MORNING - Human Rights Council Starts Dialogue on Drug Use, Harm Reduction and the Right to Health, and Concludes Discussion on Prostitution and Violence against Women
The Human Rights Council this morning started an interactive dialogue with the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, and concluded an interactive dialogue with the Special Rapporteur on violence against women and girls, its causes and consequences.
Opening the meeting, Omar Zniber, President of the Human Rights Council, noted that today marked the International Day of Women in Diplomacy. The day was designated by the General Assembly two years ago to recognise achievements in increasing the presence and participation of women in diplomacy, while acknowledging there was still a long way to go to reach true gender parity in diplomacy and leadership positions.
Tlaleng Mofokeng, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, presented her report on drug use, harm reduction and the right to health. She said the report focused on how the availability, accessibility and quality of care was affected by punitive approaches and explored how drug control disproportionately affected certain rights and individuals. The failure to adopt a human-rights based approach to addressing drug use had negative impacts, especially on those in vulnerable situations. Ms. Mofokeng said she supported the full decriminalisation of drug use, saying it was important to end the “war on drugs”, as it was a war on people.
Ms. Mofokeng also presented reports on her visits to Luxembourg and Costa Rica, and those States took the floor as countries concerned.
In the ensuing dialogue, speakers said, among other things, that the criminalisation of people with drug use disorder prevented them from accessing much-needed treatment and therapy, leading to poor community health. The removal of structural barriers to accessing services would bring better health outcomes for individuals and society. Many speakers outlined their national commitments to providing harm reduction and preventative strategies which guaranteed the health and wellbeing of all citizens. These included drug strategies, political frameworks and priorities; community collaboration; Methadone replacement therapy, and needle and syringe programmes in prisons; and post treatment reintegration of addicted persons.
Speaking in the interactive dialogue on the right to health were the European Union, Egypt on behalf of the Group of Arab States, Qatar on behalf of the Cooperation Council for the Arab States of the Gulf, Pakistan on behalf of the Organization of Islamic Cooperation, Cabo Verde on behalf of Community of Portuguese Language Countries, Gambia on behalf of the Group of African States, Iceland on behalf of a group of countries, Türkiye on behalf of a group of countries, Paraguay on behalf of a group of countries, Chile, Portugal, Kuwait, United Nations Children's Fund, Armenia, Israel, Egypt, Morocco, United Arab Emirates, Maldives and France.
At the beginning of the meeting, the Council concluded its interactive dialogue with the Special Rapporteur on violence against women and girls, its causes and consequences, Reem Alsalem. The interactive dialogue started in the previous meeting and the summary can be found here.
In concluding remarks, Ms. Alsalem said many of those in prostitution had entered it as girls. The overwhelming majority were not aware of the exploitation they had faced and had not been able to exit. Focusing on a tiny minority who were free in prostitution allowed States to get away with not addressing underlying causes which pushed women to prostitution. Ms. Alsalem said she supported decriminalising women in prostitution. However, she said she and 150 countries agreed that legalising all aspects of prostitution created more violence. The evolutionist model offered the best gender-sensitive approach, she said, calling for it to be applied comprehensively.
In the discussion, many speakers condemned all forms of violence against women and girls and exploitation, and presented international and domestic laws, national action plans and programmes addressing violence against women and girls. Some speakers said that they had implemented laws banning prostitution and pimping to protect women. They said that prostitution legalised the sexual abuse of persons and needed to be banned. Other speakers argued for the decriminalisation of prostitution, which strengthened protections for sex workers and improved their working conditions. Some speakers expressed regret that the report did not reference a diverse range of women’s voices calling for decriminalisation. The report, they said, denied the agency and autonomy of sex workers, who deserved labour rights.
Speaking in the dialogue were Bangladesh, Ethiopia, Democratic Republic of the Congo, Colombia, China, United Arab Emirates, Russian Federation, France, Croatia, Malaysia, Sovereign Order of Malta, Cyprus, Côte d'Ivoire, Tunisia, Albania, Qatar, Senegal, Holy See, Togo, Cuba, Paraguay, Austria, Yemen, Zimbabwe, Djibouti, Tanzania, Ghana, Afghanistan, Romania, Venezuela, Angola, South Africa, Mali, Sudan, New Zealand, Burkina Faso, Malawi, Mozambique, Niger, Lebanon, Antigua and Barbuda, Botswana, Namibia, Cambodia, Luxembourg, India, Ukraine, Panama, State of Palestine, Nepal, World Health Organization, Gabon, Switzerland, Benin and Barbados.
Also speaking were International Planned Parenthood Federation, Equality Now In Person, AKAHATÁ Equipo de Trabajo en Sexualidad y Géneros Asociación Civil, Global Alliance against Traffic in Women, Action Canada for Population and Development , Asia Pacific Transgender Network, International Women’s Rights Action Watch Asia Pacific, Women Deliver, Inc., Global Network of Sex Work Projects Limited, and Federatie van Nederlandse Verenigingen tot Integratie Van Homoseksualiteit - COC Nederland.
The webcast of the Human Rights Council meetings can be found here. All meeting summaries can be found here. Documents and reports related to the Human Rights Council’s fifty-sixth regular session can be found here.
The Council will reconvene at 3 p.m. this afternoon when it will continue its interactive dialogue with the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, before commencing an interactive dialogue with the Special Rapporteur on the right to education.
Interactive Dialogue with the Special Rapporteur on Violence against Women and Girls, its Causes and Consequences
The interactive dialogue with the Special Rapporteur on violence against women and girls, its causes and consequences started in the previous meeting and a summary can be found here.
Discussion
Continuing the discussion, some speakers, among other things, said prostitution resulted in various violations of the rights of women and girls. It was alarming that prostitution, exploitation and trafficking of women and girls was becoming more prevalent worldwide. One in three women worldwide experienced violence, one speaker said.
Many speakers said the international community needed to take prompt, concrete steps to address all forms of violence against women and girls and pursue education and awareness of women’s rights to deal with the underlying causes. States had the responsibility to offer support to victims and address stigmatisation. They also needed to work with offenders to prevent reoffence and address the root causes of prostitution and sexual abuse of women. All of society needed to respond to the damaging effects of prostitution and hold persons responsible to account.
Some speakers said it was important to fight the abuse of girls online. The ease of purchasing sex online had fed into the cycle of abuse of women and girls and trafficking. Around 75 per cent of trafficking cases were today facilitated by digital technologies. Digital tools created anonymity of victims. Efforts needed to be stepped up to deal with transborder cybercrimes. Some speakers also expressed concern about the prevalence of deep-fake pornography and its impact on women and girls, calling on the international community to take measures to address it.
Some speakers said that the abuse of girls in some countries in the global South was linked to sex tourism and racism. The use of girls in prostitution should be condemned by all States. The root causes of the phenomenon needed to be addressed.
The issue of violence against women was exacerbated by armed conflict in States and territories, some speakers said. They expressed concern about violence against women and girls being used as a weapon of war. The stories of women victims of abuse in conflict were heart-wrenching. Speakers called for increased efforts to prevent such abuse.
Speakers condemned all forms of violence against women and girls and exploitation, and presented international norms that helped to protect women and girls from the dangers of prostitution. They also presented domestic laws, national action plans and programmes addressing violence against women and girls, protecting women’s rights and supporting victims of trafficking and violence. Some speakers expressed support for a proposed Optional Protocol to the Convention on the Elimination of All Forms of Discrimination against Women and an independent treaty relating to violence against women and girls.
Some speakers said that they had implemented laws banning prostitution and pimping to protect women. They said that prostitution legalised the sexual abuse of persons and needed to be banned. Some speakers agreed with the Special Rapporteur’s view that prostitution was a form of systematic violence against women enabled by patriarchal norms. Sex workers faced significant health and safety risks. Prostitution commodified women and girls and exacerbated inequalities, disproportionately affecting minorities. Some speakers commended the Special Rapporteur’s work and report and welcomed her for a country visit.
A number of speakers presented an abolitionist view, arguing for the decriminalisation of prostitution, which strengthened protections for sex workers and improved their working conditions. Only by strengthening the rights of sex workers could States prevent violence against them. Prohibition did not prevent such abuse; it forced women to perform sex work in a more dangerous environment and increased the prevalence of sexually transmitted diseases and other health risks for sex workers. Some speakers expressed regret that the report did not reference a diverse range of women’s voices calling for decriminalisation, including non-governmental organizations and sex workers. One speaker said it was not appropriate for States to be qualified as “pimping States”.
Some speakers described the report as stigmatising, as it did not reference decades of research or the voices of sex workers. It promoted policies that facilitated violations of sex workers’ rights and ignored their plight. The report denied the agency and autonomy of sex workers. It conflated sex work with abuse of women and trafficking. Sex work needed to be recognised as a job and stigmatisation of sex workers needed to be addressed. Sex workers deserved labour rights. The report dangerously conflated the needs of adults and children and ignored transgender survivors of abuse. Sex workers deserved the right to make decisions about their bodies and livelihood. Some speakers expressed regret that the report used the stigmatising term “prostitute” rather than “sex worker”.
One speaker said that the report did not address families and their role in bringing up children. The speaker called on the Special Rapporteur to base her views on internationally accepted legal norms.
Some speakers asked the Special Rapporteur to reflect on the causal link between prostitution and limited access to the right to development; how to reduce victims’ fears and barriers to reporting violence to police; how to address the growing challenges of online sexual abuse and trafficking of women; how to create legislation to address the phenomenon of pornography generated by artificial intelligence; and how States could better protect women from exploitation.
Speakers also inquired about whether the Special Rapporteur would consider the impact of surrogacy in a future report; best practices for addressing cybercrime and trafficking facilitated by digital technologies; ways of addressing systemic barriers to accessing justice; the role of educational institutions in addressing violence against women; examples of non-punitive exit programmes for sex workers; possible synergies to improve the global fight against prostitution; what more could be done to provide technical assistance to developing States to prevent violence against women and girls; best practices for addressing the trauma of victims in the digital age; and meaningful steps to promote the re-entry of victims into their communities.
Concluding Remarks
REEM ALSALEM, Special Rapporteur on violence against women and girls, its causes and consequences, in closing remarks, thanked speakers expressing their support for her mandate. Her mandate also covered girls. Three hundred submissions were received during the call for input, which collectively mentioned 60 countries in seven regions. Of those, 24 governments had sent submissions and many more were made by United Nations agencies and civil society. A third of civil society who sent input wanted prostitution to be recognised as “sex work”. Many had called for the criminalisation of prostitution but did not have the resources to visit Geneva. The report was one of the most footnoted Council thematic reports and she had reviewed every submission. These were available to be reviewed online.
Many organizations of persons in prostitution were also instrumentalised by pimps and traffickers; often former prostituted women were recruited as pimps. This reality needed to be taken into account. States should involve the full spectrum in prostitution irrespective of their position when it came to designing policies. Most of the victims’ and survivors of prostitution rejected the term “sex work” because they believed it gaslighted them and trivialised the violence to which they had been subjected. Terminology needed to reflect minimum agreed-on terms by States. Ms. Alsalem said she categorically rejected sex work and sex worker terms, but other human rights sensitive terminology could be used. The term victim was not derogatory; it was a legal status which meant women and girls in prostitution had been wronged and deserved accountability and reparations.
Many of those in prostitution had entered into it as girls and therefore consent was not appropriate in this context. The overwhelming majority were not aware of the exploitation they had faced and had not been able to exit because of safety considerations or the lack of other opportunities. By continuing to focus on a tiny minority who were free in prostitution, this allowed States and societies to get away without addressing underlying causes which pushed women in prostitution; there was an urgency to address this human rights crisis.
Ms. Alsalem agreed with organizations choosing to decriminalise women in prostitution. She and 150 countries also agreed that legalising all aspects of prostitution created more violence and was not the correct approach. Focusing only on an anti-trafficking approach to abolish prostitution had produced little result. It had not helped women exit prostitution or addressed the root causes. The evolutionist model offered the best human rights and gender-sensitive approach in response to prostitution. This needed to be applied comprehensively and not in piecemeal. The European Union parliament resolutions of 2014 and 2023 on prostitution were best practices. Ms. Asalem was surprised many European speakers had not referred to them.
Businesses, including media, tourism and travel had a clear human rights obligation and needed to be held accountable. Pornography sites must open themselves up to law enforcement, to assess anti-trafficking risk. Transgender persons and their organizations were invited to the consultations but given the limited word count, she had preferred to focus on issues common to all women and girls, irrespective of gender identity or sexual orientation.
Interactive Dialogue with the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health
Reports
The Council has before it the reports of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, on drug use, harm reduction and the right to health (A/HRC/56/52), and on her visit to Luxembourg (A/HRC/56/52/Add.1) and her visit to Costa Rica (A/HRC/56/52/Add.2).
Presentation of Reports
TLALENG MOFOKENG, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, said her fourth thematic report to the Council focused on drug use, harm reduction and
the right to health. Her intervention would also focus on two country visits to Luxembourg and to Costa Rica. It was crucial to distinguish between drug use and drug use disorders; drug use was not a medical condition. Drug use disorders, including drug dependency, were medical conditions thus requiring appropriate support and treatment. The report focused on how the availability, accessibility and quality of care was affected by punitive approaches and explored how drug control disproportionately affected certain rights and individuals.
The failure to adopt a human-rights based approach to addressing drug use had negative impacts, especially on those in situations of homelessness or poverty, people with mental health conditions, sex workers, women, children, persons living with HIV, and people living in rural areas, among others. Criminalisation was a single option within a regulatory spectrum. Regulatory frameworks needed to be cohesively developed by States, dependent on scientific evidence and without undue influence from corporations. All measures necessary to implement the Nelson Mandela Rules should be taken. In addition, the Bangkok Rules and the Beijing Rules were applicable to women and children deprived of their liberty.
Women who used drugs were subject to higher rates of violence. Thus, the integration of harm reduction services with those for gender-based violence and sexual and reproductive health was required. About 1 in 10 new HIV infections resulted from drug use by injection, yet over 92 countries had criminal laws relating to HIV. Ms. Mofokeng urged all States to adhere to human rights principles when negotiating the resolution on ‘human rights in the context of HIV and AIDS.’ For both conflict and non-conflict emergency situations, access to controlled medicines was a key element of the right to health. The discriminatory perceptions of pain and who “deserved” relief, led to a failure to ensure access to essential medicines for pain relief and drug use disorders and threatened the realisation of the rights to health.
Harm reduction included a wide range of policies, programmes and practices aimed at minimising the negative health, social and legal impacts associated with drug use, drug laws and policies. Harm reduction measures also focused on the removal of criminal penalties for drug offences. Ms. Mofokeng said she supported the full decriminalisation of drug use, saying it was important to end the ‘war on drugs’ as it was a war on people. States should evaluate the possibility to create a mechanism mandated to monitor the situation of drug policies and human rights.
Ms. Mofokeng extended gratitude to the Governments of Luxembourg and Costa Rica for inviting her to assess the realization of the right to health in their countries.
On her visit to Luxembourg, she commended the authorities for the project adopted in October 2022 on Universal Healthcare Coverage, aiming to ensure access to basic health care for vulnerable groups of the population that did not have compulsory health insurance. She commended the authorities for the adoption of the agreement between the Government and the National Health Funds implemented as of April 2023, which ensured access to contraceptives and without age limit. However, the administrative burden placed on some associations was large and the basis for many interactions between ministries and departments was trust and dependency on individual relationships, arising from Luxembourg being a small country. It would be beneficial if the agreements between entities could be codified into law to ensure the perennity of good practices. There was also a need to ensure the quality and timely collection of appropriately disaggregated data to inform public policies.
Regarding the visit to Costa Rica, Ms. Mofokeng was pleased to learn about the efforts the Government had made since 2016 to move towards universal healthcare coverage and the inclusion of an important number of persons belonging to marginalised groups. The country’s efficient response to the COVID-19 pandemic was made possible by historical investment and political support for the health system. During interviews, including a visit to a mental health facility, there was an overall agreement that mental health was under strain, both regarding the experiences of the population and the response of the health system. Ms. Mofokeng urged a move to full decriminalisation of abortion; criminal and
legal restrictions were discriminatory in nature.
In concluding remarks, Ms. Mofokeng said she looked forward to continued cooperation to ensure everyone throughout the world could realise the full enjoyment of the right to the highest attainable standard of physical and mental health.
Statements by Countries Concerned
Costa Rica, speaking as a country concerned, said Costa Rica was grateful for the recognition throughout the report of some positive actions, good practices and some efforts made in the country in the field of health. However, the report did not fully reflect the reality in this area.
The promotion and protection of the human right to health had been a fundamental pillar in the development of Costa Rica. Investment in health was among the highest in the region and the State had made efforts for decades to achieve universal access to the health care system. Almost 95 per cent of the population was covered by health insurance; public spending in this area ranged between 5.3 and 5.6 per cent of gross domestic product. Social security was incorporated into all health services; it assisted persons in extreme poverty and at all levels of society. Comprehensive health insurance was provided to refugees and asylum seekers. There was a law establishing a comprehensive response to HIV in public and private areas. The State was combatting discrimination based on sexual orientation and gender identity so that all persons, including vulnerable groups, could enjoy the highest level of physical and mental health.
Costa Rica had modernised its approach to free health provision, including the provision of reproductive health services and contraception. Teenage pregnancy had dropped because of these efforts. Measures had also been implemented to reduce mother and child mortality rates. Costa Rica would continue to make efforts to promote human rights. The State had confronted a range of challenges after the COVID-19 pandemic and was continuing to address these.
Luxembourg, speaking as a country concerned, expressed its full support for the Special Rapporteur’s mandate. It had warmly welcomed the Special Rapporteur’s visit. The Special Rapporteur held some 15 meetings with State actors and Luxembourg civil society. The visit took place in the wake of the COVID-19 pandemic, which was particularly devastating and cost a significant number of lives. The response to the pandemic demonstrated the resilience of Luxembourg's health system, a system that was person-centred, inclusive and accessible. Luxembourg was fully committed to achieving the objective of universal health coverage and guaranteeing access to health care, especially for the most vulnerable populations.
The State’s health action plans were the subject of a mid-term evaluation by external and international experts, the results of which were made public. The Directorate of Health was also planning an evaluation of health promotion and prevention programmes, which should be conducted every four years. Luxembourg took note of the Special Rapporteur’s observations regarding the administrative burden placed on non-governmental organizations, but noted that administrative processes aimed to ensure transparency regarding the use of Government funds. In all sectors, Luxembourg aspired to make its administrative procedures as simple and efficient as possible.
Luxembourg was committed to building a fairer, more open and inclusive society, both nationally and internationally. It offered services through contracted partners covering multiple themes related to both mental and physical health. The State welcomed cooperation between the various State and non-State bodies. It took due note of the recommendations made in the report, and would redouble efforts to strengthen the right to access to health, including mental health.
Discussion
In the discussion, some speakers, among other things, thanked the Special Rapporteur for her report and commended her efforts in ensuring the right to health for all. Her report advocated the need to take a human rights-based and evidence-based approach to drug policy, and the utilisation of harm reduction in relation to drug use. Drug use was a significant public health concern which exacerbated inequalities and disproportionately affected persons in vulnerable situations. The criminalisation of people with drug use disorder prevented them from accessing much needed treatment and therapy, leading to poor community health. The removal of structural barriers to accessing services would bring better health outcomes for individuals and society.
Many speakers said they supported the Special Rapporteur’s call for the provision of non-discriminatory and gender-responsive harm-reduction services, which would take into account the disproportionate impact on those in most vulnerable and marginalised situations. A human rights-based approach to this issue was vital; equitable and universal access to health services was a fundamental right. There was a need to develop health systems capable of providing quality care for all, including the promotion of mental health. Governments had a responsibility to strengthen effective public policies that guaranteed the inclusion, care, respect and non-discrimination of people who used drugs.
Some speakers condemned the acts of international crimes against hospitals in conflict zones. The protection of health establishments was of paramount importance; the targeting of healthcare systems and medical facilities must end.
Many speakers outlined national commitments to providing harm reduction and preventative strategies which guaranteed the health and wellbeing of all citizens. These included drug strategies; political frameworks and priorities; community collaboration; strategic health plans; integrating mental health into primary health care; Methadone replacement therapy, and needle and syringe programmes in prisons; and post treatment reintegration of addicted persons, among others.
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