Not forgetting the humanitarian contexts in the fight against antimicrobial resistance: Operational-driven reflection on knowledge and research gaps by Médecins Sans Frontières

Despite Antimicrobial Resistance (AMR) being a growing threat to global public health, there is scarce evidence from humanitarian settings. Working in fragile contexts, Médecins Sans Frontières (MSF) is well positioned to identify knowledge gaps, raise unrecognised issues, and contribute to the global AMR agenda. Based on MSF's experience, this review intends to highlight the research priorities on AMR for the most vulnerable patients. Infection Prevention and Control (IPC), Antimicrobial Stewardship (AMS), and Diagnostics and Surveillance (D&S) should be enhanced by sustainable and context-adapted approaches, especially by strengthening data collection and surveillance. Safety and efficacy studies focusing on vulnerable populations and the development of REASSURED diagnostics should be prioritised. Building evidence to address affordability and availability barriers of antimicrobials, vaccines, and diagnostics is equally essential. Vulnerable populations, including neonates, malnourished children, individuals living with advanced HIV, and patients with war-related injuries, must be placed at the centre of research agendas. It is also essential to address the intersections between AMR, climate change, and conflict. These research priorities are essential to preserving antimicrobial effectiveness and improving patient outcomes in the most neglected settings.