AMR and Covid-19 on the Frontline: A Call to Rethink War, WASH, and Public Health

Abstract

This Viewpoint calls for a greater understanding of the role that water plays in the transmission of anti-microbial resistance and covid-19 in protracted urban armed conflict, in order to develop a ‘pathogen-safe’ practice. It argues that dealing with the twin threats is difficult enough in the best of circumstances, and is so little understood in war zones that surgeons and water engineers now question if their practice does more harm than good. Experience suggests that the known transmission routes are complicated by a great number of factors, including the entry of heavy metals through bullets in patients’ wounds, hospital over-crowding, mutation in treated water or wastewater, and other threats which endure long after the bombing has stopped. The skeleton research agenda proposes greater sewage surveillance, testing of phages and monitoring of treatment designed to dispel or substantiate these assertions.

Epidemiology of Antimicrobial Resistance and the Wash Project: Averting a Potential Public Health Crisis in Nigeria Using the United Kingdom as a Case Study

“…The Nigerian Federal Ministry of Health launched a National Action Plan (NAP) and The National Guidelines on Water, Sanitation, and Hygiene in Healthcare Facilities published by the Nigeria Federal Ministry of Health in Nigeria, aiming to mitigate the state emergency that the lack of WASH services created, including inadequate infrastructure, a shortage of trained personnel, insufficient investment, and a lack of effective regulatory oversight, failed to address the link between AMR and WASH through research conducted and published by the [34,35,40,41,36], World Health Organization, Agriculture Organization of the United Nations and World Organisation for Animal Health, 2022 all emphasizing the importance of combatting AMR through WASH in healthcare facilities, farms, schools. WASH facilities and interventions in Nigeria are concentrated on areas that experience water-borne diseases like cholera and do not address the issue of AMR.…”

Antimicrobial stewardship in primary health care programs in humanitarian settings: the time to act is now

“…In conflict-affected settings, several compounding factors can contribute to the emergence and spread of AMR [ 18 , 19 ]. In addition to that, the implementation of adequate infection prevention and control (IPC) and antimicrobial stewardship (AMS) interventions have specific challenges, including, but not limited to: constrained access to quality water as key element for proper hygiene and sanitation in communities and health facilities; self-medication practices in countries with absence of law enforcement on sales of over-the-counter antibiotics; lack of awareness on the topic among health workers involved in service delivery; absence of laboratory infrastructure; and conflicting agendas in prioritization of programs when immediate life-saving priorities need to be addressed with limited resources [ 20 – 23 ].…”

Antimicrobial Resistance and Machine Learning: Challenges and Opportunities

“…Specific concerns have been reported concerning the risk of epidemics of multidrug-resistant infections in Gaza [24], [29], under political blockade since 2007 and ranked amongst the most densely populated places in the world (Palestinian Central Bureau of Statistics) 3 . Numerous outbreaks of antibiotic resistance that have been documented are likely the result of poor infection control, irrational prescription practices, and easy access to antimicrobials [30]- [32].…”