# Tuberculosis: The insidious threat that compromises health in post-Assad Syria

## TL;DR

This paper discusses how the Syrian conflict has worsened tuberculosis control, highlighting vulnerable groups and the need for a restored health system.

## Contribution

The paper emphasizes the importance of re-establishing Syria’s National TB Program and addressing social determinants to control TB in post-conflict settings.

## Key findings

- Health system fragmentation during the conflict increased TB transmission and hindered case detection.
- Vulnerable populations like displaced people and former detainees face higher TB risks.
- Restoring the National TB Program and addressing social factors are critical for TB control.

## Abstract

•Conflict is detrimental to tuberculosis (TB) control due to health system impacts.•Particularly vulnerable populations include the forcibly displaced and former detainees.•Re-establishing Syria’s national TB program is essential to monitor and control TB.•Addressing social determinants in Syria is important to prevent further increases.•Improving healthcare access, targeted screening and active case finding are key.

Conflict is detrimental to tuberculosis (TB) control due to health system impacts.

Particularly vulnerable populations include the forcibly displaced and former detainees.

Re-establishing Syria’s national TB program is essential to monitor and control TB.

Addressing social determinants in Syria is important to prevent further increases.

Improving healthcare access, targeted screening and active case finding are key.

This perspective explores the state of tuberculosis (TB) after the prolonged conflict in Syria and fall of the regime in December 2024; we discuss key considerations in light of multiple competing health priorities within Syria’s borders and the recovering health system. During the conflict, the health system fragmentation under differing geopolitical control led to unequal access to TB prevention, diagnostics and management social determinants such as poverty, malnutrition, inadequate water and sanitation, and lack of proper shelter, along with risks associated with disadvantaged groups, including internally displaced people, detainees, former detainees, and rural communities, not only increase the risk of TB transmission and the activation of latent infections but also hinder active case finding. Tackling these risks requires re-establishing the National TB Program (NTP) across the country, which acts equitably across all geographical areas to identify new cases, support robust surveillance activities, ensure drug resistance is identified promptly, and monitor treatment. Leadership from the Ministry of Health and the World Health Organization, with support from other stakeholders e.g., humanitarian, civil society or private sector can support the NTP and optimize health worker education and referral pathways. Beyond this, addressing the social determinants, which contribute to TB in Syria, is an essential component of TB control in post-conflict Syria.