Hepatitis C: the cure exists, but too many are left behind

Every year on 28 July, World Hepatitis Day draws attention to a disease that kills hundreds of thousands of people worldwide, most of whom do not even know they carry it.

Hepatitis C is common, largely silent, and now curable with modern medicines. Yet millions of people, particularly in the Middle East and North Africa (MENA), still cannot get tested or treated.

01What is hepatitis, and what makes hepatitis C different?

Hepatitis means inflammation of the liver. It can be caused by alcohol, certain medications, or several unrelated viruses, of which hepatitis A, B, C, and E are the most common. Hepatitis C is caused by the hepatitis C virus (HCV), which enters the bloodstream and settles in the liver, where it can quietly cause long-lasting damage if it isn’t treated.

Unlike hepatitis A and E, which spread mainly through contaminated food and water, hepatitis C spreads through contact with infected blood. There is currently no vaccine against it, which makes prevention, testing, and treatment even more important.

02How is hepatitis C transmitted?

Hepatitis C passes from person to person through blood-to-blood contact. The most common routes are sharing needles or other injecting equipment, receiving blood or blood products that have not been properly screened, and unsanitary medical or dental procedures where equipment is reused without sterilisation.

It can also pass from mother to child during birth, and, less commonly, through sexual contact. In regions with weaker infection control in healthcare settings, unsterilised equipment remains a significant driver of new infections.

03What are the symptoms?

Hepatitis C is often called a silent infection, because most people who contract it have no symptoms at all, especially in the early stages.

When symptoms do appear, they can include fatigue, nausea, joint pain, or yellowing of the skin and eyes.

The real danger lies in what happens without treatment: most people who are infected fail to clear the virus naturally and go on to develop chronic infection.

Over a long period of time, this can lead to liver scarring (fibrosis), cirrhosis, and in some cases liver cancer, which is how hepatitis C most often becomes fatal.

04Who is most at risk?

Hepatitis C affects an estimated 58 million people worldwide, but the burden is not spread evenly.

The Middle East and North Africa region carries the highest burden of hepatitis C of any region globally, a finding confirmed by a 2022 study by researchers at Weill Cornell Medicine-Qatar and the WHO’s Eastern Mediterranean office, which analysed data from nearly 50 million people across the region.

Within this already high-burden region, certain groups face even greater risk and even greater barriers to care.

People who inject drugs are disproportionately affected, since needle-sharing remains one of the most efficient routes of transmission. People living in humanitarian settings and displaced populations, whether due to conflict, disaster, or protracted crisis, often face a double burden: increased exposure to unsafe medical practices where health systems have broken down, and, at the same time, the least access to the testing and treatment that could catch the virus early.

Communities with limited healthcare infrastructure more broadly also see lower testing rates and later diagnoses, meaning the disease is often only caught once liver damage is already advanced.

05How is hepatitis C diagnosed and treated?

Diagnosis starts with a blood test that detects antibodies to hepatitis C, which shows whether a person has ever been exposed. Because some people clear the infection naturally, a positive antibody result is followed by a second test that looks for the virus itself, confirming whether the infection is active.

The real breakthrough of the last decade has been treatment. Direct-acting antiviral medicines can now cure over 95% of people with hepatitis C, usually within eight to twelve weeks and with minimal side effects, replacing older treatments that were long, difficult to tolerate, and far less effective.

The biggest obstacle today is less the science, and more the price. Pharmaceutical companies often set the cost of these medicines far beyond what health systems in affected countries can pay, and patents have, in some cases, blocked cheaper generic versions from entering the market.

06Why is this a global health concern?

Hepatitis C meets every condition for a public health emergency: it is common, it is often invisible until it is advanced, it kills mostly through preventable complications, and, unlike many other major killers, it is curable.

The gap between what medicine can do and what people can access is what turns a curable disease into one of the leading causes of cirrhosis and liver cancer worldwide, with the toll falling hardest on regions such as MENA and on people already facing barriers to healthcare.

07What is MSF doing about it?

MSF treats hepatitis C in dozens of countries and started 14,774 people on treatment in 2025 alone, running community-based programmes that bring screening, diagnosis, and treatment together in one place.

Our teams are focusing on three critical areas: raising awareness, providing comprehensive testing and treatment, and breaking down the associated stigmas. Our goal for raising awareness is to actively inform the community about hepatitis C, explaining the risks and emphasising the crucial importance of seeking early treatment.

MSF has also directly challenged pharmaceutical pricing, including filing legal opposition to patents on key hepatitis C drugs to open the door to affordable generics.

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