And that does not only have consequences for Iraq, because antibiotic-resistant bacteria do not shy away from crossing national borders or even traveling to other parts of the world.
More and more pathogenic bacteria are becoming antibiotic resistant. This means that they are no longer sensitive to our antibiotics and the antibiotics therefore no longer work. And as a result, infections that were previously treatable become untreatable. It is a major and growing problem; in 2019 alone, an estimated 1.27 million people died from antibiotic resistance. And it is feared that by 2050, some 10 million people will die each year because their bacterial infection is no longer treatable.
War
The fact that more and more bacteria are becoming resistant is generally attributed to the incorrect use of antibiotics (see box).
Incorrect use of antibiotics
When you are prescribed antibiotics, the doctor or pharmacist often urges you to complete the course completely. That is important, because if you use antibiotics for too short a time, the pathogenic bacteria are not all dead yet. The bacteria that are most resistant to the drug remain and will multiply. This leads to selection of bacteria that are increasingly resistant to antibiotics, which can result in the emergence of bacteria that are no longer sensitive to antibiotics. In addition to short-term use of antibiotics, excessive use of antibiotics – both in clinical conditions and in livestock farming, for example – can also lead to resistance. Because when bacteria are exposed to the same antibiotics for a long time or repeatedly, they can gradually arm themselves against it.
But there are more factors that contribute to antibiotic resistance. For example, since the 1940s it has been suspected that wars also contribute to the emergence of resistant bacteria. And rightly so, researchers now state in the magazine BMJ Global Health. In their study, they show that a decades-long period of conflict in Iraq has led to a ‘catastrophic’ increase in antibiotic resistance. “War benefits resistant bacteria, because chaos (lack of a wide range of antibiotics, lack of microbiologists, etc.) and heavy metals give them a better right to exist than bacteria that are sensitive to antibiotics,” said researcher Antoine Abou Fayad. Scientias.nl.
The research
Although the suspicion that war and antibiotic resistance are related has been around for some time, it is still unclear to what extent wars and conflicts are really a driving force behind the growing problem that resistant bacteria pose. To get a better grip on this, Abou Fayad and colleagues looked at Iraq. The country has been dealing with a succession of conflicts since the 1980s, including the war with Iran, the US invasion and conflicts with IS. And those wars and conflicts, the researchers write in their study, coincide with the emergence and spread of resistant pathogens.
No coincidence
And that is no coincidence. “A destroyed healthcare system, inappropriate treatment of infections, limited resources, exposure to heavy metals – from both humans and the environment – and a lack of clean water, sanitation and hygiene are likely to play a critical role in the catastrophic rise of antibiotic resistance in Iraq, ” that is how the researchers summarized it forcefully.
Wounded
Conflicts and wars usually involve injuries, and Iraq has been no different in recent decades. It promotes resistance, explains Abou Fayad Scientias.nl out. “Many injuries means bacterial infections can spread more easily through hospitals.” Of course, a shortage of healthcare personnel – and microbiologists – that we often see in war zones does not help. The same goes for the fact that resources – including antibiotics – are limited in war-torn areas and hospitals. As a result, there may be a shortage of antibiotics available (which promotes resistance). Or that doctors cannot use a wide range of antibiotics to treat infections, so that infections cannot be treated with the most effective antibiotics and that bacteria are also repeatedly exposed to the same antibiotics (which can also lead to resistance).
Heavy metals
But the appalling situation in the hospitals is not the only problem. For example, people – but also bacteria – in war zones are frequently exposed to heavy metals. “During conflict, heavy metals come from a wide variety of sources: bullets, grenades and destroyed buildings, for example,” says Abou Fayad. “And heavy metals can kill bacteria.” That may sound positive. But that is not it. Because just as repeated exposure to antibiotics can cause bacteria to find ways to survive a run-in with antibiotics, repeated exposure to heavy metals can also cause them to arm themselves against those deadly heavy metals. And since heavy metals kill bacteria in much the same way as antibiotics, they also become resistant to antibiotics en passant. “If heavy metals are present in large quantities, this can lead to the activation of efflux pumps that not only pump away heavy metals (from the bacteria, ed.) but also antibiotics.”
Global consequences
War conditions thus form the perfect breeding ground for resistant bacteria. And so conflicts in Iraq have most likely been a major contributor to what researchers call “a catastrophic rise in antibiotic resistance in Iraq.” To us Westerners that may sound like a far-off show, but it is nevertheless a development that should also cause us concern. Because those resistant bacteria don’t mind national borders. “Just as COVID-19 has spread from one country to another, drug-resistant bacteria are also spreading,” said Abou Fayad. And bacteria may, in a way, do that even better than viruses. “Bacteria can multiply independently, in other words without being dependent on a host – like viruses – and then they can spread around the world by hitchhiking on people, animals and water (as you see with cholera, for example).
The research clearly hints that conflicts and wars may contribute to the emergence of drug-resistant bacteria. And we should be more aware of this and do more research into it, the researchers believe. In their study, they conclude that a better understanding of the link between antibiotic resistance and conflict is essential for the global fight against resistant bacteria. “Especially since there are no indications that conflicts worldwide will decrease in the coming years.”