AS the global health community rallies to eliminate hepatitis B virus (HBV) and hepatitis C virus (HCV) by 2030, a relentless adversary undermines progress: conflict and political instability. These crises disrupt healthcare systems, and foster conditions where infectious diseases thrive. Hepatitis elimination, which requires sustained prevention, diagnosis, and treatment services, becomes an uphill battle when such fragile systems collapse.

Political unrest diverts resources from public health initiatives to emergency responses. Hepatitis B vaccination, crucial for preventing mother-to-child transmission, are among the first casualties. Treatment programmes reliant on continuous care are disrupted when healthcare infrastructure is damaged.

In war zones and overcrowded refugee camps, unsafe medical practices like syringe reuse, poor sanitation and overcrowding, amplify hepatitis transmission risks. Displaced populations are often stripped of basic rights, clean water, and adequate healthcare, bearing the brunt of these crises and compounding the challenges of disease control and prevention.

The World Health Organisation’s target of eliminating hepatitis as a public health threat by 2030 demands consistent efforts in prevention, care, and surveillance. Yet, political instability threatens to derail this timeline, particularly in regions already burdened by weak health systems.

The WHO’s target of ending hepatitis by 2030 demands consistent efforts.

Case study— Rohingya refugee crisis: The plight of the Rohingya refugees in Bangladesh’s Cox’s Bazar camp is a stark reminder of how population displacement fuels infectious disease outbreaks. Fleeing systemic persecution in Myanmar, nearly a million Rohingya have settled in overcrowded camps, where studies have found hepatitis C prevalence rates as high as 20 per cent, figure far exceeding Bangladesh’s national average.

Decades of marginalisation and healthcare neglect in Myanmar left this community vulnerable. In the camps, limited healthcare access, unsafe injections, and unsanitary conditions have worsened the crisis. This example highlights how displacement magnifies hepatitis transmission risks and creates long-term health burdens.

The breakdown of hepatitis programmes in war zones: Conflict-affected regions like Syria, Yemen, and Sudan offer grim illustrations of hepatitis programmes brought to a standstill. Before Syria’s civil war, the country had a robust hepatitis B vaccination programme. Today, large sections of the population remain unvaccinated as war has shattered healthcare infrastructure and services. Unsafe medical practices in under-resourced clinics, combined with widespread displacement, have created ideal conditions for the spread of HBV and HCV.

In Yemen, years of conflict have led to one of the world’s most dire humanitarian crises. While cholera outbreaks and malnutrition receive urgent attention, hepatitis elimination has fallen by the wayside. For hepatitis patients, disrupted treatments have led to disease progression and increased mortality.

Charting a path forward: Despite the challenges posed by conflict, there are strategies to mitigate its impact on hepatitis elimination. Integrating hepatitis care into humanitarian responses is essential, particularly in refugee camps, where mobile clinics, vaccination drives, and collaboration with local health workers can help sustain essential care. Securing sustained global funding is also critical, as international don­ors play a vital role in bridging gaps in vaccination and tre­­atment access in conflict-affected regions.

Strengthening the health systems in these areas is an­­other priority, which involves training lo­­cal providers, re­­inforcing supply chains, and decentralising care delivery to ensure services continue during crises. Additionally, leveraging digital health tools for remote monitoring and surveillance can enable faster responses to hepatitis outbreaks in unstable environments. Ultimately, public health leaders must recognise that hepatitis elimination is closely tied to peacebuilding efforts. Addressing the root causes of instability is essential to fostering conditions where health systems can thrive.

The hepatitis B and C elimination agenda cannot succeed in isolation from the broader challenges of conflict and instability. The Rohingya hepatitis crisis and the breakdown of programmes in war-torn regions highlight the urgent need for a coordinated global response.

The writer is Hepatitis Evaluation, Research and Outreach (HERO) Fellow with the Coalition for Global Hepatitis Elimination, a programme of the Task Force for Global Health.

Published in Dawn, January 19th, 2025