The Impact of Armed Conflict on Leprosy Detection, Treatment, and Disability in Tigray, Ethiopia: a Longitudinal Comparison Across Conflict Phases (2016-2025)

Background Leprosy control depends on timely case detection and uninterrupted multidrug therapy (MDT) to prevent disability and interrupt transmission. Armed conflict disrupts health systems and may severely affect surveillance and treatment of neglected tropical diseases. The impact of the Tigray conflict (Ethiopia) on leprosy services has not been systematically assessed. This study examines how armed conflict affected leprosy detection, disability, and treatment outcomes in Tigray, Ethiopia. Methods A retrospective longitudinal analysis of routine leprosy surveillance data from the Tigray Region was conducted for the period 2016-2025. Study years were categorised into pre-war (2016-2020), war (2021-2023), and post-war (2024-2025) phases. Outcomes included number of newly detected cases, notification rates, proportion of new cases with Grade II disability at diagnosis, and treatment completion. Descriptive comparisons were made across conflict phases using Stata version 17. Results A total of 180 new leprosy cases were reported during the study period. During the pre-war phase, case detection and treatment completion were stable. No leprosy cases were reported during the war period, reflecting the collapse of surveillance and service delivery. In the post-war phase, detection partially recovered with 13 cases in 2024 and 33 in 2025. In 2024, all detected cases presented with Grade II disability (13/13), declining to 3.4 degrees'c (1/33) in 2025. Treatment completion decreased to 69.2 degrees'c in 2024, compared with 93.2 degrees Jc-100 degrees Jc during the pre-war period but returned to 100 degrees Jc in 2025. Conclusions Armed conflict in Tigray was associated with interruption of leprosy detection and care, followed by increased disability due to delayed diagnosis. Strengthening surveillance resilience, active case-finding, and post-conflict rehabilitation services are essential to mitigate the long-term impact of conflict on leprosy control.