Attachments
Executive Summary
We live in a time that is witnessing escalating humanitarian needs in the face of a diminishing response capacity. Antimicrobial Resistance (AMR) is fuelled by much of what drives humanitarian needs, conflict, climate change, displacement, infectious disease outbreaks and often overlapping politico-economic instability whilst simultaneously undermining the capacity to respond. 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.
Antimicrobial resistance poses a growing threat in humanitarian and low-resource settings, particularly in conflict-affected regions where fragile health systems, access barriers to healthcare, and environmental contamination amplify its impact. Since 2014, Médecins Sans Frontières (MSF) has made reducing the AMR burden a key priority, integrating it into its broader medical humanitarian efforts.
This report follows on from the second UN High-Level Meeting on Antimicrobial Resistance, held on September 26, 2024, which aimed to “review progress on global, regional, and national efforts to tackle antimicrobial resistance, identify gaps, and invest in sustainable solutions to strengthen and accelerate multisectoral progress, building a healthier world based on equity and leaving no one behind.” While the new declaration acknowledges the significant gaps in addressing AMR in humanitarian and low-resource settings, there remains a lack of concrete, practical steps to translate these commitments into tangible actions.
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 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.
The key findings of this report emphasize the limited understanding we have 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 brings together the testimonies, evidence and analysis to propose concrete calls for actions that should be integrated within the upcoming AMR initiatives to ensure an effective 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.
In conclusion, the lens through which we view AMR in humanitarian settings is broken—we see neither the people whose lives are impacted by AMR or the burden it places on already stretched health systems. Gaps in policy, resources, and actions leaves responses fragmented. For these reasons MSF calls on the international community to translate global commitments to tangible actions for a truly global response that leaves no one behind.