Tuberculosis Outbreaks Worsening in Nunavik While Quebec Government Ignores Calls to Declare Public Health Emergency

Lire en français sur Pivot

A health crisis has been brewing for some time in Nunavik, the Inuit region of northern Quebec, and it’s only getting worse. 

According to Dr. Yassen Tcholakov, who leads the Nunavik Regional Board of Health and Social Services (NRBHSS)’s infectious disease response, services in some communities are gravely lacking.

“Unfortunately, even to this day, despite the numerous calls for increasing services, there’s communities that have tuberculosis outbreaks that cannot take care of the basics of managing TB,” Tcholakov told PressProgress. 

“What I mean by the basics [is] being able to do screening tests, being able to do diagnostic tests, and being able to provide treatment for uncomplicated cases without the patient needing to fly out.”

Nunavik, with a population of 14,000, has seen as many cases of tuberculosis in the first three months of 2026 — around 40 — as were diagnosed in the first six months of 2025. According to a statement from the NRBHSS, eight out of the 14 communities in the region have active outbreaks currently underway. 

Earlier this year, the Nunavik regional health board signed a two-year contract with the Canadian Red Cross to help find resources — like X-ray machines and workers trained to run them, clinic space, and housing for extra workers during outbreaks — to ramp up screening activities to a level that would allow them detect and treat every patient.

Most tuberculosis cases in Canada these days are found in people who were born in other countries, but demographically, the per capita rate of disease is highest among Inuit people by a striking margin — 186.9 cases per 100,000 people, compared to 17.4 per 100,000 among people born outside Canada as of 2024, according to federal data. The rate is even higher in Nunavik, as pictured above. 

There are systemic and structural reasons for why Nunavik, as part of Quebec, is veering farther from the goal of eliminating tuberculosis by 2030, while its neighbouring Inuit-governed territory of Nunavut is getting closer, with fewer than five cases of active tuberculosis diagnosed there as of mid-March, according to an article in Nunatsiaq News. 

Last summer, the mayors of Nunavik’s 14 communities penned a strongly worded joint letter to former premier François Legault and former health minister Christian Dubé to “demand the Government of Quebec declare a public health emergency due to the escalating tuberculosis crisis” in the region. 

The regional health board has also been alerting the province to Nunavik’s dire resource needs since TB cases started to rise in 2023. 

“We made requests from the provincial government and for most of them, we’re still waiting to hear back,” Tcholakov said. “We’ve been told that there’s planning happening at the Ministry but thus far, nothing has come out of it.”

The Quebec health ministry did not respond to PressProgress’s questions prior to publication.

‘Racism at its most visible’

Nunavik’s 14 mayors sent their calls to action to the provincial government after they participated in a year-long research study in which an Indigenous-led team of researchers interviewed 156 Inuit people and 21 non-Inuit healthcare workers across five communities, between 2022 and 2023. 

This study, which was published last week in the Canadian Medical Association Journal, had clear recommendations for addressing the unfolding health crisis in the region.

In addition to the need for more resources, according to the study, the provision of tuberculosis-related health services in Nunavik needs to be put in the hands of more Inuit and Inuktitut-speaking people.

“A lot of it, for me, is common sense,” said Dr. Natasha Ita Macdonald, co-senior author of the study and Inuk from Kuujjuaraapik, Nunavik whose PhD research focused on Inuit-led approaches to decolonizing education. 

“The lack of communication, much less intercultural communication, has been an enormous barrier in all levels of healthcare.” 

Most healthcare workers who practice in Nunavik are recruited from other parts of Quebec and are mainly Francophone, while the vast majority of people in Nunavik speak Inuktitut as their first language, with English as a second language and French as a potential third. Even with translators available, experts say this language barrier presents a big challenge. 

Submitted by Dr. Ben Geboe, lead researcher in a new qualitative study published in CMAJ that asked over 150 Nunavik residents about their experiences with tuberculosis

“It’s something that the province of Quebec has not dealt with, because the priority in the province is French language. However our region is Inuktitut-first language speakers,” MacDonald said.

As it stands, getting properly diagnosed and treated for tuberculosis often requires people to travel to one of the two communities in Nunavik that has a hospital. Directly observed therapy (DOT) is compulsory in most cases, meaning patients must travel to clinics to take their medication, and anyone in Nunavik who is diagnosed with TB has to sign a form informing them that a court ordered police intervention could be used to force them to follow their treatment plan. 

“I look forward to the day when this is changed, because this isn’t a requirement that is put on other Canadians,” MacDonald said, referring specifically to the police intervention threat. “This is racism at its most visible.”

In some cases, study participants reported feeling ashamed by their or their children’s tuberculosis diagnosis, due to either stigma borne from a lack of information about the disease, or the way information is presented. 

According to MacDonald, there were instances in which people’s names were broadcast on the local radio station to let them know their TB medication was ready at the local clinic.

“Our communities are so very small, [and] isolated and so when you have your name put on the radio which all community members have on in their homes, imagine the embarrassment,” she said. 

“What our community members would like is to have TB care done in a more humane way, in a way that best reflects the needs of our communities.”

Nunavik residents remember the 1950s and 60s during which the airborne tuberculosis bacterium, introduced by colonizers to the Inuit Nunangat, spread through these northern communities. At least a third of the Inuit population at the time were sent to sanatoriums, or hospitals, in the south for years at a time, for treatment. 

Many who did not survive were buried in the south, without the informed consent of their family members. The search for deceased Inuit relatives continues to this day. 

Submitted by Dr. Ben Geboe, lead researcher in a new qualitative study published in CMAJ that asked over 150 Nunavik residents about their experiences with tuberculosis

First-of-its-kind research

The research team that interviewed residents in Nunavik in 2022-23 had a distinct difference from others: it was a study led by Inuit and First Nation researchers who spoke Inuktitut. 

“This was the first time we’ve done an actual qualitative interview where we hired Inuit people… not just as translators or coordinators, but actually to sit down and gather data, conduct interviews, [and] analyze the data,” said Dr. Ben Geboe, first author and a social worker hailing from the Yankton Sioux Tribe of South Dakota who has personally experienced exposure to tuberculosis while working with unhoused people in New York City.

According to Geboe, this was a deliberate decision made by the research team lead at the McGill University Health Centre, which shared their findings with Inuit community members and leaders before disseminating it to a wider audience. The interviews and focus group sessions also involved activities that promoted engagement, like craft workshops, feasts, and raffle events.

The effect was overwhelmingly positive. 

“It was very powerful for many Inuit who had been in research [but] they never heard back,” Geboe said. “They’re the most researched population, they say, in Canada, but the least informed about what the outcomes are.” 

Dr. Ben Geboe (left) standing with Inuit public health officers. Image Submitted by Dr. Ben Geboe

During the interview sessions, Geboe said he heard community members voice complex concerns about tuberculosis, like whether the large amount of medication they’re taking will cause side effects and why some people who get exposed to tuberculosis develop an infection while others don’t.

What surprised Geboe was that among Nunavik residents, there was no fear of the medication itself — something he’d come to expect in his own community. 

“Nobody said, ‘Western medicine is bad and we don’t want it,’” Geboe said. “They all love health. They want to protect themselves and protect others.”

The research ended just as tuberculosis case counts in Nunavik were starting to spike in 2023, after an expected drop in numbers due to screening activities going on pause during the COVID-19 pandemic. 

Social determinants of health take their toll 

While Quebec’s provincial government has been nearly silent in the face of these increasing outbreaks, there has been some support from the federal government and innovative solutions being sought at the local level. 

“We have, regionally now, two portable x-ray machines that fit in a standard checked suitcase in an airplane,” Tcholakov said. “They’re on loan from the Public Health Agency of Canada. Same goes for some of the lab machines we use to test for tuberculosis regionally.”

More loaned equipment is on its way, which will allow the regional health board to increase diagnostic capacity. 

However, operating the portable x-ray machines is something only licensed x-ray technicians can do in Quebec, while in other jurisdictions across Canada they can be run by people who undergo shorter, more targeted training specifically for these machines. 

“Right now, in some communities, you have the X-ray tech passing by one week every eight weeks,” Tcholakov said. 

“Many things in healthcare that elsewhere can be done by paraprofessionals, in Quebec are reserved acts for certain named types of professionals. Some of the very simple things that elsewhere are delegated, unfortunately, that means we cannot delegate them, at least not easily and not without complicated discussions in which we currently are.”

When it comes to finding spaces large enough to hold community-level TB screening activities or house extra healthcare workers during outbreaks, in a region that already suffers from a housing crisis, Tcholakov said the regional board has been looking to local institutions.

“For instance, the school boards have periods when they’re not using housing because the teachers are not in town for the summer,” Tcholakov said. “We’ve asked if we can use those facilities to accommodate healthcare workers, and there’s a lot of openness to that.”

A shortage of housing that forces people to live in close quarters in Nunavik is one of the social determinants of health that creates an environment ripe for outbreaks of tuberculosis, as well as other diseases.

Another is the remoteness of the relatively small communities that have few services available. But the downward trend of tuberculosis cases in Inuit-governed Nunavut, which faces similar concurrent challenges, shows how outbreak management can be done well. 

“What we’re hoping to be able to deploy this year is essentially every community that’s in outbreak, we would like them to receive the recommended screening to try to achieve screening the whole population of those communities, because that’s essentially how TB was eliminated from other regions,” Tcholakov said.

“It’s something that needs to be repeated regularly every year, maybe every two years at most, probably for a decade or more, before we can get closer to the epidemiological objectives of eliminating TB in Nunavik.”