When Sergiy Antonenko came to, he was on fire.
He had suffered third-degree burns over 25 percent of his body.
In the ensuing months, Antonenkos injuries became a nightmare.
Ukrainian soldier Sergiy Antonenko at amilitaryhospital in Belgium, recuperating from burn injuries that became infected with drug-resistant Klebsiella pneumonia.Eli Cahan
The former farmer had lived through the battle, but his larger war for survival was just beginning.
And it was taking place on a microscopic scale.
Where the burns came, the bacteria followed.
Antonenkos case is far from rare.
But the risk is not limited to soldiers alone.
The science also shows that the problem is worse than its ever been.
And as refugees flee war-torn countries, those organisms may be on the move, too.
We suspect the impact will be very big.
In that way, AMR has become the climate change of medicine.
Its a slow-brewing catastrophe: an inch of sea-level rise here, an extra nursing home death there.
Pandemicscome in different sizes and speeds, Vitek tellsRolling Stone, comparing AMR to the Covid crisis.
Its just that this ones happening at a different speed.
ON THURSDAY NIGHTS in Jamestown, South Carolina, the Gadsden family would gather for scripture.
Of all her kids, Zeada Gadsden-Morris says Jonathan the fifth of seven was the most spiritual.
Hed ask questions late into the night, Gadsden-Morris says, as his siblings begged to go to bed.
Over the next month, she sat by Jonathans bedside every day.
He didnt last five minutes, Gadsden-Morris says.
Jonathan, like Antonenko decades later, had survived the battle.
But he didnt survive the war.
Gadsden-Morris was told one bacteria in particular was responsible for her sons death: an organism calledAcinetobacter.
She couldnt even pronounce it at first, she recalls.
In fact, she still cant.
Accordingly, the supervillain received a new alias: Iraqibacter.
Narrow corridors ran between cordoned-off rooms, forming a maze in the sand.
And soon after Richard Teff arrived in the winter of 2003, the patients started pouring in.
The incineration of flesh creates temporary vacuums that suck in even more bacteria.
But so many of these injuries entailed a complicated calculus when it came to treatment.
But 6,200 miles west, those infections were quickly becoming more than an afterthought for Army physician Emil Lesho.
It would get resistant to this antibiotic, then it would get resistant to that antibiotic, Lesho says.
We were chasing our tails.
The general sentiment was that this thing seemed to have come out of nowhere.
Prior to that, in the military,Acinetobacterwasnt a big thing; it wasnt common, Lesho says.
Or, we just didnt know about it.
Partly, thats due toAcinetobacters evasive nature.
(GadsdensAcinetobacter, for example,had initially been classified asNocardia, an altogether separate organism.)
Those conversations, though, often turned circular.
The generals and the funding guys would ask us the same question how many guys didAcinetobacterkill?
And you couldnt say, Lesho recalls.
So, priorities remained elsewhere.
Theyd say, Go away, I have bigger problems, Lesho says.
Military folks theyre all focused on beans and bullets and shit.
Still, the question possessed him:Where were the superbugs coming from?
No, Chapailo said.
The next day, Chapailo set out east towards the Russian border.
On Sept. 18, Chapailos unit was driving allied helicopters roaring overhead when an explosion rocked their truck.
He was thrown to the ground and scurried to reorient himself.Were under attack, he thought.
He took stock of the situation minutes later, only then realizing he was not whole.
His hands, his feet, his face the flesh was all charred.
Then, the pain.
Its not realistic to have a go at explain it in words, he recalled to me months later.
His memory is blurry, he says, but what he does remember was hell on earth.
The dressing changes were the worst.
What he doesnt remember, though, is the thing that almost killed him:Klebsiella.
In the years after the Red Armys invasion in 2014, AMRs like Chapailos strain ofKlebsiellabecame commonplace.
In 2022, one Lviv hospital reported that the vast majority of patients had AMRs.
AMR has become the climate change of medicine: Its a slow-brewing catastrophe.
Data obtained byRolling Stonefrom the Ukrainian Ministry of Health show other species likeE.
Coli also had resistance rates to powerful antibiotics that were up to 2.5 times higher in Ukraine than globally.
In other words: Keep the soldiers alive.
As a result, wounded soldiers go for long periods with contaminated metal buried within them.
Bacteria can colonize the shrapnel, forming microscopic sleeper cells in which they can survive for weeks or months.
Onto other soldiers during mass casualty events at MASH hospitals.
Onto truck beds in transit to city centers.
Onto beds, floors, and ceilings of their hospital rooms.
Onto cargo holds of the aircraft evacuating them to acute care centers in other countries.
The bacteria are sleeping, Borodavko says, and only after [a] surgery, they wake up.
Makogonskyi, the emergency-medicine doctor in Khmelnytskyi, has seen a similar story play out over and over.
By the time they get to the hospital, he says, theres not that much doctors can do.
AMR is the price we pay, he says, for saving the lives of our soldiers.
DISCOVERING THE ORIGIN of superbugs in war zones isnt just about individual amputees or burn victims.
Its also about how war disfigures a countrys landscape.
Omar Dewachi witnessed it firsthand in Baghdad.
He was a senior in high school when America launched Operation Desert Storm.
Over the next six weeks, the U.S. dropped nearly 90,000 tons of bombs over Baghdad.
Heaps of rubble accumulated that would take months to clear, and plumes of smoke filled the skies.
That kind of contaminationcan last for decades, research shows.
In the ecological sense, [you are] dealing with a wound that doesnt heal, Dewachi says.
In other words, the same genetic light switch that turns on metal resistancealso activates antibiotic resistance.
Put differently, the threat doesnt end when a ceasefire is called.
Those corpses in those charred buildings are not just affecting people now, he says.
Theyre probably going to affect people for a long time to come.
But now, it seems, every year, the list of superbugs is growing longer.
Since the war in Ukraine began, Barzilay has watched organisms likeKlebsiellaandAcinetobacteremerge in force.
In the time of modernization and travel, diseases dont have boundaries.
About 500 traveled to two or more countries during their care.
Taken together, these patterns have put the European CDC (ECDC) on high alert.
Moreover,Plachouras worries that the implications stretch beyond hospitals.
In that scenario, Plachouras adds, [AMR is] a problem for millions of people.
Those corpses in those charred buildings are not just affecting people now.
Theyre going to affect people for a long time to come.
The EU has not been standing idly by.
Theyve already sent thousands of test kits to dozens of labs across the country, the WHOs Vodianyk says.
In the past year though, theyve been losing the battle.
Meanwhile, the war pushes into its third year, and the cycle of destruction and infection continues.
Still, Chapailo plans to re-enter the military service as soon as hes able.
I am built for the frontline, he says.
I could be put to better use there than here.
Antonenko, for his part, is now back in Dnipropetrovsk, in the eastern part of the country.
He doesnt know how his future or the future of his country will look.
As such, the WHOs strategy has pivoted.
For now, theyre not focused on turning things around, Vodianyk says.
Instead, the priority is damage control.
(The Department of Defense did not respond to multiple requests for comment.)
Domestic efforts to combat AMR have stalled, too.
In April, a bipartisan coalition reintroduced the bill for a third cycle.
The stalemate has left people like Zeada Gadsden-Morris frustrated that her son died in vain.
