Severely wounded Ukrainian soldier Anton Sushko thought he was finally safe when he spotted a rescue team after hours of crawling across the battlefield in eastern Ukraine.

“That’s it, I thought, here are the guys… We did it. He’s injured but alive,” the 40-year-old said from his hospital bed in Dnipro, southeastern Ukraine.

But Sushko was not yet out of danger.

When he escaped, a wound on his left leg became infected with aggressive bacteria resistant to antibiotics, making it difficult for doctors to treat him.

The fact that thousands of other soldiers like him have returned from the front with wounds festering with multidrug-resistant organisms speaks to the little-understood cost of war.

Bacteria have long developed resistance to drugs designed to fight them, rendering many drugs useless.

According to the World Health Organization, the process known as antimicrobial resistance (AMR) directly causes over one million deaths and contributes to five million deaths each year.

This situation has been accelerated by the massive use of antibiotics to treat people, animals and food, including in Ukraine.

But Ukraine saw a particular increase in antimicrobial resistance during the Russian occupation, according to Jarno Habicht, WHO’s representative in Ukraine.

“The ultimate reason why we are seeing the rise of antimicrobial resistance is actually the ongoing war,” he said.

– ‘Dirty, rotten’ –

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Direct clashes and air strikes have led to an increase in the number of patients suffering from traumatic injuries, filling understaffed hospitals.

Chief surgeon Sergiy Kosulnykov said that the workload of Dnipro Mechnikov Hospital, where soldier Sushko was treated, increased tenfold.

“Every explosion is an open wound and every open wound is an infection,” Kosulnykov told AFP, showing slides of purulent lesions.

Explosive battlefield injuries are rarely treated in a timely manner as evacuations from drone-infested front lines become increasingly dangerous.

Kosulnykov said that when medical teams examine the wounds, they are often “dirty, rotten, full of necrosed (dead) tissue and bones, and full of aggressive microbes that are difficult to fight.”

To save their patients’ lives, teams often have no choice but to prescribe powerful antibiotics.

And they rarely have time to wait for lab results that determine the right antibiotic.

“It is impossible to imagine all this without an increase in resistance,” Kosulnykov said.

“The more we try to kill a microbe, the more it defends itself.”

The process has doctors scrambling for even more powerful antibiotics to save the lives of patients who can do little other than hope the treatment works.

-‘Not for nothing’-

While waiting, Sushko tried to make sense of everything.

“I distract myself with music, I read literature to get to the roots of our people, to make my soul understand that our men did not give their lives in vain,” he said.

Racing to save his patients, Kosulnykov lamented the lack of equipment and modern medicine that plagued his department.

But when soldiers’ lives are at risk, the hospital can usually get the right medication, he said.

Many uncertainties still remained.

One in particular surprised Kosulnykov.

He estimated that about 50 percent of wounded soldiers accepted into his service developed antimicrobial resistance even before they began treatment.

Kosulnykov recalled a frequent question: “‘Has he been to the hospital before? Somewhere else?’ ” we ask.”

“They’re coming straight from the battlefield… It’s incomprehensible. We just don’t understand,” he said.

Ukraine has long been known for its high AMR rates compared to most European countries because antibiotics were until recently available without a prescription.

The surgeon also suggested that static trench warfare similar to World War I may have contributed to the increase in AMR.

– ‘There is no complete victory’ –

“As the fight continues, we need to better examine the root causes of antimicrobial resistance,” WHO’s Habicht said.

Part of the research is based on monitoring, Habicht said, adding that Ukraine increased the number of laboratories monitoring drug-resistant bacteria from three to 100 in 2017.

The U.S. Centers for Disease Control and Prevention, a public health agency, found that “offensive bacteria have now spread beyond Ukraine’s borders.”

But Habicht refused to give in to the fear-mongering.

He emphasized the need for monitoring and research to ensure appropriate treatment as well as an end to the war.

“We don’t want to go back to a time when we couldn’t cure some diseases,” Habicht said.

Three weeks after AFP visited the hospital, Sushko returned home with his infection under control.

The hospital team values ​​any success, but Kosulnykov remained level-headed.

“People fought infections before me, and they will fight them after me. There are some local victories, but it will not be a complete victory.”