A summary and appraisal of existing evidence of antimicrobial resistance in the Syrian conflict

Abstract

Antimicrobial resistance (AMR) in populations experiencing war has yet to be addressed, despite the abundance of contemporary conflicts and the protracted nature of twenty-first century wars, in combination with growing global concern over conflict-associated bacterial pathogens. The example of the Syrian conflict is used to explore the feasibility of using existing global policies on AMR in conditions of extreme conflict. The available literature on AMR and prescribing behaviour in Syria before and since the onset of the conflict in March 2011 was identified. Overall, there is a paucity of rigorous data before and since the onset of conflict in Syria to contextualize the burden of AMR. However, post onset of the conflict, an increasing number of studies conducted in neighbouring countries and Europe have reported AMR in Syrian refugees. High rates of multidrug resistance, particularly Gram-negative organisms, have been noted amongst Syrian refugees when compared with local populations. Conflict impedes many of the safeguards against AMR, creates new drivers, and exacerbates existing ones. Given the apparently high rates of AMR in Syria, in neighbouring countries hosting refugees, and in European countries providing asylum, this requires the World Health Organization and other global health institutions to address the causes, costs, and future considerations of conflict-related AMR as an issue of global governance.

Methicillin-resistant Staphylococcus aureus carriage rate and molecular characterization of the staphylococcal cassette chromosome mec among Syrian refugees in Iraq

“…These results are in agreement with MRSA prevalence rates in refugees residing in asylum centers or camps in Switzerland (15.7%) (Piso et al, 2017), Italy (12.5%) (Angeletti et al, 2016), and the Netherlands (approximately 10%) (Ravensbergen et al, 2017). However, the prevalence rates of MRSA in both the host community and refugees in the present study were much higher than those in the population of the Netherlands as a whole (1%), as well as those of Germany (10%), Belgium (0%), and Iceland (0%) (Abbara et al, 2018). In contrast, MRSA prevalence rates among refugees in the current study were lower than the rates of up to 37-56% found in Greece, Portugal (Ravensbergen et al, 2017), and Romania (Abbara et al, 2018;Ravensbergen et al, 2017).…”

“…Given the widespread migration of refugees, the study and wider appreciation of the importance of global and international movement of multidrug-resistant microorganisms are highly relevant. The mass movement of Syrian refugees regionally and internationally raises particular concerns about the spread of antimicrobial-resistant organisms such as MRSA (Abbara et al, 2018). Limited data are available on the prevalence of MRSA among Syrian refugees.…”

“…Limited data are available on the prevalence of MRSA among Syrian refugees. Countries neighboring Syria, including Lebanon and Jordan, have reported the emergence of multidrugresistant organisms (MDRO) among the hosted Syrian refugees (Abbara et al, 2018;Abbara et al, 2017). In contrast, Turkey has no clear data available about MRSA among refugees (Abbara et al, 2018).…”

“…Countries neighboring Syria, including Lebanon and Jordan, have reported the emergence of multidrugresistant organisms (MDRO) among the hosted Syrian refugees (Abbara et al, 2018;Abbara et al, 2017). In contrast, Turkey has no clear data available about MRSA among refugees (Abbara et al, 2018). The aim of this study was to compare the prevalence of MRSA between refugees from Syria and their host community in Iraq, which is used as an intermediate station for refugees moving to Western countries.…”

“…Amongst civilians, war and conflict promote factors that increase the prevalence of infectious diseases. These factors include mass displacement of people, overcrowding, unavailability of clean water, bad sanitation, and the collapse of public health services (Abbara et al, 2018;Ozaras et al, 2016). Refugees can pose a significant challenge for host communities and can change the map of infectious diseases.…”