Superbugs: War’s Deadliest Enemy
May Be on Its Way
Jeanne Trubek / Massachusetts Peace Action

(February 12, 2025) — War kills people.  We all know that.  But most people don’t know that wars kill people in more ways than they have ever imagined, killing people who are far from the armed conflict.

We know wars can and have killed millions, but bacteria unleashed by warfare can kill millions more, and those numbers are likely to continue multiplying. In a recent horrifying – and lengthy – article published in the New York Times Magazine, Francesca Mari warns us compellingly that “Modern Warfare Is Breeding Deadly Superbugs”.

As laid out in the New York Times piece, more and more deadly antimicrobial-resistant pathogens (AMR) are evolving, especially in war-torn areas.  Nations of the Middle East, like Iraq, Syria, Yemen and Afghanistan, now suffer from particularly high rates of multidrug-resistant pathogens, and some of the world’s most fearsome superbugs have incubated in the region.

These superbugs include E. coli, MRSA and perhaps most notably A. baumannii, a type of bacteria – aptly nicknamed “Iraqibacter” – carried home from Middle East wars by U.S. soldiers.

The risk inherent in such pathogens concerns all of us in a very direct way.  Although fighting may be confined to specific countries, pathogens— bacteria, fungi, viruses—know no borders. Mari cites a prediction from general medical journal, The Lancet, “that by 2050 antimicrobial resistance will kill 8.22 million people per year, more than the number currently killed by cancer.”Medical people familiar with the current situation in the Middle East think that this figure is a major underestimate.

A growing body of research suggests that the 21st-century way of warfare – destroying medical facilities, sanitary facilities, water sources, and access to care – plays a major role in the spread of antimicrobial resistance. Mari warns us: “As wealthier countries bomb poorer ones, devastating essential infrastructure, they have created the tragic social conditions that foster antibiotic resistance. The public-health fallout knows no borders and can carry on indefinitely, even after the bombs stop.”

Even more frightening, new antibiotic-resistant bacteria are evolving – and they are evolving much faster than new antibiotics are being developed. In her article, Mari describes first-hand accounts from several people in the medical field, including a Palestinian surgeon at the American University of Beirut, Ghassan Abu-Sittah, who has been studying resistant infections for over ten years. He saw that roughly 70 percent of his patients from Iraq and almost 80 percent from Syria had infections that were resistant to multiple drugs.

Working with an Iraqi anthropologist and physician Omar Dewachi, Abu-Sittah noted that resistance accelerated because of how bombs had changed. From the literature they learned that heavy metals from battery plants and fertilizers were correlated with increasing AMR. This is noteworthy because in the Persian Gulf and Iraq wars, the Americans had used extremely heavy bombs, weighing up to 30,000 pounds, encased in heavy metals like cobalt and tungsten.

A. baumannii, a type of bacteria – nicknamed “Iraqibacter”.

At several points in her article, Mari draws our focus to Acinetobacter baumannii, a strain of Acinetobacter. Acinetobacter baumannii emerged as a global threat during the US-led wars and occupations in the 2000s, attracting attention because it killed wounded US soldiers. In 2003, 12 percent of the Acinetobacter infections tracked by the Walter Reed Army Institute of Research were resistant to a key antibiotic called imipenem, but by 2015 the rate of resistance had risen to 99.2 percent.

According to Abou Fayad, whom Mari interviews at his lab at the American University of Beirut, resistant bacteria are classified in three ways: 1) multidrug resistant (MDR), meaning resistant to at least three classes of antibiotics;  2) extensively drug resistant (XDR), meaning resistant to all classes but two (generally colistin and tigecycline); and 3) pan-drug resistant (PDR), meaning they’re basically resistant to everything.Fayad  told the New York Times a concerning observation: back in 2017 he used to get one sample a month of PDR bacteria. Now? Fayad gets “one sample a day”. Terrifyingly, Acinetobacters are often responsible for infections in critically ill patients, accounting for 20 percent of intensive-care-unit (ICU) infections globally. And according to Mari’s article, almost all of them are pan-drug resistant – that is, they’re resistant to everything.

What is going on? As Mari gathered from speaking to researchers, one possible explanation has to do with heavy metals. Many heavy metals such as copper and cadmium are naturally antibacterial. Although nascent, the results witnessed by Abou Fayad through his research are concerning.  Mari breaks it down in her article: the Acinetobacter was absorbing small particles of heavy metals and then developing a gene that enabled it to evacuate the heavy metals by constructing an “efflux pump” within the bacteria.

The issue? As I learned from the article – heavy metals and antibiotics actually resemble one another,  and that same mechanism—the “efflux pump”—also worked to get rid of antibiotics. In simpler terms, “the microbe was evolving to flush out toxins” and in the process becoming antibiotic-resistant.

By the end of her article, Mari had honed in on a disturbing realization – although AMR wasn’t necessarily driven by one single thing, war created the perfect conditions for it: a “toxic biosphere for the acceleration of resistance”. Even more disturbing are the wide-ranging and often overlooked implications of war – resistant pathogens are just part of the story. Climate change has expanded the range of antibiotic-resistant pathogens, and globalization has made their spread inevitable.

This connection comes as no real surprise to those of us in the peace movement who are already clued into the many casualties of war, even as its strikes are varied and underhanded. As our investment in war outpaces that of healthcare and medicine, Mari’s New York Times piece illuminates yet another connection: “born in war, antibiotics now risk becoming another of its casualties.”