Communicable E40: AMR in conflict and crisis zones

It’s World AMR Awareness Week (WAAW) and we have prepared a special episode in light of that. In this week's Communicable, Navaneeth Narayanan and Thomas Tängdén host Aula Abbara (London, UK), Guido Granata (Rome, Italy) and Tuomas Aro (Helsinki, Finland) to discuss the phenomenon of AMR in conflict and crisis zones. They elaborate on how difficult conditions and austere environments amplify the spread of AMR, drawing on findings from the ongoing conflicts in Ukraine, Gaza, Syria and other regions. Other topics covered include adapting antimicrobial stewardship and infection prevention and control (IPC) practices as well as the need for genuine political will and international collaboration to end conflicts and their exacerbation on AMR.

This episode follows the webinar “Beyond the frontlines” organised by ESCMID’s AMR Action Subcommittee for WAAW 2025, featuring the same guests, and is available on ESCMID Media. This Communicable episode was peer reviewed by Arjana Zerja of Mother Theresa University Hospital Centre, Tirana, Albania.

Related ESCMID and Communicable media

• ESCMID Media, Part 1: Beyond the frontlines - tackling AMR in conflict and crisis zones, webinar
• Communicable episode 11: Nightmare series, part 2 – how to deal with carbapenemase producers
• Communicable episode 16: Climate change and infections – effects on clinical practice & sustainability

Resources

• Trainee Association of ESCIMD (TAE)
• Doctors without Borders (Médecins sans Frontières), Antibiogo, https://www.antibiogo.org/
• Doctors without Borders (Médecins sans Frontières), Mini-lab, https://fondation.msf.fr/en/projects/mini-lab

Further Reading

• Abbara A, et al. Unravelling the linkages between conflict and antimicrobial resistance. NPJ Antimicrob Resist. 2025. DOI: 10.1038/s44259-025-00099-y
• Abbara A, et al. A summary and appraisal of existing evidence of antimicrobial resistance in the Syrian conflict. Int J Infect Dis. 2018. DOI: 10.1016/j.ijid.2018.06.010
• Abu-Shomar R, et al. Multidrug-resistant Pseudomonas isolated from water at primary health care centers in Gaza, Palestine: a cross-sectional study. IJID Reg. 2025. DOI: 10.1016/j.ijregi.2025.100671
• Aldbis A, et al. The lived experience of patients with conflict associated injuries whose wounds are affected by antimicrobial resistant organisms: a qualitative study from northwest Syria. Confl Health. 2023. DOI: 10.1186/s13031-023-00501-4
• Aro T, et al. War on antimicrobial resistance: high carriage rates of multidrug-resistant bacteria among war-injured Ukrainian refugees. Clin Microbiol Infect. 2025. DOI: 10.1016/j.cmi.2025.07.010
• Bazzi W, et al. Heavy Metal Toxicity in Armed Conflicts Potentiates AMR in A. baumannii by Selecting for Antibiotic and Heavy Metal Co-resistance Mechanisms. Front Microbiol. 2020. DOI: 10.3389/fmicb.2020.00068
• Dewachi O. War Biology and Antimicrobial Resistance: The Case of Gaza, AMR Insights, 2024.
• Granata G, et al. The impact of armed conflict on the development and global spread of antibiotic resistance: a systematic review. Clin Microbiol Infect. 2024. DOI: 10.1016/j.cmi.2024.03.029
• Huang XZ, et al. Molecular analysis of imipenem-resistant Acinetobacter baumannii isolated from US service members wounded in Iraq, 2003-2008. Epidemiol Infect. 2012. DOI: 10.1017/S0950268811002871
• Hujer KM, et al. Analysis of antibiotic resistance genes in multidrug-resistant Acinetobacter sp. isolates from military and civilian patients treated at the Walter Reed Army Medical Center. Antimicrob Agents Chemother. 2006. DOI: 10.1128/AAC.00778-06
• Karah N, et al. Teleclinical Microbiology: An Innovative Approach to Providing Web-Enabled Diagnostic Laboratory Services in Syria. Am J Clin Pathol. 2022. DOI: 10.1093/ajcp/aqab160
• Keen EF 3rd, et al. Evaluation of potential environmental contamination sources for the presence of multidrug-resistant bacteria linked to wound infections in combat casualties. Infect Control Hosp Epidemiol. 2012. DOI: 10.1086/667382
• Murray CK, et al. Recovery of multidrug-resistant bacteria from combat personnel evacuated from Iraq and Afghanistan at a single military treatment facility. Mil Med. 2009. DOI: 10.7205/milmed-d-03-8008
• Petersen K, et al. Diversity and clinical impact of Acinetobacter baumannii colonization and infection at a military medical center. J Clin Microbiol. 2011. DOI: 10.1128/JCM.00766-10
• Scott P, et al. An outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection in the US military health care system associated with military operations in Iraq. Clin Infect Dis. 2007. DOI: 10.1086/518170
• Sensenig RA, et al. Longitudinal characterization of Acinetobacter baumannii-calcoaceticus complex, Klebsiella pneumoniae, and methicillin-resistant Staphylococcus aureus colonizing and infecting combat casualties. Am J Infect Control. 2012. DOI: 10.1016/j.ajic.2011.03.025
• World Health Organization. Fourth WHO Global Evidence Review on Health and Migration stresses that equitable access to and appropriate use of antibiotics for refugees and migrants is essential to tackling Antimicrobial Resistance, News, 2022.