The challenges of tuberculosis control in protracted conflict: The case of Syria
Objectives: Syria’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 conf...
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doaj-c141731659b54cf996b406234e234e2f2020-11-25T02:33:20ZengElsevierInternational Journal of Infectious Diseases1201-97122020-01-01905359The challenges of tuberculosis control in protracted conflict: The case of SyriaAula Abbara0Mohamed Almalla1Ibrahim AlMasri2Hussam AlKabbani3Nabil Karah4Wael El-Amin5Latha Rajan6Ibrahim Rahhal7Mohammad Alabbas8Zaher Sahloul9Ahmad Tarakji10Annie Sparrow11Imperial College, London, UK; Corresponding author at: Department of Infection, St Mary’s Hospital, Praed Street, Paddington, London W2 1NY, UK.American University of Beirut, Beirut, LebanonO’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, CanadaDepartment of Health and Nutrition Al-Ameen for Humanitarian Support, Gaziantep, TurkeyDepartment of Molecular Biology, Laboratory for Molecular Infection Medicine Sweden, and Umea Centre for Microbial Research, Umea, SwedenKing’s College Hospital London, United Arab EmiratesTulane University School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USAHand in Hand for Aid and Development, Gaziantep, TurkeyHand in Hand for Aid and Development, Gaziantep, TurkeyDepartment of Pulmonology and Critical Care, University of Illinois, Chicago, IL, USASyrian American Medical Society, Washington DC, USADepartment of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, USAObjectives: Syria’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. Results: Forced mass displacement and systematic violations of humanitarian law have resulted in overcrowding and the destruction of key infrastructure, leading to an increased risk of both drug-sensitive and resistant TB, while restricting the ability to diagnose, trace contacts, 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 affect the diagnosis of multidrug- and rifampicin-resistant TB, reported as comprising 8.8% of new diagnoses in 2017. Conclusions: The control 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. Keywords: Tuberculosis, Syria, Conflict, Refugees, Drug resistance, Prisoners, Besiegementhttp://www.sciencedirect.com/science/article/pii/S1201971219304084 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Aula Abbara Mohamed Almalla Ibrahim AlMasri Hussam AlKabbani Nabil Karah Wael El-Amin Latha Rajan Ibrahim Rahhal Mohammad Alabbas Zaher Sahloul Ahmad Tarakji Annie Sparrow |
spellingShingle |
Aula Abbara Mohamed Almalla Ibrahim AlMasri Hussam AlKabbani Nabil Karah Wael El-Amin Latha Rajan Ibrahim Rahhal Mohammad Alabbas Zaher Sahloul Ahmad Tarakji Annie Sparrow The challenges of tuberculosis control in protracted conflict: The case of Syria International Journal of Infectious Diseases |
author_facet |
Aula Abbara Mohamed Almalla Ibrahim AlMasri Hussam AlKabbani Nabil Karah Wael El-Amin Latha Rajan Ibrahim Rahhal Mohammad Alabbas Zaher Sahloul Ahmad Tarakji Annie Sparrow |
author_sort |
Aula Abbara |
title |
The challenges of tuberculosis control in protracted conflict: The case of Syria |
title_short |
The challenges of tuberculosis control in protracted conflict: The case of Syria |
title_full |
The challenges of tuberculosis control in protracted conflict: The case of Syria |
title_fullStr |
The challenges of tuberculosis control in protracted conflict: The case of Syria |
title_full_unstemmed |
The challenges of tuberculosis control in protracted conflict: The case of Syria |
title_sort |
challenges of tuberculosis control in protracted conflict: the case of syria |
publisher |
Elsevier |
series |
International Journal of Infectious Diseases |
issn |
1201-9712 |
publishDate |
2020-01-01 |
description |
Objectives: Syria’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. Results: Forced mass displacement and systematic violations of humanitarian law have resulted in overcrowding and the destruction of key infrastructure, leading to an increased risk of both drug-sensitive and resistant TB, while restricting the ability to diagnose, trace contacts, 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 affect the diagnosis of multidrug- and rifampicin-resistant TB, reported as comprising 8.8% of new diagnoses in 2017. Conclusions: The control 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. Keywords: Tuberculosis, Syria, Conflict, Refugees, Drug resistance, Prisoners, Besiegement |
url |
http://www.sciencedirect.com/science/article/pii/S1201971219304084 |
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