How falling cases of tuberculosis in Iraq reflect a wider health system recovery

DUBAI: Sameer Abbas Mohamed, a Syrian refugee from Qamishli who fled to Iraq in 2013, was terrified when his one-year-old son, Yusuf, was diagnosed with tuberculosis. He knew the disease was life-threatening — and highly contagious.

“I have two older boys, and I was scared they would catch the disease,” said Mohamed, who lives in Qushtapa refugee camp for Syrians in Irbil, home to most of the 300,000 Syrian refugees in the Kurdistan Region of Iraq.

“Yusuf was also very young and I worried about losing him.”

Mohamed consulted several doctors when Yusuf began coughing. Scans revealed a mass on the right anterior wall of his chest. A diagnosis was finally made when a general surgeon reported the case to Iraq’s National TB Program.

Following surgery to remove the mass, Yusuf returned home, where nurses delivered an all-oral regimen, monitored his treatment, tracked his progress, offered support, and educated the family on isolation measures to prevent the disease’s spread.

Within six months, Yusuf was cured.

His journey reflects the progress made in combating TB in Iraq, especially the drug-resistant variant that has emerged in the conflict-affected country — which until recently had the region’s highest prevalence of TB cases.

Iraq’s NTP, supported by the International Organization for Migration, the Global Fund, and the World Health Organization, is tracking TB among displaced communities using advanced diagnostic technologies and artificial intelligence.

Giorgi Gigauri, IOM Iraq’s chief of mission, told Arab News that TB detection and timely treatment have helped to drive a significant decline in cases in Iraq.

This was achieved, he said, through a tech-driven strategy, including the installation of the advanced 10-color GeneXpert detection machine across Baghdad, Basrah, Najaf and Nineveh, enabling faster diagnoses.

IOM’s mobile medical teams were also equipped with 10 AI-supported chest X-ray devices, known as CAD4-TB, which can detect the disease in seconds — even in high-burden areas such as refugee camps and prisons.

Routine screenings by these mobile units helped to increase the detection rate of drug-resistant TB from 2 percent to 19 percent, and drug-sensitive TB from 4 percent to 14 percent between 2019 and 2024, according to IOM data.

After screening, sputum samples are taken to central labs, making testing accessible for those unable to travel or living in areas with limited health care access.

Thanks to these efforts, TB cases in Iraq have fallen dramatically — from 45 to 23 cases per 100,000 people between 2013 and 2023. The current prevalence is 15 per 100,000, with an estimated mortality rate of three per 100,000.

In many ways, these numbers reflect Iraq’s wider public health recovery after decades of instability, including the crippling sanctions of the 1990s, the successive bouts of violence that followed the 2003 US-led invasion, and the 2014 rise of Daesh.

“Despite years of instability, progress made in the detection, treatment and prevention of the spread of TB restored trust in health care services by strengthening infrastructure and extending care to vulnerable groups like prisoners and displaced populations,” Gigauri told Arab News.

“It also supports upskilling of health professions and creates sustainable systems that can support responses to other communicable diseases.

“Efforts made by all partners under NTP have contributed to national recovery by addressing urgent health needs and laying a foundation for timely detection of preventable and treatable diseases.”

Despite a period of relative stability, Iraq still faces considerable humanitarian pressures amid a fragile economy and an unpredictable security landscape. According to UNHCR, more than 1 million Iraqis remain internally displaced, with 115,000 living in 21 camps across the Kurdistan Region.

Roughly five million displaced people have returned to their towns and villages since Daesh’s territorial defeat in 2017. But these areas often lack basic infrastructure, increasing the risk of TB outbreaks.

In Mosul — Iraq’s second-largest city, which endured three years under Daesh — those unable to afford housing live in overcrowded settlements, where malnutrition and exposure to the elements weaken immunity.

The mobile medical teams have been a game-changer for these vulnerable communities.

Digital X-rays equipped with CAD4-TB, powered by AI, now enable quick and accurate TB detection — a stark improvement from the three-month wait many patients once faced for CT scans.

This technology also reduces radiation exposure. A single CT scan can expose patients to the equivalent of 300 X-rays, according to Dr. Bashar Hashim Abbas, manager of the Chest and Respiratory Diseases clinic in Mosul.

Abbas said that mobile medical teams and digital X-ray devices have been vital for reaching remote communities and detainees who lack clinic access.

“The mobility of these machines helped us examine prisoners who were difficult to bring into the clinic due to complex security protocols. We discovered many cases, especially multidrug-resistant TB patients, in this way,” Abbas told Arab News.

“We conduct X-rays and take sputum samples for further lab investigations. Therefore, we take the diagnostic tools to them as much as we can, scaling up TB prevention and providing treatment.”

A centralized disease surveillance system, District Health Information Software 2, allows lab results to be registered and coordinated across labs, facilities, and the Iraqi Ministry of Health, improving routine TB reporting.

IOM’s TB services reached 6,398 people in 2024, with 120 drug-resistant TB cases treated. These efforts have been bolstered by $11 million in Global Fund support since 2022.

A key breakthrough has been shifting the treatment of multidrug-resistant TB from a burdensome series of injections to a simpler, all-oral regimen, which shortened recovery time from two years to six months and significantly improved outcomes.

“Previously, treatments involved daily injections for at least six to eight months, which were difficult to sustain for patients and treatment outcomes were relatively poor at 50 percent,” Grania Brigden, senior TB adviser at the Global Fund, told Arab News.

“However, the innovation in treatment through the all-oral regimen has reduced treatment to six months with a 75 percent to 80 percent success rate.”

Although no new TB vaccines are currently available, researchers are optimistic about developing more effective ones in the next five years. The existing BCG vaccine offers only partial protection and is less effective for adults and adolescents, who are more prone to transmission.

New vaccines are vital for achieving the WHO’s End TB Strategy goals — reducing TB mortality by 95 percent and incidence by 90 percent by 2035. Brigden said ongoing investment is key to meeting these targets.

Meanwhile, the Global Fund is focused on halting TB’s spread in Iraq. “We have invested significantly in commodity security to ensure that everyone who tests positive or is notified of TB is put on treatment,” said Brigden.

Thanks to these steps, many — like young Yusuf — are alive today who might otherwise have succumbed without proper care.

“The discussions of tuberculosis we had with the nurse who gave the medication had a positive impact on us,” said Yusuf’s father, Mohamed.

“The nurse gave us information on how to isolate him after the first two to three weeks. He reassured us that if we gave him the medication regularly and made sure there were no gaps, everything would be getting well.

“This made us less scared.”