Bacterial infection during wars, conflicts and post-natural disasters in Asia and the Middle East: a narrative review

ABSTRACT

Introduction

Bacterial infections resulting from wars and natural disasters represent a major public health problem. Over the past 50 years, Asia and the Middle East have suffered several wars. Moreover, East-Asian countries are considered the most natural disaster-prone countries in the world.

Areas covered

This review focuses on bacterial infection occurring during wars and after natural disasters, among refugees, wounded citizens and soldiers as well as the prevention and control measures that must be taken.

Expert opinion

During wars, refugees and soldiers represent the two main sources of bacterial infections. Refugees coming from countries with a high prevalence of antimicrobial resistance can spread these pathogens to their final destination. In addition, these refugees living in inadequate shelters can contribute to the spread of bacterial infections. Moreover, some factors including the presence of fixed imported fragments; environmental contamination and nosocomial transmissions, play a key role in the dissemination of bacteria among soldiers. As for natural disasters, several factors are associated with increased bacterial transmissions such as the displacement of large numbers of people into over-crowded shelters, high exposure to disease vectors, lack of water and sanitation. Here, we carry out a systematic review of the bacterial infections that follow these two phenomena.

KEYWORDS:

• Asia
• Middle East
• wars
• natural disasters
• prevention and control measures

Article highlights

• Bacterial infections, particularly the multidrug-resistant (MDR) bacteria, have become a serious challenge to global healthcare.

• Wars and natural disasters have led to a large human movement and made an enormous number of individuals’ displacements from their homes, and a serious threat, which is the dissemination of infectious diseases.

• Outbreaks of infections have been a direct result of wars, which cause huge damage to health services and medical organizations. In addition, conflict-related traumatic injuries have worsened the case.

• Several diseases can also be spread during the war as a direct effect of the mass movement of refugees living in poor hygiene conditions.

• In recent decades, the frequency of natural disasters has increased worldwide resulting in large economic damage affecting and killing millions of people.

• Outbreaks of diseases following this phenomenon are primarily related to the displacement of people into the overcrowded shelter where supplies are limited.

• Moreover, during a water-related disaster, contaminated water, waste and sharp objects may play a major role in the dissemination of bacterial infections.

• Prevention and control measures must be taken in addressing the challenges resulting from these two phenomena.

Acknowledgments

The authors thank CookieTrad for English language corrections.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by the French Government under the « Investissements d’avenir » (Investments for the Future) program managed by the Agence Nationale de la Recherche (ANR, fr: National Agency for Research), (reference: Méditerranée Infection 10-IAHU-03).