In the Democratic Republic of the Congo (DRC), conflict between the Kinshasa government and the M23 rebel group has intensified over recent weeks. Fighting around the eastern border city of Goma has caused displacement, while the destruction of health infrastructure has exacerbated outbreaks of mpox, cholera and measles.
Meanwhile, the war in Ukraine has seen the emergence of multidrug-resistant bacteria among wounded soldiers, now spreading into hospitals across Europe. These crises highlight that warfare not only disrupts healthcare systems but also creates breeding grounds for antimicrobial resistance, or AMR.
In Ukraine, the Russian invasion has decimated healthcare infrastructure, forcing many hospitals to operate under extreme conditions worsened by a significant number of casualties.
Several health organisations have highlighted a rise in multidrug-resistant bacteria among wounded Ukrainian soldiers and civilians transported for medical care across Europe. In some cases, bacteria found in these patients have shown resistance to all available antimicrobial treatments.
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Much has been written about the potential security threats posed by nuclear escalation, energy prices, and geopolitical instability; much less attention has been paid to how conflict can engender a global health crisis.
Of course, warfare has often played a crucial role in the development of medicine. Humans are, with the right incentives, quite good at coming up with solutions, and few things present medical challenges and incentives at the same scale as armed conflict.
Antibiotics revolutionised medicine in the mid-20th century, with the second World War a catalyst for their widespread use. Penicillin, first discovered in 1928, was mass-produced during the war, and saved countless lives that would have previously been lost due to infection from battlefield injuries.
The result was an era where bacterial infections could be effectively controlled in both humans and animals. However, decades of overuse and misuse have led to the rise of antibiotic-resistant bacteria, an issue that is now exacerbated by modern conflicts.
Reports from Iraq and Afghanistan indicated a surge in multidrug-resistant infections among wounded soldiers, largely due to the overuse of broad-spectrum antibiotics and poor infection control in field hospitals. But antimicrobial resistance is not just a wartime issue.
The World Health Organisation warns that, if unchecked, it could lead to 10 million deaths annually by 2050. Antibiotic-resistant infections claim about 35,000 lives each year in Europe alone. Despite this, no new classes of antibiotics have been introduced in the past three decades. The pharmaceutical industry has largely abandoned antibiotic development due to high costs and limited returns.
This is because the economic model for antibiotic development is poorly incentivised. New antibiotics must be used sparingly to delay resistance, reducing their profitability compared with drugs for chronic conditions. Estimates suggest that developing a new antibiotic can cost up to €1.5 billion, with no guarantee of viability. As a result, major pharmaceutical companies have withdrawn from antibiotic research, leaving only a handful of firms pursuing new treatments.
The war in Ukraine has highlighted the international implications of antibiotic resistance. As Ukrainian patients with multidrug-resistant infections are transferred to hospitals across Europe, previously low-incidence regions such as Norway and Germany are now seeing a rise in drug-resistant bacteria.
A study conducted by Swedish researchers in 2022 found that 6 per cent of bacterial samples from Ukrainian hospitals were resistant to all tested antimicrobials.
In the DRC, the combination of conflict and disease outbreaks presents another AMR risk. With health services severely disrupted and displaced populations lacking access to antibiotics, infections that might otherwise be treatable can become lethal. Additionally, when antibiotics are available, they are often misused due to a lack of medical oversight, further accelerating resistance.
[ The Irish Times view on the war in Congo: a dire humanitarian crisisOpens in new window ]
Tackling AMR in conflict zones requires a co-ordinated approach. Governments and international organisations must incentivise antibiotic research. Conflict-affected regions need targeted support to rebuild healthcare infrastructure, ensuring access to clean water, sanitation and effective infection control measures.
Enhanced monitoring of AMR trends in conflict zones is crucial for early intervention. The WHO and ECDC are already tracking resistant infections among Ukrainian patients, but a more co-ordinated global response is needed. Military and civilian healthcare providers must prioritise antibiotic stewardship to prevent the emergence of superbugs.
The conflicts in Ukraine and the DRC are stark reminders that AMR is not just a medical issue – it is a geopolitical and humanitarian crisis. Without urgent action, drug-resistant infections could become the defining health challenge of the 21st century, threatening millions of lives and reversing decades of medical progress.
Governments, pharmaceutical companies and international organisations must work together to confront this escalating threat before it is too late.
Stuart Mathieson is research manager with InterTradeIreland
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