Thanks, George W: Researchers warn IRAQ could be epicenter of global superbug outbreak — because war pushed bacteria to evolve resistance to antibiotics

Iraq could be the epicenter of a global superbug outbreak, a new study warns.

Scientists at American University in Beirut, Lebanon, say decades of war in the country — including the US invasion in the 2000s — had led to a ‘catastrophic rise’ in antibiotic resistance.

Destroyed healthcare infrastructure, medicine shortages, heavy metal contamination and poor sanitation were all likely to blame, they argued.

Scientists and doctors are concerned about a bacteria emerging that cannot be treated using currently available antibiotics. Estimates suggest it could cause 10million deaths a year by 2050 if no action is taken.

Last month the discovery of supergonorrhea in Massachusetts — which showed signs of resistance to antibiotics — prompted health authorities to warn the bacteria poses a ‘serious public health concern’.

Previously, antibiotic resistance has largely been attributed to the overuse of antibiotics.

But attention is now turning to other factors, such as heavy metals and disinfectants that are used in conflict, healthcare and the hospitality sector. 

War has been implicated as a factor in the emergence of antibiotic resistance since the 1940s, but the authors say it has received little attention.

The scientists said they chose to focus on Iraq because the country had been beset by conflicts for the past four decades.

This included the Iran-Iraq war in the 1980s, the First Gulf War in 1991, and the US-led invasion and occupation launched in the 2000s. The country also faced an Islamic State insurgency in the 2010s.

The study authors, whose paper was published in the journal BMJ Global Health, reviewed other studies in the paper to warn that the conflicts had led to an environment perfect for the spread of ‘microbial pathogens’ in the country, which cause disease.

Metals used in weaponry and explosives such as lead, mercury, chromium and copper, are all present in war environments.

Some bacteria species taken from these areas are already shown to have evolved resistance to combat these heavy metals’ toxicity.

Study author Dr Antoine Abou Fayad said: ‘Contemporary conflicts waged in urban and industrialized landscapes pressure microbes with selective environments that contain unique combinations and concentrations of toxic heavy metals and antibiotics, while simultaneously providing niches and dissemination routes for microbial pathogens.

‘These can include the high number of wounded, the nature of wounds, refugee displacement, the collapse of sanitation controls, loss of diagnostics and skilled healthcare personnel, the dismantlement of healthcare infrastructures and the placement of often under-resourced and improvised field hospitals where both injured combatants and civilians are exposed to harmful pathogens with limited care and resources to properly recover.’

Though war environments have been linked with the emergence of antimicrobial resistance (AMR) since the 1940s, the research team say the risk posed by Iraq has so far received little attention.

They say it needs to be studied further in order to prevent millions of unnecessary deaths.

Dr Fayad added: ‘Taken together, a destroyed healthcare infrastructure, inappropriate microbial therapies, limited resources, high heavy metal contamination in humans and the environment, and a lack of [clean water, sanitation and hygiene], combined, likely play instrumental roles in the catastrophic rise of AMR in Iraq and, by extension, regionally and globally.

‘Understanding these linkages between AMR and conflict, especially across time, is essential for a global response to AMR, especially as there is little indication that conflict, worldwide, will abate in years to come.’