Cooperation saves lives: TB care in Iraq’s communities and prisons

Zainab’s family had received a call when her aunt was diagnosed with TB—part of a Doctors Without Borders/Médecins Sans Frontières (MSF) program for early TB detection among children, which has been carried out in collaboration with the Ministry of Health.

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

Although Zainab did not have symptoms, she was tested for TB along with her four siblings. She was the only one who ended up testing positive for the disease, and she was then put on treatment while her siblings received preventive care. 

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

Feeling a mix of hope and fear, Umm Salam accompanied Zainab on trips between a health center and Ibn-Baladi Hospital, which became routine. Thousands of Iraqi families share similar stories of diagnosis and eventual recovery from TB.

Coming together to take on TB

Iraq has made great progress in controlling TB over recent years, decreasing incidence by about 61 percent, according to the National Tuberculosis Institute, yet many challenges persist. The health system faces technical and financial hurdles that further challenge access to treatment. Modern diagnosis equipment like GeneXpert devices are costly and need steady maintenance and supplies, while administrative red tape slows the purchase of medicines through international channels. 

Further, some groups remain at high risk: children, people with malnutrition, people with poorly managed diabetes, and smokers. Incidence of the disease also remains high in detention facilities.

The Sadr City district in Baghdad accounts for more than one-fifth of TB cases in the whole country. It continues to be a hotspot due in part to overcrowding, poverty, and the difficulty of accessing health care. Stigma is also major barrier to treatment; many patients hesitant to speak about their illness or seek care for fear of discrimination.

An overhaul to phase out older, painful treatments 

MSF’s TB program in Iraq launched in 2018, aiming to support the country's National Tuberculosis Institute and update treatment protocols in line with World Health Organization (WHO) recommendations.

When the program started, patients in Iraq were still being treated with regimens based on daily injections, which can be painful, come with toxic side effects, and are 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, deputy manager of the National Tuberculosis Institute. “But after working with MSF and introducing modern regimens, the success rate jumped to almost 90 percent. Among neighboring countries, Iraq is now a leader in treating [TB].”

MSF’s support goes 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.

We have also begun an early detection initiative for children based on WHO guidelines. Zainab, along with dozens of other children, received early testing this year because of this program. The detection initiative, combined with community awareness sessions, has started to make a positive impact. Families are becoming more engaged and open to testing and treatment.

Treating TB in Iraq’s prisons  

MSF’s TB response in Iraq extends to detention facilities. In 2024, MSF supported screening campaigns in several prisons in collaboration with the justice and health ministries. 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 in an older version of preventive treatment. This has reduced the burden of regimen compliance, making follow-up easier and more realistic for people in 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.”

Building a model of cooperation for TB care

Despite these successes, challenges remain to jointly tackle TB. First, funding for the national program can change from year to year. Every screening campaign that never takes place, each testing cartridge left unpurchased for lack of resources, has a real effect on patients and the professionals trying to treat them. Stigma also remains a silent burden for people, causing delays in testing and anguish for patients. 

At the core of MSF’s work with partners is the aim to turn cooperation into real, tangible results. As Dr. Laith said, one month of 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 for those living in crowded quarters with limited resources.

The result is clear: Cooperation saves lives. MSF’s collaboration with Iraq’s ministries and the National Tuberculosis Institute is a model of what can happen when medical expertise, national structures, and community come together for the greater good. It’s possible to create a higher standard of TB care in Iraq with more stable funding, spreading awareness, and programming that bridges gaps. 

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