title: Complex emergencies in the Eastern Mediterranean Region: Impact on tuberculosis control.
abstract: OBJECTIVE
  The Eastern Mediterranean Region (EMR) has witnessed the largest refugee crisis in history. Overall, 70% of the global refugee populations are from Palestine, Syria, Afghanistan, or Somalia. We reviewed the possible impact of such crisis on the tuberculosis situation in EMR.
  
  
  METHODS
  We used the available data and information from the World Health Organization and other international and national institutions.
  
  
  RESULTS
  Overall, 15 out of 22 countries in the EMR are either engulfed in complex emergencies (10 countries) or suffering from their neighbors' complex emergencies (7 countries), whereas two countries suffer from both. Eighty-five percent of the total population (636 million) in the region lives in these 15 countries. For tuberculosis, these 15 countries account for a significant burden in EMR: 94% of the estimated total incidence of 740,000 cases a year and 95% of the estimated total mortality of 91,000 a year. These countries have yet to show the significant negative impact on tuberculosis epidemiology as such changes take considerable time to manifest. Still, there are reports on health systems impact: access to health facilities, destruction of health facilities, health staff casualties, and shortage of medicines.
  
  
  CONCLUSIONS
  Complex emergencies pose a significant negative impact on tuberculosis in the EMR. This issue should be raised in the global health and political arena. This is a time bomb for tuberculosis.
authors.affiliation: United Nations Relief and Works Agency for Palestine Refugees in the Near East, Jordan. Electronic address: a.seita@unrwa.org.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Seita
keywords: Complex emergencies; Eastern Mediterranean Region; Refugees; Tuberculosis