Addressing tuberculosis and mental health amidst the Sudan conflict

We read with great interest the recently published Letter discussing the challenges facing healthcare in Sudan amidst the ongoing conflict.1 As healthcare providers with close ties to the region, we would like to expand on the escalating public health crisis, particularly concerning pulmonary tuberculosis (TB), and to address the critical need for a comprehensive response that also includes mental health. TB remains a significant global health concern, with the World Health Organization (WHO) estimating that 10 million people are infected annually with active disease, and 1.5 million die each year as a result.2 In Sudan, the burden of TB has been exacerbated by the armed conflict, which has resulted in the displacement of 5.1 million people and the collapse of more than 70% of the healthcare facilities.3 The conflict has disrupted TB control programs implemented by the WHO and the Sudanese Federal Ministry of Health, leading to treatment interruptions and increasing the risk of multidrug-resistant tuberculosis (MDR-TB). Patients who were previously on treatment are now unable to access their medications, posing a significant public health hazard as untreated individuals can transmit the disease to others. Additionally, the lack of healthcare access has led to a rise in undiagnosed TB cases. The conditions in overcrowded camps, where displaced populations live with inadequate nutrition and sanitation, further fuel the spread of TB. The main risk factors—poverty, malnutrition and limited access to healthcare—are well-documented in relation to TB, and these have only worsened under the current circumstances. Without immediate and targeted intervention, the progress made in TB control over the past decades could be lost, not just in Sudan but potentially spreading to neighbouring regions. It is essential for the global health community, international organizations and local authorities to recognize the urgent need for action. Measures such as mobile clinics to reach displaced populations, providing TB diagnostics and treatments and further training for healthcare workers on the front lines are crucial to controlling the spread of TB and MDR-TB in the region. Beyond the physical health consequences, the mental health impact of the conflict is equally critical and often overlooked. War and displacement have led to significant psychological distress, including anxiety, depression and post-traumatic stress disorder (PTSD). These mental health issues, if unaddressed, can further complicate TB management, as psychological well-being is closely linked to adherence to TB treatment regimens. A recent study by Ahmed et al. highlighted the high levels of depression and anxiety among Khartoum residents during the conflict, stressing the need for mental health services, particularly for vulnerable groups.4 Addressing the mental health needs of the population alongside TB is essential for a holistic response to the crisis. The situation in Sudan is a reminder of how conflict can transform a public health challenge into a full-blown crisis. It is imperative that both the psychological and physical health of those affected are prioritized in any intervention efforts. None declared.