Conflict and drug-resistant tuberculosis in Ukraine
The UN released a report on Aug 29 about the worsening situation for human rights in the conflict region of Ukraine (1). An average of 36 people are killed every day and at least 260 000 people have been displaced from this region (1). Ed Holt in The Lancet (Aug 30, p 735) (2) reported about the threat to medical staff, equipment, and essential drugs, including for tuberculosis. Ukraine is one of the 27 countries in the world with a high burden of multidrug-resistant (MDR) tuberculosis and in 2012, there were an estimated 6800 new cases in the country (3).In view of the large number of people displaced, the control of tuberculosis and MDR-tuberculosis in Ukraine and surrounding countries will not only depend on the provision of medicines and health-care services in the conflict zone, but also on effective measures for detection and care of internally displaced people (IDP) and refugees.
Migrants, particularly IDP and refugees, are populations susceptible to contracting or developing tuberculosis or MDR-tuberculosis (4). Several factors increase this population's risk for transmission of disease, including poor underlying health and, often, overcrowded temporary living conditions. In the conflict areas of Ukraine, essential medicines are either in low supply or cannot be delivered because of continuing fighting (1), placing patients with tuberculosis at risk of interrupted or inadequate treatment and subsequent drug resistance, treatment failure, or death. Furthermore, thousands of unregistered IDP do not have access to medical services (1). With an estimated 3·9 million people living in areas directly affected by the conflict in Ukraine (1), the number of IDP and refugees will probably continue to increase.
The tuberculosis situation in the conflict zone needs to be improved. However, since this change might not be feasible or safe for health and humanitarian workers until the conflict ends, the international community needs to be prepared to support detection of disease and care in people who have been displaced. Studies have suggest that transmission of tuberculosis is largely contained in migrant communities (5). Therefore, now is a crucial time in Europe to ensure a minimum package for IDP and cross-border tuberculosis control and care, including a legal framework for tuberculosis cross-border collaboration (6). Programmes to screen for latent and active tuberculosis should be scaled up to provide adequate management of close contacts of people with tuberculosis, increase availability of rapid diagnostic tests for MDR-tuberculosis, and ensure access for migrant communities to effective treatment for all forms of the disease. Such measures are crucial if the tuberculosis and MDR-tuberculosis situation is to be controlled.
We declare no competing interests. The authors alone are responsible for the content of this paper, which might not necessarily represent the policies, decisions, or views of WHO.
References
1 . Report on the human rights situation in Ukraine. http://www.ohchr.org/Documents/Countries/UA/UkraineReport28August2014.pdf. (accessed Sept 10, 2014).
2 . Ukraine: health workers fear for their safety. Lancet 2014; 384: 735. Full Text | PDF(80KB) | CrossRef | PubMed
3 . Surveillance report: tuberculosis surveillance and monitoring in Europe. http://www.ecdc.europa.eu/en/publications/Publications/tuberculosis-surveillance-monitoring-Europe-2014.pdf. (accessed Sept 10, 2014).
4 . Drivers of tuberculosis epidemics: the role of risk factors and social determinants. Soc Sci Med 2009; 68: 2240-2246. CrossRef | PubMed
5 . Screening for pulmonary tuberculosis among immigrants: estimated effect on severity of disease and duration of infectiousness. Int J Tuberc Lung Dis 2001; 5: 419-425. PubMed
6 . The minimum package for cross-border TB control and care in the WHO European region: a Wolfheze consensus statement. Eur Respir J 2012; 40: 1081-1090. CrossRef | PubMed
a Tuberculosis and M/XDR-TB Control Programme, Division of Communicable Diseases, Health Security and Environment, WHO Regional Office for Europe, DK-2100 Copenhagen, Denmark
b WHO Country Office, Ukraine, Borychiv Tik, Kiev, Ukraine
Source: The Lancet
