Tuberculosis continues to cause more deaths worldwide than any other single infectious pathogen, accounting for an estimated 10.7 million cases and 1.23 million deaths in 2024. In Northern Ethiopia, the armed conflict that began in 2020 badly damaged the health system, destroying or damaging over 70% of health facilities in the region. Despite this, little is known about the quality of tuberculosis care delivered in these settings after the conflict. This study used the Donabedian Structure-Process-Outcome model to evaluate tuberculosis care quality in conflict-affected health facilities in Northern Ethiopia. We conducted a facility-based cross-sectional study across nine public hospitals in the Tigray and Amhara regions; a tenth planned facility (Lalibela General Hospital) was excluded prior to data collection due to active security concerns. A total of 42 tuberculosis patients and 42 healthcare professionals were enrolled per facility through consecutive sampling. Data were collected using facility performance-monitoring checklists and patient exit interviews. Descriptive statistics were computed using SPSS version 26. A total of 378 TB patients and 378 healthcare professionals were assessed across nine conflict-affected facilities. Overall TB care quality was good (87.3%), demonstrating healthcare system resilience despite severe conflict-related disruption. Structural quality averaged 82.1%, with service accessibility critically weak (only 22.2% of facilities meeting standards). Process quality was 83.6%, reflecting high health professional knowledge (92.8%) with patient knowledge (80.4%); with critical gaps in symptom recognition (42.1%). Outcome quality was excellent (96.1%), though sputum microscopy documentation remained weak (68.7%). Patient satisfaction was good overall (77.8%) but varied widely across facilities (54.6%–100%). The conflict’s impact was devastating: 66.7%–83.3% of Tigray facilities were non-functional during active hostilities, 59.5% of patients could not access medications, and healthcare providers reported that all patients (100%) expressed fear or safety concerns when seeking follow-up care. TB care quality has largely recovered to good levels in the post-conflict period, demonstrating notable healthcare system resilience. However, critical gaps in service accessibility, patient knowledge, and sputum documentation persist and require urgent, targeted intervention to strengthen TB care delivery in conflict-affected settings.