MSF and partners make a real difference for tuberculosis patients in Iraq

As part of a Médecins Sans Frontières (MSF) programme to detect TB early in children, through a collaboration of outreach activities with the Ministry of Health, Zainab’s family was called after her aunt was diagnosed with TB.

“They asked me to have Zainab tested because she had been very close to her aunt, who had pulmonary tuberculosis,” says Umm Salam.

While Zainab did not have symptoms, she and her four of her siblings were tested. The others were put on a preventive treatment, and Zainab was diagnosed. As treatment began, Zainab and her grandmother started a routine of travelling between a health centre and Ibn al-Baladi hospital in their district. These travels were often accompanied by Umm Salam’s tears, caused by a mix of fear and hope.

“I cried a lot when I learned she had TB, but the doctor comforted me and assured me that recovery is possible,” she says.

Zainab’s story of recovery is not unique. It is a story known to thousands of Iraqi families.

The challenges of tackling TB, and the efforts being made by MSF, the Ministry of Health, the National Tuberculosis Institute, and the Ministry of Justice to do so, are all apparent. Both in the district of Sadr City, which records more than one fifth of Iraq’s TB cases, and in detention facilities, where incidence is much higher.

Challenges in diagnosis and treatment

Iraq has made great progress in controlling TB over recent years—bringing down incidence by about 61 per cent, according to the National Tuberculosis Institute.

Still, those most at risk are children, people with malnutrition, people with poorly controlled diabetes, and smokers. The Sadr City district in Baghdad continues to be a main hotspot, due in part to overcrowding, poverty, and the difficulty of accessing healthcare.

Alongside these social pressures, the health system in the country faces technical and financial hurdles. Modern diagnosis equipment, like GeneXpert devices, is costly and needs steady maintenance and supplies, while administrative red tape slows the purchase of medicines through international channels. Stigma remains one of the highest barriers to treatment, with many patients hesitant to speak about their illness or seek care for fear of discrimination.

Overcoming challenges through collaboration

MSF has been running a TB programme in Iraq since 2018, to support the National Tuberculosis Institute and update treatment protocols in line with the World Health Organization’s recommendations.

When we started, patients in Iraq were still treated with regimens based on daily injections—treatments that were painful, had toxic side effects, and not effective enough. With the introduction of new oral medicines, MSF helped launch safer and more effective treatment protocols. “Before 2019, we used to tell patients with drug-resistant TB and their families that the chance of death was very high,” says Dr Laith Ghazi, the deputy manager of Iraq’s National Tuberculosis Institute. “But after working with MSF and introducing modern regimens, the success rate jumped to almost 90 Among its neighbouring countries, Iraq is now a leader in treating”.

MSF’s support has gone beyond treatment; we have strengthened diagnosis by providing modern GeneXpert machines. This has reduced the time needed to detect preliminary drug resistance from more than a month to just one day.

MSF has also begun an early detection initiative for children according to the World Health Organization’s guidelines. Zainab, along with dozens of other children, received early testing this year because of this programme. The detection initiative, combined with community awareness sessions, has started to make a positive impact. Families are becoming more engaged and more open to testing and treatment.

MSF’s work has extended from community health facilities to detention facilities. In 2024, MSF supported screening campaigns in several prisons in collaboration with the Ministries of Justice and Health. We have also recently introduced a short-term preventive oral-regiment treatment, called 1HP TPT, which is given to close contacts for just one month instead of the six required for an older version of preventive treatment. This has reduced the burden of regimen compliance, making follow-up easier and more realistic for prisons.

“What makes our work in Iraq unique is the close cooperation with the national health and justice authorities,” says Dr Aparna S. Iyer, MSF’s project medical coordinator for TB. “Thanks to this collaboration, we improved both diagnosis and treatment, and we were the first to roll out short-term preventive treatment inside Iraqi prisons.”

Challenges remain in enhancing care

Despite these successes, challenges remain to jointly tackle TB. First, the funding of the national programme can change from year to year. Every screening campaign that may not be run, and each testing cartridge left unpurchased because of lacking resources, affects real patients, and the professionals trying to treat them.

Stigma also remains a silent burden for people, causing delays in testing and anguish for patients.

The core idea of MSF’s work with its partners is turning cooperation into real, tangible results. As Dr. Laith said, one month of short prevention is “gaining life”—not only because it shortens treatment, but because it brings care closer to people’s daily lives and makes it possible in crowded places with limited resources.

The simple truth is clear: cooperation saves lives. What has been achieved between the Ministry of Health, the Ministry of Justice, the National Tuberculosis Institute, and MSF is not an exception—it is a model of what can happen when medical expertise, national structures, and community will come together.

With more stable funding, awareness messages that respect patient dignity, and programming that bridges gaps, it is possible to create, higher, standard of TB care in Iraq.

MSF is committed to creating tangible results with communities, through our partnership with the Ministries of Health and Justice, and the National Tuberculosis Institute.

*Names changed to protect privacy.