Table 1 Specific challenges of HAT control in conflict zones

• Conflict-afflicted areas are often already remote with minimal (if any) health infrastructures and limited numbers of trained medical staff, and their often precarious state is further eroded by insecurity.

• Insecurity often hinders active case-finding activities since mobile teams are often restricted in their travel.

• Populations often move, hampering treatment provision and post-treatment monitoring and follow-up.

• Population movements can also trigger new foci or reactivate old ones.

• Community awareness and support are important factors for effective screening and treatment. Population displacement due to insecurity can rupture community networks.

• Direct attacks of treatment centres or transport trucks can lead to programme interruption or cessation, withdrawal of supporting international NGOs and key national staff, or disruption of logistic support.

• Difficult diagnosis, complex treatment, and long follow-up are especially challenging in conflict situations, because of the high technical skills and continuity of service required.