Between July 2019 and September 2020, hundreds of tuberculosis (TB) cases were detected in northwest Syria. However, there are still several challenges and some missing links for the optimal implementation of the End TB Strategy according to World Health Organization guidelines. Rifampicin- and multidrug-resistant tuberculosis (MDR/RR-TB), which requires more complex treatment than drug-susceptible (DS) TB, is one of the biggest obstacles to meeting 2020 milestones to end TB.

Since the beginning of July 2020, there has been a reported increase in RR/MDR-TB cases detected in northwest Syria, totalling 12 cases in the most recent reporting period.

However, the necessary drugs required to start the treatment of these cases remain scarce. As a result, many of those patients suffered from a deterioration in their overall health condition, including an 18 year-old male patient named Housam* who did not have access to effective treatment.

Housam was one of the millions of people suffering from the ravages of war in northwest Syria. He was a healthy child, but because of the circumstances he faced during the war, including deteriorating socioeconomic conditions and exposure to mass displacement in northwest Syria, he developed TB at age 15. Access to TB medications continues to be a challenge for most civilians in northwest Syria, due to the debilitation of the health system, including over half of facilities closed down due to increasing hostilities, leading to incomplete treatment regiments and inconsistent uptake of TB medications.

In September 2020, Housam visited one of the TB centres in northwest Syria because he had suffered from coughing, night sweats and weight loss. Clinical, laboratory and radiological findings performed in the TB centre were consistent with TB disease. A sample of his sputum was tested by Gene Xpert system and the result was positive and the resistance of Rifampicin was detected. Housam’s condition continued to deteriorate with little means to secure his medication. A month later, he passed away.

Housam’s 32 year-old sister, Leila, was also diagnosed with TB about a year ago. She had received treatment for DS-TB twice without any benefit before she was diagnosed with RR/MDR-TB at the same time when her brother was diagnosed. Several days ago, she managed to cross the Syrian-Turkish border illegally, hoping that she would be able to obtain the Turkish temporary protection card in an attempt to receive treatment in Turkish hospitals so that she would not face the same fate as her brother. While WHO is working closely with partners to secure additional second-line medications for MDR cases, there continue to be significant challenges in procuring medication to treat these cases.

*Names are fictional.