War inflicts a multitude of devastations, visible and invisible, direct and indirect. It is not uncommon for hospital wards in conflict zones to be saturated with soldiers and civilians grappling with open wounds, malnutrition, and the psychological stresses of living amidst turmoil. On top of these immediate medical concerns, a more insidious threat looms: the risk of acquiring an antimicrobial resistant infection that could further jeopardize their wellbeing.
As it stands, antimicrobial resistance (AMR), a global predicament fuelling as many as five million deaths annually, is on a worrying upward trajectory. Although much of this escalation is attributed to the inappropriate use and over-prescription of antibiotics in medicine and farming, the exacerbating effect of warfare on this issue is attracting mounting attention.
AMR transpires when bacteria, viruses, or fungi evolve by developing genetic alterations, enabling them to withstand drugs previously lethal to them. This phenomenon not only poses a risk to routine medical procedures but also complicates the treatment of infections. Conflicts can contribute to this latter concern in several ways.
Foremost, battlefield injuries tend to be laden with contaminating substances like soil, significantly heightening the risk of infection. Additionally, the toxic heavy metals introduced into wounds by weapons and explosives further push microbes to mutate survival mechanisms. The intense volume of casualties resulted from combat and aerial attacks floods health systems and hampers treatment availability.
Healthcare workers, particularly in conflict zones, often find themselves torn between administering broad-spectrum antibiotics to stabilize patients quickly and minimizing the risk of AMR development. However, indiscriminate usage of these broad-spectrum drugs fosters resistance among new bacterial colonies, paving the way for resistant organisms to multiply. In healthcare-deprived settings, these resistant infections can then swiftly proliferate from one person to another. Amassing patients due to raw-bed shortages may also inadvertently introduce AMR into other parts of the country.
Dr. Ezra Barzilay, Ukraine’s Country Director for the US Centers for Disease Control and Prevention, shared concerns about Ukraine’s high pre-existing levels of AMR coupled with a large number of injured patients. This combination has crafted a ‘perfect storm’ for the extensive spreading of antimicrobial-resistant infections. As Barzilay eloquently put it, infections ‘don’t respect borders.’ New strains of antibiotic-resistant bacteria have cropped up in hospitals worldwide that have treated patients from Ukraine.
This problem isn’t confined to conflict-inflamed Ukraine. Other war-torn regions, such as Iraq and Gaza, are facing similar challenges. Addressing this issue is complex, especially when factoring in the destruction of health infrastructures and critical shortages in professionals and essential antibiotics.
Despite such grim circumstances, coordinated efforts to curb this issue are taking shape. In Ukraine, the CDC, alongside local and international partners, has been working to strengthen laboratory detection, enhance clinical treatment, and fortify infection control responses.
In conclusion, while it may seem that the health sector is relatively powerless in preventing wars, these proactive steps could mitigate the medical blowbacks that often trail in its wake.
Source: https://www.gavi.org/vaccineswork/devastating-impact-war-antimicrobial-resistance