Infectious Disease Epidemiology and Antimicrobial Resistance in Displaced Populations During Humanitarian Emergencies: A Systematic Review

Humanitarian emergencies and forced displacement create conditions that accelerate infectious disease transmission and antimicrobial resistance (AMR). This systematic review synthesizes evidence on infectious disease epidemiology and AMR patterns among displaced populations. PubMed/MEDLINE and Scopus were searched for studies published from January 2015 through March 2026 reporting laboratory-confirmed infections or antimicrobial susceptibility data among refugees, asylum seekers and internally displaced persons. A total of 61 studies from 28 countries were included and narrative synthesis was performed due to substantial heterogeneity. The AMR burden in conflict zones was severe, with rates of methicillin-resistant Staphylococcus aureus (as high as 94.4%), extended-spectrum beta-lactamase–producing and multidrug-resistant Enterobacterales (over 80%) and carbapenem-resistant Acinetobacter baumannii (exceeding 70%) markedly higher than baseline resistance levels. Transborder dissemination of highly drug-resistant organisms via medical evacuations from Ukraine and Syrian refugee movements was documented, and clones that simultaneously carry multidrug-resistance and virulence factors are prevalent. Neglected tropical diseases followed migration routes: Syrian refugees accounted for 93.8% of cutaneous leishmaniasis cases in Turkish border provinces and the 2022 European diphtheria outbreak was linked to migration via the Balkan route. Scabies was among the most frequently reported skin conditions in displacement settings. Critically, conflict-affected countries had significantly fewer AMR surveillance sites than non-conflict countries (0.16 vs. 0.76 per million population; P <0.001), suggesting substantial underestimation of the true resistance burden. These findings support the urgent need for standardized screening protocols, the integration of neglected tropical disease screening into primary care, and investment in surveillance capacity in conflict-affected regions.