A/79/177 experience of crises depends heavily on such intersecting factors as: age; sex or gender; migration or displacement status; race, ethnicity or national origin; sexual orientation; disability status; and social and economic status. During a crisis, as resources become more limited and controlled by those with power, mental and physical health risks increase along with the prevalence of violence, and access to health, education and social services becomes diminished. Further, crises are often used as a pretext to increase the policing or criminalization of already vulnerable or marginalized populations, often adding to, rather than mitigating, the harms of the crisis itself. Given the risks associated with climate change, technological advancements, and humanitarian settings, the intersection between crises and harm reduction is critically important. 88. In the context of people who use drugs, the COVID-19 pandemic meant that people often lost access to harm reduction services that were not considered “essential”, or were in situations in which lockdowns and other restrictive measures prevented them from accessing services. 189 Supply chain disruptions of medicines, including antiretroviral treatment for people living with HIV/AIDS, anti -tuberculosis drugs, antiviral and interferon drugs for hepatitis, and naloxone, caused shortages, leading to access issues and higher prices. 190 Meanwhile, lockdowns and isolation exacerbated situations of stress, trauma and abuse that are associated with drug use and drug use disorder. 191 89. At the same time, some Governments and service providers – especially peerled services – demonstrated an incredible resolve and agility. For example, 47 of the 84 countries that provide opioid substitution therapy provided expanded take -home supplies in 2020, and 23 countries provided home delivery or dosing through pharmacies or outreach programmes, so as to ensure continued access. 192 Switzerland has continued the harm reduction policy of permitting take-home distribution of diacetylmorphine for the treatment of opioid use disorder, following a relaxation of rules during the COVID-19 pandemic, because the approach proved effective. 193 90. Realizing sexual and reproductive rights is challenged during crises and emergencies, especially where criminalization or stigmatization is pre -existing. During the COVID-19 pandemic, some countries restricted access to abortion care, including by designating abortion as “non-essential” in order to delay or cease procedures, requiring abortion clinics to close, or banning the use of telemedicine for abortion. 194 Meanwhile, abortion restrictions were eased in at least 11 countries during the pandemic, including by raising gestational limits, omitting waiting periods and enabling the use of telemedicine for abortion. 91. Crises and humanitarian settings bring increased risks with respect to maternal mortality and morbidity; child, early and forced marriage; sexual and gender -based violence; and human trafficking. Importantly, States’ human rights obligations to respect, protect and fulfil sexual and reproductive health rights extend to conflict and emergency settings, 195 including, for example, obligations to ensure access to services __________________ 189 190 191 192 193 194 195 20/28 Laura Grau-López and others, “COVID-19 lockdown and consumption patterns among substance use disorder outpatients: a multicentre study”, European Addiction Research, vol. 28, No. 4 (June 2022). Harm Reduction International, The Global State of Harm Reduction 2022, 8th ed. (London, 2022). Grau-López and others, “COVID-19 lockdown and consumption patterns”. Harm Reduction International, The Global State of Harm Reduction 2020 (London, 2020); and submission from UNAIDS. Submission from Switzerland. Isabella Ong and others, “The global impact of COVID-19 on abortion care”, Heliyon, vol. 9, No. 5 (May 2023). Committee on the Elimination of Discrimination against Women, general recommendation, No. 30 (2013). 24-13226