"Iraqibacter": Exploring the Links Between War and Antimicrobial Resistance

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WHO and the G20 have identified the growing threats of Anti-Microbial resistance (AMR) as a major concern that will define the future of global health. Despite these urgent calls, the emergence of AMR in settings of war and distress migration has not been systematically explored. Case reports from Syria, Iraq, Libya, Yemen, and Afghanistan have shown the proliferation of AMR in combatants and civilians injured in these protracted conflicts. With regional conflicts spreading across state borders as well as one of the largest global refugee crises in decades, AMR in the context of conflict has come to pose a serious threat both regionally and internationally. So began penicillin in the Second World War: antibiotics arose in war. Today, in the context of long-running military conflicts we see harbingers of the end of antibiotics.The core question underpinning this proposal is how war, particularly weapons and the industrialised, urbanised context of contemporary conflicts, drives antibiotic resistance by contaminating the environment and the human and non-human organisms that live there. So far, there has been no systematic or holistic consideration of the environmental health impacts of contemporary conflicts conducted in cities. Our program draws together scholars working in the fields of medicine, anthropology, history of science, ethics, epidemiology, microbiology, molecular biology, and environmental sciences to examine the specific intersection of antibiotic resistance and war. Rather than focus on antibiotic resistance as a universal problem afflicting modern societies in general, we focus first on the impact of global conflict on antibiotic resistance more holistically, and second on the case of multi-drug resistant Acinetobacer baumanii (MDRAB), initially reported by American military surgeons under the moniker Iraqibacter, and that has been identified recently by the WHO as a "critical pathogen" for research and the development of new antibiotics. We will focus on a number of specific countries - Iraq, Syria, Palestine, Yemen, and Lebanon-places with history of protracted conflicts and with different, yet overlapping, ecologies of war. The potential global health significance of conflict-related heavy metal mediated antimicrobial resistance is enormous and warrants further study. It will contribute to the field of environmental pathways for antimicrobial resistance more broadly as well as informing the specific intersection of war and antibiotic resistance.