Antimicrobial resistance in a protracted war setting: a review of the literature from Palestine

Antimicrobial resistance (AMR) is a growing global health crisis, particularly in war-affected regions like the occupied Palestinian territories (oPt). A scoping review of 1,787 articles revealed high rates of AMR, with 40% of Klebsiella pneumoniae producing ESBL and 55% of Streptococcus pneumoniae resistant to penicillin. The study also found significant gaps in antibiotic prescription, dispensation, and consumption regulation. Most studies attributed AMR to local practices, overlooking broader structural and socio-political drivers. The review underscores the need to contextualize AMR within the environment, particularly under conditions of sustained warfare. It also highlights the need for comprehensive strategies to address AMR under conflict conditions, guiding physicians and policymakers in designing effective AMR stewardship programs.