Abstract

Armed conflict significantly exacerbates the emergence and spread of antimicrobial resistance (AMR), 
compounding global public health challenges. Disruption of healthcare systems, population displacement, and 
unregulated antimicrobial use in crisis settings create conditions conducive to the proliferation of multidrug
resistant pathogens. Conflicts in Syria, Ukraine, Yemen, Afghanistan, and Iraq illustrate how war undermines 
infection prevention, surveillance, and stewardship, while amplifying transmission dynamics both within and 
across national borders. The combination of damaged infrastructure, inadequate pharmaceutical supply chains, and 
compromised governance hinders effective response, surveillance, and stewardship interventions. This review 
highlights the mechanisms linking conflict to AMR, explores public health and regional consequences, and 
underscores the ethical and policy dimensions of equitable antimicrobial allocation. Strengthening global health 
governance, implementing context-specific stewardship programs, and enhancing surveillance and supply chain 
resilience are essential strategies to mitigate AMR in conflict-affected settings. Coordinated international action, 
grounded in humanitarian law and public health principles, is crucial to prevent long-term global proliferation of 
resistant pathogens.