The Invisible Fallout of War: Antimicrobial Resistance in Fractured Water Systems
Antimicrobial resistance (AMR) is a silent, transboundary threat. Drug-resistant infections were associated with nearly 5 million deaths worldwide in 2019, a toll that could reach 10 million per year by 2050 if no action is taken (UNEP, 2022).
In fragile and conflict-affected settings (FCAS), the risks compound dramatically. Damaged WASH infrastructure, sewage intrusion into displacement shelters, disrupted healthcare, collapsed pharmaceutical oversight, and limited laboratory capacity together create conditions particularly conducive to the emergence and spread of resistant pathogens.
One of the brief's most striking findings: water can test negative for standard indicators such as E. coli while still containing antibiotic-resistant bacteria and resistance genes that threaten public health — a pattern documented in Gaza prior to October 2023, where resistant strains of Pseudomonas spp. and Staphylococcus aureus were detected in samples otherwise deemed microbiologically safe.
To address this hidden crisis, the brief proposes three coordinated policy actions under a One Health framework:
- Enhancing WASH infrastructure and safe water management;
- Establishing integrated AMR surveillance in water and the environment;
- Promoting antimicrobial stewardship and environmental controls across sectors.
The brief also recalls that under International Humanitarian Law (Additional Protocols I and II to the Geneva Conventions, 1977), water and sanitation infrastructure are protected as objects indispensable to civilian survival.
Developed within the JI-RISE project (Jameel Institute – Real-time Intelligent Support for Emergencies), led by Imperial College London and funded by Community Jameel through the Jameel Institute, the brief was co-authored by Reem Abu-Shomar (UNU-INWEH), Imane Messaoudi-Mattei and Mark Zeitoun (Geneva Water Hub), with the support of the Swiss Agency for Development and Cooperation (SDC), the University of Geneva, and the Geneva Graduate Institute.