors from the region. We had many regional meetings with them to talk about harm reduction. They understand better now. And another group of Muslim and Christian religious leaders with whom we discussed more deeply. And we have a training package for them. They are trainers. Some of them went high beyond their face of religious leaders. So someone was talking about condom, for example, which is unacceptable by the religion. So we are doing this kind of work. and lately also we opened i think uh uh i'm just talked about that we opened the uh the the door for other kind of services like tb in collaboration with the stop tv partnership like the working in in egypt on three studies currently with frontline aids and unit aid and other partners trying to include the long depot of buprenorphine, which is a kind of new service under the harm reduction services in Egypt. trying also to introduce the loaded space syringes and needles and creating a kind of community model of services. So we're still looking for some improvement, yeah, for some improvement, yeah.
04:48 - 04:54
[SPEAKER_02]
Okay, great. So what made you start working in HIV, AIDS and harm reduction?
04:54 - 04:55
[SPEAKER_01]
Me personally?
04:55 - 04:56
[SPEAKER_02]
Yes.
04:56 - 08:08
[SPEAKER_01]
Basically, I'm a nurse, a community health nurse. So since the 80s, I wanted to create in Lebanon home care. At that time, we didn't have home care, and until now, it's not regulated yet. So I started to market this work among the hospitals and receiving requests from some medical doctors at that time. They were mainly oncologists who had to treat people living with HIV. And I treated people living with HIV at their home, but for the public it was cancer patients. This is how we started with SIDC NGO that I founded, as I mentioned. We also started to receive, after the end of the Lebanese civil war in 1990, we started to receive calls from parents saying that I have my children who was doing the war during the war and he was using drugs and we need this and that. So we tried also to find a way how to follow up, how to treat these people, especially that this is private in Lebanon. The detox cost is more than $1,000, American dollars. And there were only one NGO who was providing the rehabilitation services. And it is a kind of therapeutic community, so people couldn't accept, not all of them could accept to go to a therapeutic community, although it was free of charge. But they have to go back to their university, they have to go back to their work, to their families, etc. So we started the work on follow-up and created a kind of daycare service for them. And until we, in 93, 94, we knew it was the new era of the harm reduction. So we introduced harm reduction to Lebanon. And this is how we also worked with people living with HIV. We created the first self-support group of people living with HIV and the hotline in Lebanon at that time. So we were involved in all this work. Frankly, personally, I learned a lot. I worked with passion with these people because they really taught me a lot of things. Working with marginalized people, people who are rejected from the society or those who are afraid from being revealed from their health situation, you know. or having someone who's coming from the LGBTQ community, having HIV, so it's a double stigma. Counseling session with them was like a real school for someone like me. So this is how, yeah.
08:08 - 08:15
[SPEAKER_02]
That's great. Okay, so how has the organization helped scale harm reduction approaches in MENA region?
08:17 - 11:29
[SPEAKER_01]
It wasn't so easy. It wasn't easy because we live in a region where the drug use is criminalized. LGBT practices also or people who are from these communities are criminalized. Sex work is also criminalized. So you're dealing with very sensitive issues. And you're dealing also with, as I mentioned, with people who doesn't have any support, neither from the society nor from their family even. And we were working, as I said, we are people working against the law somehow with people who are outlaws. Because usually if you are a social worker, if you are an NGO, a healthcare provider, you are at your place and those who have demand, they come to you. But when you go to the street working with them, you are trying to create the demand. And this is the difficulty as well. So the backup of WHO and HRI at that time, especially the UN agencies, UN aids and others, was very good for us to somehow trying to knock the door of ministers in the region, trying to knock the door of the police officers. So this is what helped somehow, but also we used evidence, as I mentioned. I remember in 2009, we organized the first regional conference on harm reduction. Mainly the speakers were coming from England, from Europe, etc. In 2011, the presentations were more coming from the region. People started to show their work because in the meantime, Menara was training people and also we had money to support them to start implementing this work. So, yeah, it was a long journey. I can't say that it was so easy. In one of the countries, the high police officer said, I can reject you from my country. You cannot come back to this country because... For them, I'm preaching to, you know, encouraging people to use drugs. In my own country as well, yeah, they said distributing syringes, for example, is encouraging people to use drugs. It's like the dealer. They could have been treated as a dealer. It's hard to work in the country where everything is... But it was challenging as well, and a good challenge that ended by acceptance, if you want, from the ministers of health with the regional committee at WHO. They had three times, consecutive times, a recommendation that they will implement harm reduction in their countries. And this is how we started to escalate somehow the services and to scaling it up. Step by step.
11:30 - 11:39
[SPEAKER_02]
Okay, and the last question to you. What is today's biggest barrier to public health and HIV response in the region?
11:39 - 13:38
[SPEAKER_01]
First, I can tell you that our feeling is that MENA is left behind. Although the slogan, the international slogan, no one left behind, we were left behind. We are not a priority for the international society. And this, you can say that it's, especially that we are one of the two regions with the highest prevalence lately. So if you go back to see, we have lack of political commitment from our governments. And these governments has new emerging priorities and emergencies due to the instability, to the economic crisis, to many things. to the war. So we have these problems. And this lack of commitment led to lack of domestic funding. So we don't have funds from our government, but few, scarce, let's say. the second thing is the laws the repressive laws that prevent people from seeking services and puts them at high risk stigma and discrimination in the society and of course all the the the in many countries the the whole work is on the on the shoulder of the civil society organizations so we have to go to the international donors that don't have interest again an international economic crisis and so on and so on so it's very very challenging period of time challenging and very interesting activities yes okay thank you so much thanks to you thanks