UNGASS Women 2016: North Africa

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North Africa is one of the primary sources of drugs trafficked to and sold in Europe, especially cannabis resin. Drug laws in the region are harsh and services for people who use drugs are scarce. Very little information about the impact of drug policies and practices on women in the region is available.

Law enforcement approaches to drugs

Drug use and drug trafficking are harshly punished in North African countries. Egypt, Libya and Sudan’s drug laws provide for the death penalty for drug-related offences, although it is rarely applied.[1] Many countries have pursued a repressive approach, focusing on arrests, conviction and mandatory treatment of people who use drugs (which is often just enforced abstinence).[2]

Egypt has conducted eradication campaigns, targeting cannabis and opium poppy cultivation sites.[3] This has been extremely problematic for local communities, given that drug crop cultivation is often people’s sole livelihood.[4] Women often suffer disproportionately from such eradication campaigns, as crop cultivation may be their only available means of income in the context of very limited educational and professional opportunities for girls and women.

Tunisia’s ‘Law 52’, adopted in 1992, imposes a mandatory one-year minimum prison sentence for first-time use or possession of cannabis and a mandatory minimum five-year sentence for repeat drug offenders. Judges do not have discretion to impose less severe or alternative sentences. The law also allows for ‘administrative surveillance’, meaning that after release, a person convicted of a drug-related offense could be compelled to register at a police station regularly, sometimes daily, for up to 10 years. People convicted of drug-related offences can also be denied a passport. This law has significantly increased Tunisia’s prison population: in December 2015, of all people serving sentences for drug-related offences, about 70% had been convicted of using or possessing cannabis. In total, there were 7,451 people (including 145 women) serving prison sentences for drug-related offences in December 2015, accounting for 28% of the total state prison population. Enforcement of the law has led to serious human rights violations, including beatings during arrests and interrogations, threatening and rude police behavior, mistreatment during urine tests, illegal searches of people’s homes without warrants, pre-trial detention without access to family members or a lawyer and incarceration in overcrowded prisons. Attempting to reverse the harmful effects of Law 52, the government recently drafted a law abolishing prison sentences for first-time offenders convicted of drug use or possession, abolishing mandatory minimum sentences, allowing for alternative noncustodial sentences and placing greater emphasis on treatment services. The draft law, however, has expanded the range of investigative measures available to police, including surveillance, phone tapping and interception of communication. The draft law also introduces the offence of “public incitement to commit drug-related offenses,” which could be used to criminalize the activities of civil society organizations advocating for the decriminalization of drugs, artists whose work depicts drug use (for example, some musicians) and organizations that provide harm reduction services. Three months after the draft law was submitted, the Tunisian parliament has still not scheduled debate on the law.[5]

In Morocco, people who use drugs are at high risk of incarceration: a 2011 study of 300 people who use drugs in Northern Morocco found that 82% of respondents had been incarcerated, and 6% had experienced inhumane treatment while incarcerated.[6] Seeking to reduce the criminalization of people who use drugs, members of Moroccan civil society have called for the legalization of marijuana use and cultivation.[7]

Services for people who use drugs

Harm Reduction International reports that the rate of injecting drug use in the region is high, with the bulk of the world’s opium being produced in nearby Afghanistan and the price of heroin thus being significantly lower than in the rest of the world. Sharing injecting equipment is common, with 63.9% of injecting drug users in Morocco sharing syringes, and only 45.5% of injecting drug users in Egypt using sterile equipment. This has serious health consequences. In Morocco, 11.4% of injecting drug users are HIV positive, although the rate is much higher in the northern parts of the country, where 17.9% of injecting drug users are HIV positive. Libya has an extremely high rate of HIV transmitted through unsafe injecting practices, although data has only been collected in the capital city of Tripoli, so the prevalence of HIV and injecting drug use in other cities and rural areas is unknown.[8]

Recognizing the need for a public health approach to drug use, since 2010, some governments have introduced policy reforms and harm reduction programs. Civil society organizations promoting harm reduction initiatives have been increasingly active in the region, with private donors and international organizations providing financial and institutional support. Key organizations in the region include the Middle East and North Africa Network of People who Use Drugs (MENAPUD), the Network of Associations for Harm Reduction (NAHR), and the Middle East and North Africa Harm Reduction Association (MENAHRA), a network of governments, civil society organizations and researchers.  MENAHRA, in particular, has been central to encouraging governments and civil society actors to pursue a harm reduction approach to drug use in the region.[9] Several harm reduction initiatives, however, have been disrupted by political unrest in the region.

Tunisia has explicitly supported a harm reduction approach to drug use. Its national HIV strategy specifically mentions people who inject drugs as being at a higher risk of contracting HIV. In 2014 (latest available data), Tunisia had three needle and syringe exchange sites in operation.[10] In 2011, 137,000 needles and syringes were distributed to 9,000 people who inject drugs. This is a coverage rate of 15.2 needles and syringes per person per year,[11] which is considered low.[12]

Morocco has explicitly supported taking a harm reduction approach to drug use. In recent years, it has been extending its national action plan on drug use and has implemented a national action plan on harm reduction. Methadone was approved for use in opioid substitution therapy in 2009, and in 2010 methadone programs were established at three pilot sites in Tangier, Salé and Casablanca.[13] The pilot program was later expanded to seven more sites, including in one prison.[14] Morocco also operates needle and syringe exchange programs in six NGO-run sites. In 2011, Morocco distributed 13 syringes per person; although an improvement from seven syringes per person in the previous year, it is still too low to have a real impact on reducing the spread of viruses amongst people who inject drugs. Further, despite these harm reduction policies, the rights of people who use drugs are routinely violated. A 2011 study of 300 people who use drugs in Northern Morocco found that 87% had experienced police violence and 50% had experienced human rights violations by medical personnel. A community-based study documented widespread human rights abuses against people who use drugs committed by police and officials within the justice and health care systems. Such abuses deter people who use drugs from seeking or accessing harm reduction services. Several stakeholders have called for the adoption of policies that would better protect the human rights of people who use drugs.[15]

Due to punitive drug laws in the region, many people who use drugs are incarcerated. Although there is no data on the number of people who use drugs in prison, there is a clear need for harm reduction services in prison. In 2013, Morocco ran an opioid substitution therapy program in a prison; it is not clear whether this program was expanded beyond the pilot.[16] Egypt’s multi-sectoral Prisons Health Steering Committee coordinates integrated health services and activities in prisons, including joint responses to illicit drug use, HIV and TB; Egypt does not, however, provide needle exchange programs or opioid substitution therapy in prisons. In 2012, the Libyan government, in collaboration with UNODC, ran an HIV awareness program aimed at people who inject drugs in prisons.[17]

North African women who inject drugs are less likely than men to access harm reduction programs, which is problematic because although women comprise a small proportion of people who inject drugs in the region, they are more likely than men to contract blood-borne viruses like HIV and hepatitis C, and experience greater discrimination because of the stigmatization of their drug use.[18] Thus, an urgent need remains for gender-sensitive harm reduction programming in North Africa.

The way forward

Although some health sector reforms have promoted a harm reduction approach to drug use, people who use and cultivate drugs in the region are still subject to a repressive legal environment. There is an urgent need for more thorough drug policy reform, to address not only drug users’ medical needs, but also to reduce the harmful impact of harsh law enforcement policies.

Further, there is a real need for data collection on drug use and drug cultivation in the region, and on the treatment of those convicted of drug-related offences. Information about who is subject to the implementation of drug policies, and how these policies affect them is crucial to developing better policies. This is especially true for women who use drugs and women involved in the drug trade, about whom very little is currently known.

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[1] Gallahue, P. & Lines, R. 2015. The Death Penalty for Drug Offences: Global Overview 2015. London: Harm Reduction International. At: http://www.ihra.net/files/2015/10/07/DeathPenaltyDrugs_Report_2015.pdf [Accessed April 4, 2016].

[2] Himmich, H., Kazatchkine, M.D. and Stimson, G.V. 2016. Drug policy and human rights in the Middle East and North Africa: Harm reduction, legal environment and public health. International Journal of Drug Policy. 31.

[3] International Narcotics Control Board. 2016. Report of the International Narcotics Control Board for 2015. New York: United Nations. E/INCB/2015/1. At: https://www.incb.org/incb/en/publications/annual-reports/annual-report-2015.html [Accessed April 4, 2016].

[4] Buxton, J. 2015. Drug crop reduction, poverty and development. Open Society Foundations. At: https://www.opensocietyfoundations.org/sites/default/files/drug-crop-production-poverty-and-development-20150208.PDF [Accessed April 4, 2016].

[5] Guellali, A. 2016. All this for a Joint: Tunisia’s Repressive Drug Law and a Roadmap for its Reform. Human Rights Watch. At: https://www.hrw.org/report/2016/02/02/all-joint/tunisias-repressive-drug-law-and-roadmap-its-reform [Accessed April 11, 2016].

[6] Harm Reduction International. 2012. The Global State of Harm Reduction 2012: Towards an integrated response. Harm Reduction International. At: http://www.ihra.net/files/2012/07/24/GlobalState2012_Web.pdf [Accessed April 4, 2016].

[7] Felbab-Brown, V., Trinkunas, H & Barakat, S. March 22, 2016. “Breaking bad in the Middle East and North Africa: Drugs, militants, and human rights”. Brookings. At: http://www.brookings.edu/blogs/markaz/posts/2016/03/22-drug-policy-middle-east-felbabbrown-trinkunas-barakat [Accessed April 4, 2016].

[8] Harm Reduction International. 2014. The Global State of Harm Reduction 2014. Harm Reduction International. At: http://www.ihra.net/contents/1524 [Accessed May 5, 2016].

[9] Harm Reduction International. 2012.

[10] Harm Reduction International. 2014.

[11] Harm Reduction International. 2012.

[12] The World Health Organization recommends distributing 200 needles and syringes per person who injects drugs per year in order to effectively reduce the spread of HIV. See: World Health Organization. 2004. Effectiveness of Sterile Needle and Syringe Programming in Reducing HIV/AIDS among Injecting Drug Users. Evidence for Action Technical Papers. Geneva: World Health Organization. At: http://apps.who.int/iris/bitstream/10665/43107/1/9241591641.pdf [Accessed July 1, 2016].

[13] Harm Reduction International. 2012.

[14] International Narcotics Control Board. 2016.

[15] Harm Reduction International. 2012.

[16] Harm Reduction International. 2014.

[17] Harm Reduction International. 2012.

[18] Harm Reduction International. 2012.