The impact of COVID-19 on drug use and harm reduction programming in the Middle East and North Africa (MENA) region: a regional consultation of stakeholders and people who use drugs

COVID-19 (SARS-CoV-2) was classified a pandemic on March 11, 2020, with early reports of the disease occurring in the Middle East and North African (MENA) area. On January 2021, the World Health Organization Eastern Mediterranean Regional Office (WHO-EMRO) reported 5,566,708 confirmed cases with 131,886 fatalities to date. Since 2016, the Middle East and North Africa (MENA) area has seen a modest but steady growth in the harm reduction response.

Little is known about the region's health response and the situation of drug users (PWUD) during the outbreak. During COVID-19, the MENA Harm Reduction Association (MENAHRA) performed a mixed method research to examine the state of PWUD and its influence on harm reduction services.

Two major data collecting activities were carried out:

• The first of which was a distributed survey addressed to regional and all nation level professionals in order to obtain an updated view on how important populations and harm reduction programs are responding to the COVID-19 problem. Twelve countries and two regional viewpoints responded to the survey.
• Second, a virtual focus group (Zoom) was held with MENA Network of People Who Use Drugs (MENANPUD) focal points (n = 11) to investigate the situation and impact of COVID-19, with a particular emphasis on their navigation of public health guidelines and lockdown measures.

The study demonstrates the below:

• First, how COVID-19 increased existing marginalization and stigmatization of PWUD and other important communities in the MENA area, with COVID-19 having a significant influence on government level resourcing.
• Second, it also demonstrates harm reduction non-governmental organizations' (NGOs') dedication to diversifying their response, notably through mobile outreach to drug hotspots and dependence on technology to assist awareness raising, telemedicine, and medication supply.
• Third, governments in numerous MENA countries have made positive changes to their harm reduction policies, as has the continued commitment of existing harm reduction NGOs to assist PWUD populations.

As a conclusion, continued advocacy for and implementation of harm reduction responses at the domestic and regional levels should be supported by integration in state health emergency planning and disease control efforts, raising awareness about innovation and telemedicine to support health and NGO support systems and medication supply chains, resourcing NGOs, and providing economic support for PWUD, disease control, and prevention efforts in addition to research.