A Participatory Assessment on the Mental Health Status and Needs of Key Populations in 5 Countries in the Middle East and North Africa Region



The MENA region, which includes Arab countries, has lagged other regions in terms of mental health awareness and response.  The Covid-19 pandemic generated a momentum for identifying and addressing mental health as a public health priority. In parallel, harm reduction has gained ground, despite traditional resistance, as an acceptable approach to lessen the impact of opiate use on people and communities. Despite relatively few resources countries that have used one or other of the interventions that fall under this umbrella have seen significant benefits in people who live with HIV/AIDS (PWLHIV) and people who use opiates (PUO). 


The mental health of these Key Populations (KPs) explicitly is uncommon as a primary designated aim, whether in the form of symptom reduction or general well-being. As a result, in nations in the region where a variety of harm reduction services or campaigns have been active, the topic of mental health and psychological well-being merits additional exploration. They include Egypt, Jordan, Lebanon, Morocco, and Tunisia, the nations selected for this report. This prompted MENAHRA and its associates to investigate the current state of affairs with a view to suggesting implementable recommendations.

The report used two different strategies. Initially, using freely accessible scientific resources, a scoping review of the literature on the topic was conducted. Second, a participative component using semi-structured interviews with Key Informants (KIs) in the 5 designated countries using snowball sampling starting with pre-identified individuals and organizations directly involved in the fields of advocacy, clinical care, policy, service development, and provision. An initial reading of transcripts allowed the development of a preliminary list of emerging themes. The themes highlighted were perceptions on mental health, current factors contributing to the success of delivery of mental health services to KPs, causes and risk factors of mental health, mental health needs among KPs, impact of lack of mental health services on KPs.

The report demonstrates a sizable mental health burden for KPs particularly people with drug use disorders, specifically those with opiate use disorders, and People Living with HIV (PLHIV). This burden is exacerbated by cost, stigma, and a lack of skilled labor. In all five nations, stigma seems to be the major contributor to psychological burden. KPs suffer from being stigmatized by family members, society, and most commonly Health Care Providers (HCPs). More efforts are needed to socially integrate KPs at household/community/medical services level.

Again, across all nations, lack of availability or affordability of care comes in second. The lack of a network of specialized centers, primary care physicians' understanding of substance use disorders (SUD), and their involvement in prevention and treatment are further factors that affect service accessibility in both the public and private sectors. Regardless of whether they are designated as service users or service providers, KIs are generally in agreement about the need for and the best course of action for providing adequate care. For effective delivery of services, HCPs must receive constant training in order to collaborate with KPs. Additionally, for KPs who are in desperate need yet unable to pay for them, KIs pushed for the need of free mental health care.

Rome Consensus 2.0 Summit: Advancing Humanitarian Drug Policy Reform


The Rome Consensus 2.0 Summit, held in Rome, Italy from May 2nd to May 5th, brought together global stakeholders to discuss and advance humanitarian drug policy reform.


The Summit aimed to address the criminalization, discrimination, and stigmatization faced by people who use drugs (#PWUD). It emphasized the need to invest in health services and social reintegration, prioritizing a compassionate approach over punitive measures.


"Why are people who use drugs criminalized? Authorities prefer to invest in prisons and punitive laws that marginalize them, rather than in health services and social reintegration. I believe that this is a crime!"

This statement highlighted the Middle East and North Africa Harm Reduction Association’s Executive Director's viewpoint on the unjust treatment faced by individuals who use drugs and called for a shift towards a more humane and supportive approach.


The Rome Consensus 2.0 Summit provided a crucial platform for stakeholders to engage in discussions surrounding comprehensive drug policy reforms. It emphasized the importance of upholding human dignity, addressing human rights issues, and combating discrimination within drug policy frameworks. The summit shed light on the negative consequences of the ongoing war on drugs and underscored the urgency to implement new policies that prioritize the well-being and rights of affected individuals.


By fostering dialogue and international collaboration, the Rome Consensus 2.0 Summit aimed to effect positive change in drug policies and programs worldwide. Stakeholders, including the MENAHRA Executive Director, advocated for evidence-based and inclusive approaches that consider the diverse needs and experiences of people who use drugs. The summit served as a significant opportunity to raise awareness, challenge discriminatory practices, and promote a future where all individuals are treated with dignity and provided the necessary support to lead healthier lives.


The Rome Consensus 2.0 Summit served as a milestone in advancing humanitarian drug policy reform. It provided a platform for stakeholders to address the criminalization and stigmatization faced by people who use drugs. Through collaborative efforts and advocacy, the summit aimed to create a more compassionate and rights-based approach to drug policy, ensuring that individuals are provided with the necessary tools, healthcare, and support they need.

Urgent Call to Address Drug Problems and Achieve Universal Health Coverage in the MENA Region



Urgent action is needed to support sustaining and scaling up services for people who use drugs in the MENA region. The 66th Session of the Commission on Narcotic Drugs (CND) held in Vienna in March was a success in bringing together experts, practitioners, activists, and beneficiaries to discuss effective strategies for addressing drug problems and achieving universal health coverage from a humanitarian approach.


One of the highlights of the event was the side event organized by the Rome Consensus, called "Rome Consensus 2.0: Achieving Universal Health Coverage and Addressing Drug Problems." The event aimed to explore human and evidence-based solutions to reduce the suffering and stigmatization of people with drug disorders.


The event covered key topics such as removing legal barriers to accessing care, including harm reduction services in universal health coverage, and funding for community-based organizations that are run by and for people who use drugs, as well as marginalized communities such as women, refugees, and migrants who are affected by drug use.

Elie Aaraj, the Executive Director of MENAHRA, discussed the challenges faced by the MENA region, including low HIV prevalence coverage, repressive laws preventing people who use drugs from seeking services, and a lack of specific healthcare services.


However, Aaraj pointed out that community-led organizations like MENANPUD and MENA Rosa are becoming stronger and more vocal, and there are national and regional thematic networks working on HIV.


In conclusion, the CND 66 event was a success in bringing together experts to explore human and evidence-based solutions to reduce the suffering and stigmatization of people with drug disorders. While challenges in the MENA region still need to be addressed, urgent action is needed to support sustaining and scaling up services for people who use drugs in the region.

TB Situation Assessment Among Key Populations in Algeria, Egypt, Lebanon, and Morocco

Harm reduction is an approach that aims to reduce the negative consequences associated with substance use, including HIV, hepatitis C, and tuberculosis (TB). The Middle East and North Africa (MENA) region faces unique challenges related to harm reduction, including stigma, criminalization, and limited access to healthcare services.


Among the strategies of harm reduction that MENAHRA focuses on is TB. The goal is to raise awareness about TB, prevent its spread among key populations (KPs), and advocate for treatment availability for KPs in the MENA region.


To investigate the challenges and opportunities in delivering TB services to KPs in Algeria, Egypt, Lebanon, and Morocco, MENAHRA conducted assessments. The assessments considered the WHO National Assessment Checklist for the Multisectoral Accountability Framework on TB (MAF-TB) to assess the level of national commitments made on TB and the actions taken on those commitments, as well as monitoring and reporting approaches and the nature of any high-level review mechanisms.


The assessment was a crucial step in identifying gaps and areas for improvement in TB control and harm reduction among KPs in the MENA region. If you're interested in learning more about the MAF-TB, you can access the checklist here: https://www.who.int/publications/m/item/who-multisectoral-accountability-framework-for-tb-(maf-tb)-baseline-assessment-checklist-for-country-use-in-pursuing-a-national-maf-tb


MENAHRA’s study employed a qualitative research design using purposive sampling and was conducted in two phases: data collection and analysis, and roadmap validation. The study was based on three main components: a desk review, key informant interviews (KIIs), and focus group discussions (FGDs). The desk review synthesized available national policies and peer-reviewed/Grey literature on TB needs among KPs. The KII and FGD phases collected qualitative data from National Tuberculosis Program (NTP) managers, Civil Society Organizations (CSO), and KPs who currently access or have completed TB treatment.


The report highlights the need for a collaborative effort from different sectors to ensure effective TB control, particularly among KPs. Increasing awareness, promoting access to high-quality TB services, and providing adequate resources and follow-up after treatment is necessary to improve KPs' access to TB-related services.


MENAHRA's commitment to promoting a more conducive environment for KPs and people who use drugs in the MENA Region is reflected in the reports. The organization recognizes that achieving this goal would not have been possible without the tireless efforts of its partners and the entire harm reduction community in this region.


In conclusion, MENAHRA's report on the challenges and opportunities in delivering TB services to key populations in the MENA region is a critical resource for civil society organizations and decision-makers working to scale up harm reduction efforts. The organization remains committed to advocating for the health and well-being of key populations in the region and hopes that this report will contribute to an effective and collaborative approach to TB control and harm reduction among KPs in the region.





Partners in Progress: The Global Fund's Support of MENAHRA's Harm Reduction Efforts with Religious Leaders in the MENA Region



The Middle East and North Africa Harm Reduction Association (MENAHRA) is dedicated to improving the lives of people who use drugs through advocacy, capacity building, and technical assistance.


The organization's goal of advocating for the implementation of harm reduction strategies, which have been proven to be effective in preventing the spread of HIV, Hepatitis B, and Hepatitis C among people who inject drugs (PWID), is made possible through its partnership with religious leaders, civil society organizations, and other stakeholders.


In 2014, MENAHRA published the "Religious Leaders Manual on Harm Reduction," a comprehensive guide in Arabic Language1 that covers the scientific facts about substance abuse, HIV, stigma and discrimination, and harm reduction, and the Global Fund has been instrumental in supporting these efforts. The manual also includes information on communication and advocacy skills, as well as the role that religious leaders can play in promoting harm reduction.


As part of its three-year plan (2019-2021), MENAHRA has continued to work with religious leaders to educate them about harm reduction and to support their advocacy efforts. The following activities have taken place:

• In 2019, MENAHRA organized a religious leaders' conference to review and update the 2014 guide and brainstorm the structure of a training module.


• In 2020, Part 4 of the 2014 publication's guide was developed, and thereafter MENAHRA organized an online training of trainers (TOT).

• In 2021, the trained religious leaders began educating other religious figures and local communities about harm reduction in their region.

• In 2022, a favorable shift in attitude regarding the Harm Reduction approach, programs, and religious leaders' dedication to the cause was observed during the advocacy training for religious leaders.

In 2022, MENAHRA conducted a three-day advocacy training program for religious leaders in Beirut. The training was participant-centered, allowing participants to share their experiences, build advocacy interventions, and simulate their roles as advocates.


While MENAHRA has no current activities with religious leaders in 2023, the organization remains committed to its mission of improving the lives of people who use drugs through advocacy, capacity building, and technical assistance in the Middle East and North African region. 


Support Us