The Broken Lens: Antimicrobial Resistance in Humanitarian Settings
We live in a time that is witnessing escalating humanitarian needs. Antimicrobial Resistance (AMR) is fuelled by much of what drives humanitarian needs, conflict and ensuing displacement, climate change, infectious disease outbreaks and often overlapping politico-economic instability. The global failures to act now and to anticipate the consequences of our continued inaction in humanitarian settings will leave vulnerable populations to bear the burden for years to come.
The lens through which we view AMR in humanitarian settings is broken—we see neither the people whose lives are impacted by AMR nor the burden it places on already stretched health systems. Gaps in policy, resources, and actions leave responses fragmented. For these reasons, MSF calls on the international community to translate global commitments into tangible actions for a truly global response that leaves no one behind.
Paving the way forward, this report draws on nine operational case studies from Gaza, Afghanistan, Mozambique, North Syria, Ukraine, Sierra Leone, South Sudan, and Bangladesh. These case studies illustrate the critical drivers, challenges and consequences of AMR in a range of contexts where MSF works—conflict-affected regions, areas disproportionately impacted by climate change, countries with underfunded health systems, and displaced populations. This report highlights the pressing need to develop a context-adapted approach to AMR for vulnerable groups such as newborns, malnourished children, those who have sustained trauma injuries, and women and girls living in humanitarian settings.
This report's key findings emphasise our limited understanding of AMR in these settings due to a paucity of available data and research and inadequate microbiology services and infrastructure to inform the urgently needed context-specific interventions to effectively tackle AMR in these environments.
It highlights the fundamental role of equitable access to quality healthcare, water sanitation and hygiene (WASH), infection prevention and control (IPC), vaccines, antimicrobial stewardship and medical and laboratory supply chains, improved living conditions – particularly for those displaced, nutrition and consideration of AMR risk and the need for mitigation in all healthcare and non-healthcare associated policies. It stresses that discourses that focus only on the importance of controlling excess use of antibiotics miss a reality in humanitarian and low-resource settings marked by lack of access to diagnostics, antibiotics, and healthcare more broadly.
This report then combines the testimonies, evidence, and analysis to propose concrete calls for action that should be integrated into the upcoming AMR initiatives to ensure an effective and equitable global response. These recommendations address critical areas such as accountability and governance, access to microbiology services and antibiotics, improving the quality of healthcare through enhanced IPC and antimicrobial stewardship (AMS), achieving universal healthcare coverage, and increasing AMR financing.