Human conflict, from minor disruptions to the all-too frequent escalation of war, stretches people and the environment to its limits. At the same time, microorganisms create an equally devastating—but largely invisible—scene.
During times of human conflict, infections thrive among the wounded and overcrowded, and the surrounding environment is likely to become contaminated with heavy metals and unsafe water, which further propagates the spread of disease.
Meanwhile, hospitals struggle to save lives with restricted resources (e.g., shortages of medical staff, medications and supplies), and people have difficulty accessing, or simply cannot access, health care if/when it is available.
In short, conflict fuels the uncontrolled spread of infections in environments where proper health care is hard to come by, which leads to misuse of antibiotics without proper diagnosis and treatment. This, in turn, allows pathogens to rapidly develop antimicrobial resistance (AMR).
Understanding the factors driving AMR in areas of conflict can be difficult, and take time to assess, as research, understandably, does not take precedence during triage. Yet, a look back at conflicts that have occurred over the past 20+ years reveals some noteworthy trends.
Hard choices: Life over AMR
During times of human conflict, medical professionals face impossible choices. For instance, in the Gaza Strip, already exhausted and under-resourced individuals must prioritize immediate lifesaving interventions in locations that are often under continuous threat or bombardment.
Every minute that could be spent determining appropriate antibiotic protocols is, instead, used to save a limb or a life, leaving limited capacity to monitor or address how far AMR may have spread during the war.
Research supports this concern: during the 2018 Great March of Return protests in Gaza—an event far less violent than the conflict that began in 2023—microbes isolated from wounded individuals showed AMR increases of up to 300% for specific antibiotics compared to samples from non-wounded individuals. Although the data are not yet available, the current situation, with its greater scale of casualties and damage, likely presents an even more alarming escalation of AMR.
by Mahmoud Ebied, American Society for Microbiology