The word “gauze” may have originated from the Palestinian territory Gaza, but even that wound care staple is running out in the besieged region. According to the Palestinian Health Ministry, over 30,000 people, mostly women and children, have now been confirmed dead in Gaza as a result of the ongoing siege and bombardment by Israel, with over 70,000 injured, although these figures are considered to almost certainly be undercounts.

The conflict was sparked in retaliation for the Hamas massacre of approximately 1,200 civilians and soldiers and kidnapping of around 250 others on Oct. 7th. Now more than two million people — the entire surviving population of Gaza — are housing insecure and living in unsanitary conditions. The majority, especially in the north, are acutely starving. The untenable situation has threatened to spill over into neighboring nations, with many implications for global conflict. One issue which might not immediately come to mind, but which ought to concern us all, is antimicrobial resistance (AMR).

AMR is a broad phenomenon, but simply describes when our tools defending against deadly microscopic nasties stop working. Bacteria, fungi, parasites and viruses can all develop resistance to antibiotic, antifungal, antiparasitic or antiviral drugs. When such medications become ineffective, even formerly mild diseases can become serious threats to public health.

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Over the past century, heavy use of antibiotics and similar medications has given AMR a boost, threatening to upend the public health gains of the 20th Century that saw child and elderly mortality from common bacterial infections drop dramatically, raising life expectancies from a 19th century average of around 47 years.

Diseases of all kinds have been making a worldwide comeback thanks to societal inequities, air travel, a backlash against even basic childhood vaccinations, the tendency of bacterial infections to follow viral ones, and apparent immune dysfunction resulting from COVID-19. But to really come to grips with this new age of disease, you must add the failure of antibiotics to the mix — which brings us back to Gaza.

The impact of antimicrobial resistance isn’t confined to a single patient, but affects all of us.

While volunteering in Gaza for the first 43 days of the war that started after Oct. 7th, Dr. Ghassan Abu-Sittah, a British-Palestinian plastic and reconstructive surgeon, volunteered under absurdly difficult conditions in Al-Ahli Arab Hospital and Shifa Hospital in the north of Gaza, as well as Al-Awda Hospital in the Jabalia refugee camp. He was at Al-Ahli when hundreds of displaced people were killed by a blast of disputed origin — some may remember him from the press conference he held in the hospital courtyard, surrounded by dead bodies.

He left Gaza on day 43 of the war after hospitals were mostly besieged and shut down in the north where he had been working. Since returning to the UK, he has testified to a British war crimes investigation unit about the apparent deliberate targeting of healthcare facilities by Israel, alleging also that he saw patients with chemical burns consistent with the use of white phosphorus, which is a war crime. While still in Gaza, Abu-Sittah co-authored a November letter in The Lancet describing a documented rise in antimicrobial resistance in the territory previous to the current bombardment and siege, and highlighting aspects of the current situation conducive to further spread of AMR.

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“War-related contributing factors to antimicrobial resistance include restricted resources, high casualties, suboptimal infection prevention control and environmental pollution from infrastructure destruction and heavy metals release from explosives,” the authors write generally, also summing up the situation in Gaza.

Abu-Sittah, who has also worked in Lebanon, Syria, Yemen and Iraq, previously described development of antimicrobial resistance in the context of war in Syria, teasing out factors contributing to the problem before the conflict started in 2011, and afterward. Others have documented AMR associated with conflict in Ukraine and Sudan.

One of Abu-Sittah’s co-authors, Antoine Abou-Fayad, has also contributed to a study of........

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