Women account for one in every three people who use drugs worldwide and tend to progress to drug use disorders in a shorter time than men. There is limited understanding of the situation of women who use drugs in the Middle East and North Africa. A multi-stakeholder rapid situation assessment (RSA) was conducted which aimed to investigate gendered and contextual vulnerabilities and service level responsiveness to the needs of women who use drugs (WWUD) in Egypt. An updated profile of female service user characteristics was sought via mapping of addiction and harm reduction services in the National Drug Observatory system. In-depth interviews were conducted with a purposive sample of representatives of UN agencies and health professionals providing treatment/harm reduction (government, private, community) (n = 21). Focus groups were facilitated with a convenience sample of women in treatment, accessing HIV services and community harm reduction services (n = 75). Thematic analysis and triangulation across data sources occurred. Eight themes emerged: profile of women who use drugs; access to drugs and settings for female drug use; dimensions of stigma; trauma and drivers of female drug use; networks and intimate partner relationships; high-risk behaviours and harms; barriers to help-seeking and accessing services; and enhancing gender-responsive and gender-transformative evidence-based services. This RSA yields a contemporary insight into the vulnerabilities, traumas, discrimination and stigma-related challenges experienced by WWUD in Egypt. Recommendations are made to enhance harm reduction awareness and uptake and to integrate gender-responsive care within existing maternal, addiction and harm reduction service structures.