Highlighting the forgotten: Tuberculosis amidst the humanitarian crisis and COVID-19 in Afghanistan

In Afghanistan, there is an ongoing humanitarian crisis that will have severe consequences on the health of the Afghan population.There are estimates that 1 million children may die of malnutrition across 2022.Factors such as the lack of basic sanitation, a fragile healthcare system and limited access to medicines will also contribute to a significant and likely excess burden of disease over the coming years.Afghanistan is a country with a huge burden of respiratory health diseases, including tuberculosis [1].According to the Global Tuberculosis report, Afghanistan is one of the countries with the highest incidence of tuberculosis in the WHO Eastern Mediterranean Region (EMRO).There are an estimated annual 13 thousand Afghans die due to tuberculosis.In 2016, over 65,000 cases and 11,000 deaths were registered because of TB [2].In 2018, Afghanistan reported 48,420 TB cases out of the estimated 70,000 incident cases [3].According to Afghanistan's National TB Program (NTP), in 2019 over 48,420 TB cases were diagnosed and reported [4].In 2020, the first year of the COVID-19 pandemic, the Ministry of Public Health of Afghanistan reported 50,000 new tuberculosis cases with 10,000 deaths.However, WHO estimates indicate that this is likely to be significant under-reporting, with a probable 73,000 people had tuberculosis in 2020 in Afghanistan [5].Worldwide, the COVID-19 pandemic has disrupted the surveillance and management of TB programs.Following a large increase of cases between 2017 and 2019, there was a fall of 18% between 2019 and 2020, from 7.1 million to 5.8 million.Additionally, the global number of people who were provided with TB preventive treatment increased from 1.0 million in 2015 to 3.6 million in 2019, but this positive trend was reversed in 2020, with a 21% reduction to 2.8 million [6].The Global Fund estimates that was a 19% decrease in the number of people treated for drug-resistant tuberculosis in the countries receiving Global Fund support and a 37% decrease in people treated for extensively drug-resistant tuberculosis [7].In Afghanistan, the country's healthcare system diverted significant healthcare resources to the containment of the pandemic.A consequence of that is that other infectious diseases like polio spiked, due to this diversion [8].To date, Afghanistan has entered into the third wave of the pandemic.As of 16th of April 2022, 178, 387 cases and 7676 deaths are registered [9].The true number of cases will undoubtedly be higher than the official reported count with under-reporting due to political unrest, and a lack of a comprehensive surveillance system.Given that the limited availability of healthcare resources, the cases of tuberculosis in Afghanistan have significantly increased in comparison to the previous years.The history of the Taliban government gives great cause for concern around the intricate sociopolitical affairs of the country and how this will impact upon both healthcare, and healthcare access for specific demographics.For example, there are serious human rights concerns around access to healthcare for women.The burdens of