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

• Conflict is deterimental to tuberculosis control due to health system impacts. • Particular vulnerable populations include forcibly displaced and former detainees • Re-establishing Syria’s national TB program is essential to monitor and control TB • Addressing social determinants in Syria are important to prevent further increaes • Improved healthcare access and active case finding are This perspective explores the state of tuberculosis (TB) after the prolonged conflict 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 and living conditions. Social determinants such as poverty, malnutrition, inadequate water and sanitation, and lack of proper shelter, along with disadvantaged groups including internally displaced persons, detainees, former detainees, and rural communities, not only increase the risk of TB transmission and the activation of latent infections but also hindered active case finding. Tackling these risks requires re-establishing a robust 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 to monitor treatment. Leadership from the MoH and WHO with support from other stakeholders e.g. humanitarian, 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.