More and more multidrug-resistant bacteria are circulating in Gaza and Ukraine. These so-called superbugs do not respond to antibiotics. As a result, injuries to war victims are becoming increasingly difficult to treat, sometimes resulting in amputations or death. Nieuwsuur spoke to doctors, microbiologists, hospitals and health institutions in the Netherlands and abroad. They are very worried. The World Health Organization (WHO) speaks of “an alarming trend”. “This could spread to neighboring countries,” warns Dr. Hatim Sati of the WHO’s antibiotic resistance department.
‘Engine’ behind infection problems
Krystel Moussally, an epidemiologist at Médecins Sans Frontières, also sees that danger. “New forms of resistance, born out of the war in Ukraine, are now also being discovered in Europe, in the Netherlands, in Denmark, even in the United States.” The more difficult bacteria are to kill or to slow down with antibiotics, the more difficult it is to fight infections. The risk of spreading infections and of diseases and deaths then increases. In Gaza and Ukraine, there was already a lot of resistance before the wars due to incorrect and too much antibiotic use and wrong guidelines. The wars make the problems worse. “War is really a driver of infection problems,” says clinical microbiologist Heiman Wertheim, who is going to Ukraine on behalf of the WHO to help. “The environment that a war creates is like a feast for bacteria in which they quickly become resistant and are easily passed on,” says Moussally, “Sometimes you get 300 or 400 wounded in half an hour. Then the cleaning of wounds is not optimal. That is an ideal vehicle for spreading an infection.
The extent of the problems in Gaza and Ukraine is difficult to quantify. For example, antibiotic resistance is not listed as a cause of death. Moussally: “You count deaths due to malnutrition or chronic diseases, but you don’t count deaths due to multidrug-resistant infections.” According to Ukrainian infectious disease doctor Maxym Krasnov, antibiotic resistance in Ukraine is one of the leading causes of death of patients with severe injuries. “It’s a big challenge for all of our doctors.” In Gaza, Nieuwsuur hears something similar from doctor Khaled al-Nabrisi in a hospital in Deir al Balah. “Due to the many patients and the shortages, we cannot test everyone. And when we do perform tests, we sometimes don’t have the right Antibiotic. Then we give something else, less effective.
Unprecedented numbers
Concerns are also growing in the Netherlands. War victims from Ukraine, among others, are cared for in Dutch hospitals. They increasingly suffer from multi-resistant bacteria. Clinical microbiologist Wertheim speaks of a situation without precedent. “The bacteria, how resistant they are, that is new.” He often sees patients at Radboud UMC, such as people that return from holiday or people who have been treated in a foreign hospital, who are infected with ‘super bacteria’. “But with these numbers and so many different resistant bacteria in one patient, that is unprecedented for us.” A 2023 annual report from the RIVM shows that in 2022 the number of resistant bacteria that are difficult to treat was significantly higher than the year before. This can partly be explained by the treatment of Ukrainian patients in the Netherlands. Between the Russian invasion and August 2023, a Dutch patient was infected by a Ukrainian patient at least three times, according to the RIVM. Such a contamination is not necessarily immediately dangerous; You can carry a ‘super bacterium’ with you for a long time without noticing. But it can lead to problems in vulnerable patients.
The Netherlands ‘model country’
For the time being, infections in the Netherlands can be contained well, thanks to prevention and control mechanisms. The WHO even calls the Netherlands a “model country”. For example, isolating patients with dangerous diseases to prevent the spread of multi-resistant bacteria is well regulated here. In war situations, this isolation is often impossible; The healthcare system and the sanitary situation are not optimal and are sometimes even the target of attacks. In addition, the presence of heavy metals, for example due to the use of bullets and bombs and destroyed infrastructure, has a reinforcing effect on resistant bacteria. “The bacteria are forced to genetically adapt in such a way that they become resistant to the heavy metals,” explains Moussally of Médecins Sans Frontières. “The genetic elements build up resistance to antibiotics in the same way. That’s how bacteria adapt and defend themselves against antibiotics or heavy metals.” Antibiotic resistance has been a growing problem for years. In countries where antibiotics are used a lot, infections caused by resistant bacteria are more common than in countries where there is a higher degree of reluctance to use antibiotics, such as in the Netherlands. The use of antibiotics in livestock farming also contributes to the spread of resistance. It is estimated that in 2019, antibiotic resistance was directly responsible for 1.27 million deaths worldwide and indirectly responsible for 4.95 million deaths. According to the WHO, this makes it one of the biggest public health problems.
By: Sophia Mons, reporter: Zainab Hammoud. Nieuwsuur