At the bottom of the Pandora’s box: preserving AMR surveillance in Gaza’s collapse

K umar et al. warn of severe antimicrobial resistance (AMR) in Palestine driven by prolonged conflict and health-system collapse, urging a ceasefire, restored humanitarian access, rebuilding water, sanitation, and hygiene/labs/vaccination, stronger stewardship/diagnostics, antibiotic regulation, and context-rooted policy (1).In Gaza, however, the situation has deteriorated far beyond the conditions described just 2 months ago.Resources are reported to be exhausted, humanitarian access is obstructed, and the near-term outlook is bleak.In this context of complete resource depletion and no prospect of immediate aid, the otherwise valid priorities identified by the authors are, at present, unattainable, while the problem continues to escalate (2).More concerning still, beyond the direct clinical threat, is that system fragility has eliminated the capacity to measure the problem: with the loss of lab capacity, pharma ceutical supply chains, and operational tools, the data required to locate and quantify outbreaks have vanished.Without measurement, stewardship and outbreak control become conjectural, a de facto surrender to AMR and other communicable threats (3).Yet even under such conditions, minimal functional capacity can and should be preserved.Ultralight syndromic surveillance-weekly aggregated counts of sentinel conditions (sepsis, infected wounds, acute respiratory infection, and diarrhea), combined with any available microbiological data, as well as deaths and critical stock-outs-can and should be collected at facility level and relayed to a central coordinating unit through available communication channels.Week-on-week trend analysis can provide an operational overview to guide the targeted allocation of scarce antibiotics, fluids, dressings, and infection-prevention resources.Experiences from other protracted emergencies illustrate this potential.In Somalia, reactivating an electronic early warning and response network (EWARN) improved the timeliness of weekly reporting from approximately 25% to near universality over 4 years, with severalfold increases in alert verification (4).In Yemen, an electronic early-warning system became the de facto national communicable-disease backbone, covering around 2,000 facilities and sustaining weekly dashboards despite the collapse of routine surveillance (5).Regional analyses from the eastern Mediterranean show EWARN platforms meeting core timeliness thresholds and verifying a high proportion of alerts even under emergency conditions (6).In Syria, parallel early-warning systems functioned where routine systems had fractured, but coordination and data sharing proved decisive for outbreak control (7).In Gaza, even with minimal operational capacity, the health system could identify priority needs through the systematic collection of standardized site-level data and their timely submission to a central coordinating body.Such aggregated information would enable the development of a shared operational overview, supporting the targeted allocation of scarce resources (Table 1).While lacking diagnostic precision, this approach