Middle East and North Africa

One year ago, on 15 April 2023, armed conflict broke out in Sudan between the Sudanese Armed Forces and the Sudanese Rapid Support Forces. Since then, the situation has worsened. The hostilities, which were initially centred in Khartoum State, have intensified and rendered over half the country inaccessible.

The impact of this conflict has been devastating. Some 8.6 million Sudanese have been forced to flee their homes, 6.8 million are displaced with in the country and 1.8 million have sought refuge in neighbouring countries – Chad, Egypt and South Sudan.

The severity of the humanitarian emergency has been compounded by a deepening famine crisis, with 17.7 million Sudanese facing acute food insecurity, close to 5 million of whom are on the verge of starvation, as reported by OCHA and the Integrated Food Security Phase Classification.

In addition to the humanitarian crisis, the conflict has severely disrupted the healthcare infrastructure. The central depot, which stored all the antiretroviral treatment for people living with HIV in the country is inaccessible and the stock that it holds has since expired.

Before the conflict erupted, 11,000 people living with HIV in Sudan were on HIV treatment, 4000 of whom were lost to follow-up when the war broke out. All HIV prevention and testing services were suspended.

“We are adapting the HIV response in Sudan to the situation in the country. Our priority has been to get anti-retroviral treatment to those who need it, in whatever way we can,” said Elsheikh Ali, UNAIDS Country Director for Sudan.

Despite these challenges, there are unsung heroes who are working tirelessly to ensure that the HIV response continues uninterrupted.

Amidst active war, the displacement of critical partners in the HIV response, poor internet connectivity and communications, sporadic electricity and growing food insecurity, the HIV national response team, with UNAIDS’ support, were able to reconsider, plan and raise resources for this new, national context of the HIV response in the country. The team was able to submit a funding application to the Global Fund to Fight AIDS, TB and Malaria (Global Fund) and to finalize the Global Fund Grant Making process. This secured critical financial support to HIV, TB and Malaria for the next three years. The funds received from previous Global Fund cycles have been used to replace stocks of antiretroviral treatment (ARVs) as well as to establish new HIV treatment storage facilities in safer regions.

During the COVID pandemic, Sudan established a ‘Search and Rescue’ system to track people living with HIV who had  their treatment interrupted. Once the conflict in the country escalated, the HIV national response team were able to draw on the ‘Search and Rescue’ system to locate most of the 4000 people living with HIV who were lost to follow-up because of the war and to re-enrol them again to receive HIV treatment services.

“We have heroes here in Sudan, including networks of people living with HIV, who are working in very difficult circumstances, traveling tens of kilometres and risking their safety, to personally deliver ARVs to the people who need it,” said Elsheikh Ali, UNAIDS Country Director, Sudan. “These are the people we should be applauding; they are the ones keeping the HIV response going in the middle of a war and famine.”

The Ministry of Health, whose infrastructure has been significantly disrupted, is trying to provide critical HIV services including treatment and PEP (emergency medicine for HIV taken to prevent the virus in case of potential exposure to the virus) in regions of the country where there is active warfare. In more stable areas, more comprehensive HIV services are now being offered to those who need them.

In the face of the escalating humanitarian crisis in Sudan, there are dedicated people who remain steadfast in their commitment and working selflessly to mitigate the impact of the conflict on the HIV response.

“The HIV national response team exemplify the resilience  the AIDS response,” said Anne Githuku-Shongwe, UNAIDS Regional Director Eastern and Southern Africa. “In the face of adversity – war, displacement, famine – and against all odds, they have found a way to continue collaborating to uphold the HIV response.” She adds, “They have completed a successful Global Fund grant in the middle of an active war. They have made sure that people living with HIV across Sudan are not being left behind, that they are found, there is treatment available for them and that they receive it.  That is resilience, commitment and leadership.”

The first Arab Forum for Equality, held in Amman on 30-31 May 2022, is organized by the ESCWA and the Pathfinders for Peaceful, Just and Inclusive Societies, and hosted by the Center on International Cooperation at the New York University. This is the inaugural meeting of the Forum, and the theme this year is “Towards inclusive youth employment in the Arab region”.

Following is UNAIDS Executive Director Winnie Byanyima’s address:

Greetings to all participants at this first and vital Arab Forum for Equality. 

Thank you my dear sister, Rola Dashti, Executive Secretary of the United Nations Economic and Social Commission for Western Asia for inviting me.

I’ll share three lessons that we’ve learnt about inequality.

The first lesson is a worrying one: that inequality which was already extreme is being exacerbated even further.

In 2022, nearly half of humanity, 3.3 billion people are projected to be living below the poverty line of 5.50 USD a day. (Source: Oxfam)

New Oxfam estimates show that over a quarter of a billion more people could be pushed into extreme poverty in 2022.

A new billionaire has been created every 26 hours since the pandemic began.  The world’s ten richest men have seen their fortunes double. (Oxfam)

A year and a half since the first doses of a COVID vaccine were delivered, 78% of people in the US are fully vaccinated, 69 % in Europe but still under 50% (46.26%) of people in the Arab region. (Our World in Data).

We also see huge inequalities within the Arab region. United Arab Emirates has reached 97% Covid vaccination. But it is a health emergency that Algeria is only at 15 % and Yemen at just 2.2%. (Our World in Data)

Since the onset of COVID19, wealth inequality has considerable increased in the Arab region, with the richest 10% of the population now controlling more than 80% of total regional wealth. (ESCWA)

Social protection expenditures among developed countries in the Arab States are just 4.2 per cent of GDP, lagging far behind the world average of 20 per cent. (ILO)

On average health expenditure across the Arab World is just 5% of GDP, nearly half that of the European Union (9.92%). (World Bank)

The second lesson is even more worrying: that we won’t be on track to overcome health or economic crises until inequalities come down.

These kinds of extreme, intersecting, inequalities increase the risks our societies face from pandemics such as AIDS and COVID-19. And we’ve seen with COVID just how quickly a health crisis is turned by inequalities into becoming a social, a political, an economic crisis.

The third lesson is a hopeful one, but that hope depends on action: inequalities are a political choice. Courageous leaders can tackle inequalities

We can close tax loopholes and tax holidays for companies.

We can go beyond the 15% tax rate agreement for all corporate taxation around the world, up to 25%.

We can ensure taxes are paid where economic activity happens.

We can increase investment in health, education and social protection.

We can reform laws and policies so that they help us reduce harm and risk, not worsen it.

We can change the global trade rules which kept life-saving vaccines locked up in the North

Inequality is a crisis but it is not fate, tackling it is within our hands.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

The HIV epidemic in the Middle East and North Africa is still growing—an estimated 20 000 new HIV infections in 2019 marked a 25% increase over the 16 000 new infections in 2010. The region is far from controlling its HIV epidemic and HIV treatment coverage is low, with only 38% of people living with HIV accessing HIV treatment in 2019, resulting in 8000 people dying from AIDS-related illnesses in the region.

Community-based organizations can play important roles in the region’s HIV response, but they are constrained in many countries by limited civic space and resources. In response, community leaders living with HIV have come together to launch the first regional network of people living with HIV, MENA Plus, to strengthen the community HIV response in the region.

“It is time people living with HIV have a network where they make their own decisions and get our rights without stigma and discrimination,” said Amina Ibrahim (not her real name), a member of MENA Plus from Egypt.

With a vision of a society where people living with HIV live with respect and dignity, enjoy their full rights and have equal opportunities, MENA Plus aims to enhance the leadership, representation and effective engagement of people living with HIV across the Middle East and North Africa.

“We need to discuss the suffering of people living with HIV, and especially of children living with HIV, and how to educate them about living their lives,” said Soumayya Abdelwafi (not her real name), a member of MENA Plus from Morocco.

The network will advocate for HIV treatment and prevention services in the region, the sustainability of HIV funding and ending vertical (from mother to child) transmission of HIV and new HIV infections among children.

MENA Plus will put a strong emphasis on human rights, campaigning on sexual and reproductive rights, sensitization on gender diversity and sexual orientation and the rights of minorities and key populations—vital for a region whose HIV epidemic is highly concentrated among key populations and their sexual partners.

“With diversity, we enrich networking and advocacy to help achieve rights,” said Souhaila Abdalla (not her real name), a member of MENA Plus from Tunisia.

Through enhancing the leadership, representation and effective participation of people living with HIV, especially in decision-making around health and social and financial programmes, MENA Plus aims to empower people living with HIV in the region.

“MENA plus is a welcome addition to our UNAIDS team of partners across the Middle East and North Africa. Our friends, family and colleagues living with HIV have shown remarkable resilience, determination and innovation in responding to the interconnected challenges posed by HIV and COVID-19 in recent years. Through MENA Plus, their work has the potential for even greater impact, as the new global AIDS strategy puts community-led responses at the heart of UNAIDS’ work,” said Shereen El Feki, Director of the UNAIDS Regional Support Team for the Middle East and North Africa.

UNAIDS and the African Union have signed a new memorandum of understanding (MoU) to reinforce their partnership and to recommit member states to end AIDS through the Catalytic Framework to End AIDS, TB and Eliminate Malaria in Africa by 2030.

The MoU commits partners to work towards addressing the socioeconomic and political impact of HIV in Africa and accelerate the goal of reaching universal health coverage to take AIDS out of isolation. It will pave the way for more resilient, agile and inclusive health systems in Africa.

“The renewed MoU between the African Union and UNAIDS opens new windows of cooperation and new opportunities for ending AIDS in Africa. We need to deliver on this promise—it is doable,” said Amira Elfadil Mohammed Elfadil, Commissioner for the Department of Health, Humanitarian Affairs and Social Development, at the signing ceremony.

The Department of Health, Humanitarian Affairs and Social Development, formerly known as the Department of Social Affairs, will coordinate African Union Commission departments and organs to ensure that HIV remains a continental priority and is integrated into the broader development, human rights, humanitarian and peace and security agenda of the African Union. 

“I am delighted to sign the renewed MoU with the African Union,” said UNAIDS Executive Director, Winnie Byanyima. “The African Union is one of UNAIDS’ most important partners. I look forward to reinforcing our relationship to put communities at the centre of the response to HIV, address other health challenges such as COVID-19 and reduce inequalities that increase people’s vulnerability.”

This year is a pivotal year as United Nations Member States are expected to recommit to the HIV response with the adoption of a new political declaration in June. The partnership agreement with the African Union is being signed as the continent grapples with overburdened and insufficiently financed health systems in the face of the COVID-19 pandemic.

The 34th Ordinary Assembly of the African Union Heads of States and Government was held virtually on 6 and 7 February 2021.

The President of the Democratic Republic of the Congo and new Chair of the African Union, Félix Tshisekedi, pictured above, urged Member States not to forget devastating global epidemics, such as malaria and AIDS, and learn from them to strengthen health systems, including the reinforcement of the Africa Centers for Disease Control and Prevention. 

“Leveraging the experiences we have gained in the fight against adversity and our ability to adapt, we should not give up. Let us not forget other pandemics, often more deadly, that are still affecting the continent, like malaria and HIV,” said the President of the Democratic Republic of the Congo.

The assembly recognized the African Union’s role in mounting a united, innovative and strong partnership among Member States to address the COVID-19 pandemic, which has had a significant economic impact on Africa and further weakened its health systems.

Heads of states committed to sustaining efforts to curb the spread of the virus and mitigate its socioeconomic impact by using the Africa Continental Free Trade Agreement and to implement a coordinated vaccination programme through the Africa Vaccine Acquisition Task Team to ensure that no country is left behind.

“In responding to the pandemic, we have been at the forefront of innovation. We established the groundbreaking Africa Medical Supplies Platform to assist African Union Member States to access affordable medical supplies and equipment,” said the President of South Africa, Cyril Ramaphosa, pictured above.

The President of South Africa commended heads of states for their extraordinary and decisive leadership in tackling the COVID-19 crisis. He expressed dismay at the increase in violence against women and called on the continental body to prioritize women’s economic empowerment and develop a convention to promote, protect and fulfil women’s rights. He called on Member States to ratify International Labour Organization Convention No. 190 on eliminating harassment and violence in the world of work. 

Aside from the African Union Chair’s handover from South Africa to the Democratic Republic of the Congo, the two-day assembly marked critical decisions on the implementation of the African Union’s institutional reform, including its Commission, and the election of four new commissioners. Moussa Faki Mahamat was re-elected as the African Union Commission Chairperson for a second four-year term and newly elected Monique Nsanzabaganwa, the first female in the history of the Commission, as his deputy. 

“I congratulate the President of the Democratic Republic of the Congo, Félix Tshisekedi, for taking the reins as the Chair of the African Union for 2021 and commend him for calling on his peers to sustain efforts in the AIDS response and strengthen health systems in Africa while we are still facing the COVID-19 pandemic. I reaffirm UNAIDS’ support to the African Union. Saving lives, tackling inequalities and advancing universal health care are lessons learned from AIDS to address current and future pandemics successfully,” said Clémence Aissatou Habi Baré, Director of the UNAIDS Liaison Office to the African Union and United Nations Economic Commission for Africa.

Like HIV, the COVID-19 pandemic thrives on inequalities and inequities. In addition to its impact on people’s health, the COVID-19 pandemic has resulted in significant increases in gender-based violence around the globe, including in the Middle East and North Africa.

Some countries in the region lack essential services for survivors of violence, especially in, for example, rural areas, conflict zones or humanitarian settings. Where services do exist, they do not always reach marginalized women and girls, and in many cases have been reduced or de-prioritized during the pandemic. Gender-based violence in the Middle East and North Africa is also sometimes not prioritized by the police and justice systems and many countries do not criminalize domestic violence, marital rape and other forms of gender-based violence that are particularly relevant in the region, such as female genital mutilation.

The United Nations Issue-Based Coalition on Gender, Justice and Equality is taking a twin-track approach to gender-based violence in the region, combining a programmatic response that prevents gender-based violence and supports survivors with the launch of a region-wide awareness campaign. The campaign uses the regional goodwill ambassadors of the coalition United Nations agencies to shed light on the risks that women and girls face as a result of the health crisis and to raise people’s awareness on how to counter gender-based violence and support survivors.

“Any form of violence against women and girls is a direct violation of human rights. I want to assure every violated woman and girl through this campaign that we are all with you,” said Yousra, UNAIDS Goodwill Ambassador for the Middle East and North Africa.

The joint campaign is an illustration of the strength of collaboration among United Nations agencies and what partnerships can do in building and empowering the global appeals and calls to action of the United Nations Secretary-General and the Spotlight Initiative, a global, partnership between the European Union and the United Nations to eliminate all forms of violence against women. The campaign leverages the ability of regional celebrities to reach local communities to raise awareness on the compounding impact of COVID-19 on gender-based violence and the vulnerabilities of marginalized and vulnerable groups.

“The response to COVID-19 in this region, and globally, has shown us that when we act in solidarity, in true partnerships and with a sense of shared responsibility, we can win against the intertwining health threats of COVID-19, HIV and the shadow pandemic of gender-based violence,” said Rangayian Gurumurthy, Director, a.i., of the UNAIDS Regional Support Team for the Middle East and North Africa.

“During COVID-19, most of us are confined in our homes with our partners. This has increased relationship problems, as well as social and economic problems. Many are subjected to violence from our close family or our intimate partner. That is why our nongovernment organization dedicated a hotline for psychological support,” said a woman living with HIV in the Islamic Republic of Iran.

This story was first published by WHO

In the first year of the Stronger Collaboration, Better Health: The Global Action Plan for Healthy Lives and Well-being for All (GAP), 12 signatory agencies have engaged with several countries to help them achieve their major health priorities. The initial focus has been on strengthening primary health care and sustainable financing for health.  Somalia is one of the countries where progress under the GAP is most advanced and where its added value has been most clearly demonstrated.

The Somalia country Director and Representative of the World Food Programme, Dr Cesar Arroyo underlined the vital importance of the GAP – through cementing collaboration among the 12 agencies: “The GAP initiative marks a crucial step towards solving health-related challenges in Somalia and offers us an opportunity to strengthen our partnerships across the humanitarian community thereby enhancing operational efficiency, particularly within the COVID-19 context and beyond”.

Three decades of civil war and instability have weakened Somalia’s health system and contributed to it having some of the lowest health indicators in the world. The situation varies from region to region but between 26-70% of Somalia’s 15 million people live in poverty and an estimated 2.6 million people have been internally displaced.

But the Government is committed to using current opportunities to strengthen health and social development. These include implementation of Somali National Development Plan for 2019–2024 and the Somali Universal Health Coverage (UHC) Roadmap, launched in September 2019.

Both plans identify primary health care as the main approach to improving health outcomes in the country.  Primary health care provides whole-person care for most health needs throughout the lifespan, ensuring that everyone can receive comprehensive care ─ ranging from health promotion and prevention to treatment, rehabilitation and palliative care ─ as close as possible to where they live.

Working together, the Government of Somalia, GAP agencies and multilateral and bilateral partners have identified 5 priorities for enhanced collaboration to accelerate progress towards UHC.

Says Monique Vledder, Head of Secretariat for the Global Financing Facility for Women, Children and Adolescents: “The launch of the Global Action Plan has helped accelerate momentum across global health agencies to align their support to country partners. In Somalia, the GFF has brought the spirit of the GAP from the global to the country level, convening partners across the federal and local governments, Somaliland, UN agencies, donors and civil society to establish the Health Sector Coordination Committee. Country stakeholders and GAP agencies are now building consensus around a priority package of essential services and critical health system reforms”.

Establishment of a health coordination mechanism
Efforts are underway to set up a coordination mechanism for all health partners to strengthen primary health care and fill gaps in services at the district level, building consensus around a priority package of essential services and critical health system reforms and mapping the availability of services and health workers.

Improving access to a package of high-quality essential health services
The country’s health services package is being updated with support from GAP agencies and other partners, with a focus on prevention and community-based components, communicable and noncommunicable diseases, and mental health.

Strengthening emergency preparedness and response through UHC
Somalia is prone to emergencies from natural disasters and disease outbreaks and is now responding to COVID-19. GAP agencies are exploring opportunities to support the finalization and implementation of components of a National Action Plan for Health Security, which includes strengthening of laboratory and early warning systems and ensuring that a package of essential health services and key commodities are effectively delivered in humanitarian settings.

Strengthening the role and capacity of the Ministry of Health
This is essential to address fragmented health service delivery and funding arrangements; improve institutional capacity for policy-making, regulation, coordination, planning, management and contracting; and use of data in decision-making.

Harnessing the private sector for UHC
Private health services and the pharmaceutical sector are largely unregulated in Somalia but could contribute to improving access and achieving UHC. GAP agencies are exploring opportunities to support the development and operationalization of a strategy for the private health sector, to assess its current role in service delivery and implementation of regulatory frameworks and contracting mechanisms.

“GAP provides us an opportunity to accelerate progress in achieving universal health coverage in Somalia through coordinated action and alignment with development partners and UN agencies. More than ever, we now need to push this agenda as we support the health systems of Somalia recover stronger and better from the COVID-19 pandemic“, said WHO Country Representative in Somalia, Dr Mamunur Malik.

“Our collective engagement in improving access to care for women, children, and other vulnerable groups will be decisive in improving health and well being in the country. Through an integrated, coordinated and collaborative approach such as the GAP, we can also build the required capacity of national and local health authorities to  deliver not only cost-effective health interventions using a primary healthcare approach, but also monitor and track porgress of the health-related indicators of sustainable development goal in the country", he added.

Although there are many health and social challenges in Somalia, the GAP is leveraging emerging opportunities to strengthen primary health care to support the country in achieving UHC and other health-related SDGs.  

To move these efforts forward, GAP agencies are collaborating with the Government to develop an operational plan. They aim to align this with the new funding that a number of agencies are providing for the response to COVID-19, to support the scale-up of primary health care, including implementation of the package of essential health services.

Hundreds of thousands of people around the world have been stranded abroad due to the bans on flights and border closures imposed to stop COVID-19. As elsewhere, thousands of non-nationals have been stranded in Egypt indefinitely.

Travel restrictions have had many repercussions on the daily lives of non-nationals, putting significant economic pressure on them and potentially putting their well-being at risk.  

The UNAIDS Country Office for Egypt has been working on COVID-19 from the start of the pandemic in the country, establishing a direct line of communication with the National AIDS Program and working with it to ensure the continuation of HIV treatment by everyone on it and to help non-nationals in Egypt to get supplies of antiretroviral therapy.

Sophia Bianchi (not her real name) is an Italian tourist stranded in Sharm El Sheikh. “I ordered my antiretroviral treatment in late April from Italy via a courier service. Unfortunately, the shipment was stuck at the airport customs in Cairo for weeks. I contacted UNAIDS and they have been very helpful, following up daily with the Egyptian Ministry of Health and Population to get approval for releasing the shipment and checking on me and my health. They kept pushing through the Eid holidays and it all got resolved in two weeks. It was a stressful time but now I am relieved,” she said.

Antiretroviral therapy is available in Egypt free of charge to all nationals and registered refugees. However, as there is no community-based dispensing, nor private market purchase of antiretroviral medicines, gaps remain in ensuring that non-nationals can access treatment. For this reason, UNAIDS’ work during the COVID-19 pandemic has been essential in bridging the gaps.

There are strict rules on the dispensing of antiretroviral therapy in Egypt—only close family members are able to collect it from the dispensing centre. For Fatima Ahmed (not her real name), a refugee from Yemen who because of chronic illnesses that put her at higher risk from COVID-19 cannot leave her house, this was a significant barrier to accessing her HIV treatment. UNAIDS got in contact with the Egyptian Ministry of Health and Population to get an exceptional approval to dispense her medicine through a nongovernmental organization.

“I have not left the house for more than three months. My family has not been able to support me financially, so I was left without revenue. Thanks to the support of the National AIDS Program and MENA Rosa, a nongovernmental organization, peer supporters have delivered three months of antiretroviral treatment to my doorstep,” said Ms Ahmed.

However, much still remains to be done in reaching out to the most in need in Egypt. UNAIDS in Egypt has been advocating for the right to health and universal health coverage for everyone and is working in partnership with the Egyptian Ministry of Health and Population to ensure treatment for all nationals and non-nationals in the country.

“We believe in the absolute right of everyone to have access to their basic right to health. Ensuring access to antiretroviral therapy during these exceptional times is therefore our upmost priority. We are working relentlessly with our governmental and nongovernmental partners to build long-term policies to ensure treatment and care services for people living with HIV during times of emergency,” said Walid Kamal, the UNAIDS Country Director for Egypt. 

“For five years I have been subjected to harassment and threats—rape threats, murder threats, vilification, character assassination, phone calls to my family, to my mom,” said Lebanese television anchor Dima Sadek.

To raise public awareness about sexual harassment and bullying in Lebanon, particularly against female journalists during the recent protests, the Arab Foundation for Freedoms and Equality—UNAIDS’ regional partner on rights and health—has produced a video that sheds light on this human rights abuse committed against many women in the country.

Made in partnership with the HIVOS Women Empowered for Leadership (WE4L) programme, with funding from the Dutch Ministry of Foreign Affairs, the video highlights cases of harassment and assault—reporters whose bodily autonomy has been violated, whose personal telephone numbers have been leaked and who subsequently received rape threats and pornography and who have been verbally and physically attacked while live on television.

“You don’t expect that someone could be this hurtful or that they could say such things. You don’t know them and they don’t know you, but because you differ on politics, they feel they are allowed to talk to you in this way,” said Layal Saad, a reporter.

Since similar attacks, including online bullying and harassment both online and offline, have also been reported by female protesters, the video also seeks to raise awareness about the everyday sexual harassment, bullying and violence that women in general are subjected to, emphasizing the need for policies that allow women to become leaders.

Diana Moukalled, a journalist, explained that legal protection against sexual harassment is needed, since at present there are no laws that criminalize sexual harassment in Lebanon. “Lebanese women are among the most politically marginalized in the world, not just in the region. We see women present on many levels, yet there is a sharp discrepancy between the role of Lebanese women and their representation,” she said.

The video’s title is We Carry On, echoing the sentiment of the many women who watched and reacted to it—a feeling of resilience in the face of adversity and a determination to achieve the social justice demanded by women in Lebanon.