Yusra* packed up her bag deliberately, taking care to gather everything she would need. For how long? Weeks? Months? No one could say. Inside her luggage, she tucked two precious items: baby photos of her children on one side, emergency antibiotics on the other.

The escalation of the Israeli attacks in Lebanon since 17 September 2024 has meant that home is no longer safe for Yusra. And she is not alone. As of mid-October 2024, the Government of Lebanon estimates that over 1.2 million people have fled their homes, including over 800,000 internally displaced people.

In Yusra’s case, that has meant travelling to Saudi Arabia to stay with her daughter, Nour Shamas, an infectious diseases clinical pharmacist and specialist in antimicrobial stewardship.

As in previous trips, Yusra travels with her back-up antibiotics on hand and prays that she’ll be able to get medical care if necessary. She’s had these acute needs since 2018, when she got a life-threatening drug-resistant infection following emergency surgery on her back. Yusra recovered after months of treatment, but now she is particularly susceptible to serious recurrent drug-resistant urinary tract infections.

Increasingly the global community is recognizing the link between conflict and antimicrobial resistance (AMR). In Yusra’s case, conflict makes it extremely difficult and costly to access urgently needed medical care, including diagnostics and antibiotics. She worries that emergency medical care in a foreign country without access to her private health insurance or regular doctor could cripple her financially and put her life at risk.

More generally, displaced people in conflict settings may move into temporary, crowded shelters without access to clean water, facilitating the spread of infections. Conflict often interrupts routine medical care like flu shots and childhood vaccinations, facilitating the spread of certain bacteria and viruses. In war zones, traumatic injuries received and/or treated in non-sterile conditions can become contaminated with bacteria and then spread as people move and as soldiers return home. Studies further suggest that bacteria evolve to develop resistance when exposed to the toxic heavy metals used in modern warfare.

Coincidently, Yusra’s daughter Nour has been a leader in implementing antimicrobial stewardship programmes. Such programmes are designed to foster appropriate use of antimicrobials and diagnostics for optimal care that minimizes the spread of drug resistance. Yet Nour and her mother know that well-designed stewardship programmes are only one key part of the solution. Far beyond the hospital walls, conflict is contributing to the AMR crisis.

*Name has been changed for privacy.