Antimicrobial resistance in the ongoing Gaza war: a silent threat

Conflicts and wars, such as those in Iraq and Syria, contribute substantially to the development and spread of antimicrobial resistance.1 In the Gaza Strip (or Gaza), such resistance is rising, with a 300% increase in resistance to specific antibiotics seen in isolates from injured patients after the Great March of Return demonstrations, compared with non-injured patients.2 War-related contributing factors to antimicrobial resistance include restricted resources, high casualties, suboptimal infection prevention control, and environmental pollution from infrastructure destruction and heavy metals release from explosives.2,3 Before the start of the war on Oct 7, 2023, inadequate wastewater management in Gaza led to bacterial contamination in 34% of hospitals' water and surface samples with high resistance to antibiotics, particularly to carbapenems and cephalosporins.4 Access to essential antibiotics, primarily through donations, has been a continuous challenge due to the blockade of Gaza, resulting in availability as low as 45%.5 An already restricted national surveillance system for antimicrobial resistance adds to these challenges. [...]heavily contaminated wounds with substantial devitalised tissue are not being operated on as frequently as needed to prevent infection. A severe shortage of medical professionals puts further strain on already exhausted staff who prioritise limb-saving and life-saving procedures over infection and antimicrobial resistance prevention. [...]critical shortages in basic medical equipment and essential antibiotics, along with chaos, destruction, and dysfunctional microbiological laboratories, make implementing antimicrobial stewardship an unattainable luxury.