The challenges of tuberculosis control in protracted conflict: the case of Syria.

Abstract

OBJECTIVES\nSyria s protracted conflict has resulted in ideal conditions for the transmission of tuberculosis (TB) and the cultivation of drug resistant strains. This paper compares TB control in Syria before and after the conflict using available data, examines the barriers posed by protracted conflict and those specific to Syria, and discusses what measures can be taken to address the control of TB in Syria.\n\n\nRESULTS\nForced mass displacement and systematic violations of humanitarian law have resulted in overcrowding and has destroyed key infrastructures leading to an increased risk of both sensitive and drug resistant TB while restricting the ability to diagnose, contact trace, treat and follow up. Pre-conflict, TB in Syria was officially reported at 22 per 100,000 population; the official figure for 2017 of 19 per 100,000 is likely a vast underestimate given the challenges and barriers to case detection. Limited diagnostics also affects the diagnosis of multidrug and rifampicin resistant TB which is reported at 8.8% of new diagnoses in 2017.\n\n\nCONCLUSION\nControl of TB in Syria requires a multipronged, tailored and pragmatic approach to improve timely diagnosis, increase detection, stop transmission and mitigate the risk of drug resistance. Solutions must also consider vulnerable populations such as imprisoned and besieged communities where the risk of drug resistance is particularly high and must recognize the limitations of national programming. Strengthening capacity to control TB in Syria with particular attention to these factors will positively impact other parallel conditions; this is key as attention turns to post-conflict reconstruction.