Finding the ‘missing’ cases of Tuberculosis

from UN Development Programme
Published on 22 Mar 2018 View Original

Bringing TB diagnosis and treatment into Djibouti's refugee camps to ensure no one is left behind

Djibouti hosts more than 27,000 refugees from neighbouring countries, equivalent to roughly 3% of its population. With one of the highest densities of refugees in the world, crowded camps create a fertile breeding ground for the transmission of tuberculosis (TB).

The government of Djibouti, in partnership with UNDP, UNHCR and the Global Fund are working to bring TB diagnosis and treatment facilities into camps, increase awareness, reduce stigma and stop the spread of TB.

Having fled the civil war in Somalia seven years ago, Fatouma lives in the Ali Addeh refugee camp with her mother and her four brothers and sisters. The camp is home to 14,546 people, the majority seeking refuge from conflict in nearby Somalia, Ethiopia and Eritrea.

“At the beginning, I was feeling chest pains, and I had a fever. I was feeling so very tired; I could not move at all. And then I started coughing all the time, so I went to the health centre in the camp.

At the health centre, Fatouma was diagnosed with TB. After two months at the hospital of Ali Sabieh, one-hour drive away from Ali Addeh refugee camp, she was able to return to her family and continue her treatment at the camp's health centre.

“I was afraid I would never be healthy again. The health centre at the camp were provided the drugs from the hospital weekly, so every morning for the last four months of my treatment, I went to the health centre to take my TB medicine,” she explains.

More than 10 million people around the world get sick every year with TB, and 40 percent of them fail to be diagnosed, treated, or reported by health systems. Finding the people missed by health systems is a major challenge, as is the growing problem of drug-resistant TB.

The health centre and laboratory in the Ali Addeh refugee camp helps to address this challenge by allowing the diagnosis and management of TB to be done at the camp. This also means that people like Fatouma can be around their families during what can be a long and tough course of treatment.


With just a small laboratory, a microscope and a committed team of health professionals, the camp's health centre has already made huge strides in breaking the cycle of TB transmission: The number of confirmed cases has halved over the last five years.

“We have a very qualified outreach team sensitizing the community” says Ali, the head nurse of the Ali Addeh health centre. “There is no case of drug-resistant TB now.”

Ali works with the Ministry of Health to support patients in the clinic, which sees approximately 200 people a day with a variety of ailments. The centre also supports pregnant women and offers a vaccination programme, all of which is carried out in close cooperation with the United Nations Refugee Agency (UNHCR).

“We have a partnership with UNDP, supported by the Global Fund, which focuses on activities to fight HIV, malaria, and tuberculosis,” explains Moussa Abdourahman Bock, Assistant Programme Officer at UNHCR Djibouti.

“The refugees are integrated into the national health system. They have the same rights concerning health facilities.” - Moussa Abdourahman Bock.

While support to adhere to TB treatment via the clinic is critical in ensuring people can easily access medicines, community outreach to demonstrate how to avoid TB has proven to be equally vital in preventing new cases.


TB is an airborne disease which remains most prevalent among the poor. Refugees can be at particularly high risk of developing TB due to over-crowding, poor air circulation and inadequate sanitation.

To ensure people are aware of the risks and can take preventative steps, UNDP and UNHCR are working closely with community health workers; members of the refugee community who are trained to disseminate messages on healthy living and how to prevent the spread of disease.

“I came here in 2011 as a refugee and I started working as a community health worker in 2014. It is my first job,” says Ahmed.

Originally from Somalia, Ahmed is now responsible for the Somali section of the camp, where he works to help people understand how to live healthy lives.

“The first thing I realized is that people didn’t know [much] about health. But now the people understand … why it is important to go to the health centre, how to take the medicine; people now understand the meaning of good health. It’s what I love about my job.”

Ahmed also has high hopes for the future:

“When I was in Somalia, I was studying English; I was not working yet. I came here because there was a civil war, but my hope for the future is to support my country.

“Here I am only a refugee, but … being a refugee has to stop one day. And I hope one day I will be able to get back to my country and have a good future there.”


The 2030 Agenda for Sustainable Development has set ambitious targets of ending the TB epidemic by 2030 and achieving universal health coverage. The challenge is considerable, in part because TB is leaving millions behind: 95% of new TB cases and 98% of all TB deaths are in low- and middle-income countries.

In October 2015, the World Health Organization (WHO) announced that TB had surpassed HIV as the leading cause of death from infectious disease. TB is also the leading cause of death in people living with HIV.

In line with its HIV, Health and Development Strategy, and as outlined in the UNDP Strategic Plan 2018-2021, UNDP partners with the Global Fund to support and strengthen multi-sectoral national responses to TB in 11 countries by providing integrated policy, programme and capacity development support.

Working closely with national governments and civil society organizations, this partnership has resulted in 850,000 people receiving treatment for TB and 19,139 people receiving treatment for multi-drug resistant TB.

Ending TB by 2030 will require a partnership approach, which strengthens the capacity of national health systems. UNDP, UNHCR and the Global Fund are working closely with the Government of Djibouti to ensure camp populations and host communities affected by TB have equal access to the treatment, care, and support they need.