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Written By Dr. Firdosi Mehta
Former WHO Country Rep., Adjunct Prof. Global Health York U, member Steering Committee Stop TB Canada

Armed conflict triggers complex humanitarian and public health crises. While immediate attention focuses on casualties, infrastructure damage, and geopolitical instability, indirect consequences for infectious disease control—particularly tuberculosis (TB)— can be profound and far-reaching.

TB, a preventable and curable disease, thrives in conditions of weakened health systems, displacement, and poverty. The ongoing war in Iran exemplifies how conflict can reverse years of progress in TB control, not only within affected countries but across entire regions and beyond.

Countries such as Canada aren't immune – TB is already concentrated in newcomers and refugee populations. Should the war eventually lead to further displacements across the globe, those directly affected will be made more vulnerable to TB.

Prior to the escalation of hostilities, Iran had made measurable progress in reducing TB incidence through improved health-care services, early detection, and treatment adherence programs (Yousefi 2025 ), although the progress had been slowed by funding gaps and the impact of COVID-19 (Crisis24 2025 ).

An immediate impact of the war has been the degradation of health-care infrastructure. The World Health Organization (WHO) has confirmed attacks on health-care facilities as well as deaths of health workers (WHO 2026). Such attacks cripple essential services, including TB diagnosis, treatment, and follow-up care, and lead to increased risk of drug-resistant disease.

Furthermore, tens of thousands of people have fled affected areas, while hundreds of thousands across the region are living in overcrowded shelters (WHO 2026). Displaced populations face heightened barriers to health-care access, from the lack of documentation and financial constraints; children, the elderly, and individuals with weakened immune systems bear the greatest brunt of these burdens.

The impact of this war is, however, extending well beyond Iran’s borders. Neighbouring countries—many already burdened by high TB rates—are likely to experience increased pressure on their health systems with cross-border movement. Previous research shows that war significantly alters TB dynamics in affected countries and refugee-hosting regions (Monedero-Recuero 2026).

The conflict has also disrupted global health logistics, including operations at key emergency supply hubs (WHO 2026). This has implications for TB programs in other parts of the world that rely on international supply chains for medications and diagnostics. At a time when global TB control is already off track to meet international targets, hard-won gains risk being reversed. Funding shortages—exacerbated by shifting geopolitical priorities—may further limit the ability of international organizations to respond effectively (Reuters 2025).

There is an urgent need for co-ordinated international action to protect healthcare services, ensure the continuity of TB programs, and support of key affected populations in dire need of refuge and care. Refugee-hosting countries such as Canada can and must invest more in domestic TB policies that attend to these complex migratory pathways keeping equity at the forefront. Human rights-based approaches are necessary to ensure forces migrants in need of TB prevention and treatment services, among other care, have exceptional access, unmitigated by avoidable structural barriers not only documentation but additionally the fears perpetuated by perceived risks around deportation. This crisis is a stark reminder of our interconnected world, and that health consequences of war are never just confined to battle zones.

About the Author:

Dr Firdosi Mehta is a Public Health Physician with over 30 years of experience, more than half of which was spent with the WHO. He has served as the WHO Country representative in Sri Lanka as well as the Country advisor on TB in a complex emergency country – Somalia, as well as in Indonesia a high burden TB country. Currently he is an Adjunct Professor at York University and a member of the Steering Committee of Stop TB Canada.

Keywords: COVID-19; Cross-sectional studies; Diagnosis; Epidemiologic factors; Iran; Tuberculosis.

Methods
This qualitative study was conducted in two phases, using an integrative literature review and individual interviews. Studies were gathered without time restriction from MEDLINE databases, Institute for Scientific Information (ISI), Google Scholar, Scopus, and EMBASE, as well as national databases, including Scientific Information Database and Magiran. The findings of 38 studies that met the inclusion criteria were analyzed through the conventional content analysis method based on the ecological approach. After reviewing and forming the data matrix, purposive sampling was performed among healthcare professionals, elderly tuberculosis patients aged 60 and over, and family caregivers of elderly patients to conduct individual interviews. Data obtained from 20 interviews were analyzed using the directed content analysis method. After coding, the data from individual interviews were entered based on similarity and difference in the categories of data matrix obtained from the literature review.

Results
In general, the aforementioned codes were placed in four main categories, including individual factors (i.e., biological factors, affective-emotional factors, behavioral factors, cognitive factors, tuberculosis-related factors, and economic factors), interpersonal factors (i.e., patient's relationship with treatment team and family-related factors), factors related to healthcare service provider centers (i.e., medical centers' facilities and capacity building in healthcare service provider), and extraorganizational factors (i.e., social factors and health policymaking).

Conclusion
The results of this study showed that medication adherence in elderly patients with tuberculosis was a complex and multidimensional phenomenon. Therefore, society, policymakers, and healthcare providers should scrutinize the factors affecting medication adherence in this group of patients to plan and implement more effective interventions.