The rise and spread of such virulent infections adds to the devastation of war, increasing medical costs, blocking hospital beds because patients need care for longer, and often leaving people whose injuries might once have been healed with life-changing disabilities.
Gaza is a particularly fertile breeding ground for superbugs because its health system has been worn down by years of blockade, and antibiotics are in short supply.
“This is a global health security issue because multi-drug-resistant organisms don’t know any boundaries,” said Dina Nasser, lead infection control nurse at Augusta Victoria hospital in East Jerusalem, who has also worked in Gaza. “That’s why the global community, even if it’s not interested in the politics of Gaza, should be interested in this.”
Even though doctors in Gaza knew protocols to prevent the rise of drug-resistant bacteria, persistent shortages of antibiotics meant they could not always follow them, they told reporters. Patients take incomplete courses of antibiotics or are prescribed a mix because the right medicine is not available.
Shortages of water, power and fuel for generators mean doctors cannot always meet even basic hygiene standards, making it easier for any drug-resistant infection to spread. At times doctors are not even able to wash their hands and there are shortages of gloves, gowns and chlorine tablets for disinfecting.
The US military noted the spread of drug-resistant bacteria from Iraq more than a decade ago; it logged such a huge rise in injured personnel returning with resistant Acinetobacter that the bacteria were eventually nicknamed “Iraqibacter”.
But Gaza is not totally cut off. Small numbers of patients do transfer to other hospitals in Palestine, Israel and nearby countries such as Jordan, Egypt and Lebanon.
Healthy people can carry the bacteria without showing any symptoms, so doctors and aid workers travelling in and out of Gaza could transport superbugs to other countries. The bacteria can also travel without human hosts.
The first antibiotic, penicillin, was brought into mass production towards the end of the second world war. Since then, antibiotics have saved millions of lives and prevented countless disabilities, particularly among those injured in war, by allowing doctors to avoid amputations.
But no new class of antibiotic has been developed since the 1980s, and as the world’s superbug crisis grows ever more severe, some modern conflict zones are starting to resemble those in pre-penicillin days.