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

世卫组织和20国集团已将抗生素耐药性（AMR）日益增长的威胁确定为将决定全球卫生未来的主要问题。尽管有这些紧急呼吁，AMR在战争和危难移民环境中的出现还没有得到系统的探讨。来自叙利亚、伊拉克、利比亚、也门和阿富汗的病例报告显示，AMR在这些旷日持久的冲突中受伤的战斗人员和平民中扩散。随着区域冲突跨越国界蔓延，以及几十年来最大的全球难民危机之一，冲突背景下的抗菌素耐药性已在区域和国际上构成严重威胁。青霉素在第二次世界大战中开始了：抗生素在战争中出现。今天，在长期军事冲突的背景下，我们看到了抗生素终结的预兆。支撑这一提议的核心问题是，战争，特别是武器和当代冲突的工业化、城市化背景，如何通过污染环境和生活在那里的人类和非人类生物体来驱动抗生素耐药性。到目前为止，还没有系统或全面地考虑到当代城市冲突对环境健康的影响。我们的计划汇集了在医学，人类学，科学史，伦理学，流行病学，微生物学，分子生物学和环境科学领域工作的学者，以研究抗生素耐药性和战争的具体交叉点。我们并没有将抗生素耐药性作为困扰现代社会的普遍问题来关注，而是首先关注全球冲突对抗生素耐药性的更全面的影响，其次关注多重耐药鲍曼不动杆菌（MDRAB）的情况，最初由美国军事外科医生以Iraqibacter为绰号报道，并且最近被世界卫生组织确定为研究和开发新抗生素的“关键病原体”。我们将重点关注一些特定的国家--伊拉克、叙利亚、巴勒斯坦、也门和黎巴嫩--这些国家有着长期冲突的历史，有着不同但重叠的战争生态。冲突相关重金属介导的抗菌素耐药性的潜在全球健康意义是巨大的，值得进一步研究。它将有助于更广泛地研究抗菌素耐药性的环境途径，并为战争和抗生素耐药性的具体交叉点提供信息。

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.