1. Yvan J-F Hutin, Director, Antimicrobial Resistance, World Health Organization
2. Muhammed Shaffi Fazaludeen Koya, Medical Officer (AMR-IPC-One Health Unit)
WHO Regional Office for the Eastern Mediterranean
3. Philip Mathew, Technical Officer (AMR), World Health Organization
In 2019, WHO identified antimicrobial resistance (AMR) as one of the 10 most important threats to global health. In 2021, the Global Burden of Disease estimated that more than 1 million deaths were attributable to drug-resistant infections and this number is expected to rise to nearly 2 million annually by 2050. In fragile and conflict-affected settings, this risk is magnified, the defenses are weak, and the consequences are often invisible to the world.
In most conflict zones, health systems become fractured, in others they collapse. Governance is weak, infrastructure damaged, supply chains disrupted, and human resources depleted. As systems collapse, AMR thrives. Policies which work well when health systems are functional, are not compatible with on-the-ground realities in fragile settings. To overcome these challenges, we must recognize the issue and adapt AMR mitigation to fragile contexts, integrate it into humanitarian and development agendas, and build a people-centred approach rooted in local realities.
AMR’s dangerous foothold in fragile settings
War, displacement and disruption create a “perfect storm” for drug resistance as it leads to a collapse of the systems to prevent, diagnose and treat infections. Trauma and catastrophic injuries are common, with high risk of infection and often delayed or suboptimal surgical care. Studies have documented high rates of drug-resistant pathogens in wounds treated in conflict settings. At the same time, diagnostic microbiology capacity is minimal or destroyed; laboratories are often non-functional, infection control is limited or absent, staff displaced and supplies interrupted. Resistance patterns are unknown, undermining rational treatment decisions.
Disruptions in the antibiotic supply chain aggravate this situation. In places such as Gaza, essential first or second choice antibiotics are absent, leaving patients un-or undertreated. In others, over-the-counter and counterfeit drugs flood informal markets, fueling misuse. The collapse of public services amplifies indirect risks: overcrowded camps with poor water and sanitation, malnutrition, lack of safe shelter, and environmental contamination from the toxic remnants of war. Cross-border displacement spreads resistant pathogens far beyond conflict zones, often into neighboring health systems ill-prepared to cope.
However, and given other competing priorities, it is difficult to assign to AMR the level of priority it deserves in fragile settings. Humanitarian actors and intergovernmental organizations tend to focus on immediate emergencies such as epidemics, malnutrition and trauma care. AMR is perceived as secondary or long-term, even though it directly undermines the emergencies they address.
Adapting AMR response to fragile and conflict settings
In fragile settings, protecting vulnerable communities means starting with the basics. Infection prevention and control is the first line of defense- simple hygiene standards, mobile tools for monitoring, and clear protocols can go a long way in keeping both patients and frontline workers safe. Vaccines against outbreak prone infections like cholera, typhoid, meningitis, measles, and rotavirus must also be part of humanitarian health packages. They don’t just save lives- they prevent the outbreaks that drive unnecessary antibiotic use.
Accurate diagnosis is equally critical. Field laboratories guide treatment even in the harshest conditions. By adapting existing rapid diagnostic systems for broader use, we can expand access to diagnostics and gain a clearer picture of resistance patterns.
Treatment must be smarter. Emergency antibiotic kits should follow WHO’s AWaRe (Access, Watch, Reserve) system, with simplified stewardship protocols to keep everyone on the same page. Surveillance systems must capture resistant infections early, using mobile tools, sentinel sites, and integration into existing alert systems, to allow early action. Resilient supply chains for safe and quality-assured essential antibiotics, diagnostics and vaccines secures availability.
But none of this will succeed without communities at the centre. Training local health workers and first responders in hygiene, wound care, and appropriate antibiotic use builds capacity and trust. Listening to affected communities ensures interventions are realistic and sustainable. Offering a core package of services for infectious diseases, which consider infection control and stewardship, in both primary and mobile health services reduces dependence on informal drug markets where misuse flourishes.
Making AMR visible in the humanitarian agenda
These interventions face many risks: destroyed infrastructure, disrupted electricity and water, displacement of health workers, insecurity and sanctions. Yet there are enablers to build upon. International organizations and global funding mechanisms are increasingly open to fragile contexts, and new technologies offer innovative diagnostic and monitoring solutions. With predictable financing, stable supply chains and quality-assured essential medicines, integrating AMR into humanitarian response initiatives is possible.
World AMR Awareness Week (WAAW) 2025 is a reminder that resistance respects no borders. When a hospital is bombed, a laboratory destroyed, or water systems contaminated, those are not just immediate tragedies- they drive emergence and spread of AMR. If we fail to act now, AMR erode important lines of defense for some of humanity’s most vulnerable populations, with consequences that extend far beyond conflict zones, for example when patients and wounded are evacuated for care.
AMR is not a distant, long-term and abstract threat. It is a pressing reality, especially on the frontlines of fragility and conflict. The global community has the tools, knowledge and frameworks to respond, but only if they are brought together and adapted to the harshest realities where they are needed most. As we mark this WAAW, we must ‘act now to protect our present and secure our future’.
Note: Please click on this link to access the latest policy brief from WHO Regional Office for the Eastern Mediterranean on AMR in fragile and conflict affected settings
Originally published on Global Cause on 24 November 2025.