🦠 The ongoing war in Ukraine has created a serious new threat to tuberculosis (TB) control in Europe, just as healthcare systems were beginning to recover from the disruptions of the COVID-19 pandemic. According to a recent report by the Global Tuberculosis Network, published in the European Respiratory Journal, TB control efforts—particularly for multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains—face mounting challenges in the wake of armed conflict, mass displacement, and healthcare disruption.

📊 A Fragile Victory Undermined by War

Between 2010 and 2020, countries like Ukraine and Russia achieved notable reductions in TB incidence and mortality, with Russia seeing an average 10% annual decline in TB deaths. However, despite this progress, the eastern European region remains the epicenter of the global MDR-TB burden.

• Ukraine and Russia rank 5th and 2nd globally for XDR-TB prevalence.
• Drug-resistant TB and TB-HIV co-infection rates remain alarmingly high.
• In Ukraine, 22% of TB patients are also HIV-positive, compounding treatment challenges.

Even before the conflict, TB care in Ukraine was hindered by limited diagnostic capacity, medicine shortages, and socioeconomic factors—such as poor nutrition, lack of access to care, and housing instability—that contribute to disease transmission.

🚨 Conflict-Fueled Surge in TB Risk

The Russian invasion of Ukraine has triggered massive internal displacement and refugee movements, with over 3 million Ukrainians fleeing the country within the first three weeks of the conflict—marking the fastest refugee crisis in Europe since World War II.

This mass migration, combined with overburdened healthcare systems, raises urgent concerns:

• Increased risk of TB transmission across borders
• Higher rates of interrupted or incomplete treatment
• Greater potential for drug resistance and treatment failure
• Strain on TB services in host countries, many of which are already under-resourced

Historically, wars and displacement have resulted in up to a 20% increase in TB incidence, driven by:

• Overcrowding in shelters or camps
• Limited access to food, clean water, and sanitation
• Disruption in public health services
• Delays in diagnosis and treatment continuity

👶 Children and Women at Elevated Risk

With the majority of refugees being women and children, additional risks emerge:

• Children are more susceptible to progressing from latent to active TB.
• Pediatric TB is often a sentinel indicator of ongoing transmission.
• Refugee children face higher mortality risk if TB is left untreated.

Moreover, the psychosocial impact of conflict, stigma associated with TB, and economic barriers to care may further deter individuals from seeking or completing treatment.

🛑 Call to Action: A Global Health Emergency

The combined effects of the COVID-19 pandemic and the war in Ukraine are expected to significantly delay progress toward achieving the WHO End TB Strategy targets.

“TB remains in the shadow of other healthcare concerns, but it continues to pose a serious threat to global health—especially during crises like war,”
— European Respiratory Journal, 2022

📌 What Needs to Be Done:

• Strengthen TB surveillance and detection systems, especially at borders and refugee entry points.
• Expand rapid diagnostic capabilities and ensure treatment availability for drug-susceptible and drug-resistant TB.
• Scale up prevention programs, particularly among migrants, displaced populations, and close contacts of TB cases.
• Ensure continuity of care for displaced individuals, including psychosocial and logistical support.

🌍 Why It Matters for All of Us

While TB may seem like a distant issue, its resurgence in conflict zones can have far-reaching consequences for global public health. The international health community—and supporting organizations—must be ready to respond with speed, solidarity, and sustained investment to limit the damage and prevent a new wave of TB transmission and mortality.

📖 Reference

European Respiratory Journal (2022). War in Ukraine: an immense threat to the fight against tuberculosis. Retrieved from https://publications.ersnet.org/content/erj/59/4/2200493