Tens of millions of people will die over the next 25 years because of so-called ‘superbug’ bacterial infections that can resist antibiotics – and refugee camps or humanitarian crisis settings could be the worst hit, new research predicts.

There will be 1.91 million annual deaths as a direct result of antimicrobial resistance (AMR) by 2050 and 8.22 million with AMR as a factor, according to forecasting published in the medical journal The Lancet.

This compares with to 1.27 million deaths from AMR in 2019. From 2025 to 2050, the researchers predicted, AMR will kill 39.1 million people and contribute to 169 million deaths.

Humanitarian crises settings – which often suffer from disrupted healthcare, poor infection control, and deteriorated antibiotic regulations – are potential hot spots for these superbug infections, according to experts from groups like Médecins Sans Frontières (MSF).

The research was published ahead of a high-level UN General Assembly meeting to discuss AMR.

The meeting, intended to boost international coordination and funding to fight AMR, will culminate in a political declaration, which is still being negotiated by diplomats.

The new research demonstrates the scale of the challenge, which is notoriously difficult to manage, requiring coordination between governments in a tense geopolitical atmosphere and major reform across sectors as disparate as farming and pharmaceuticals.

The research also indicated geographic hotspots for AMR are expected to overlap with many crisis settings and regions affected by the worst impacts of climate change.

“The future AMR burden is highest in south Asia, southeast Asia, east Asia, and Oceania, and sub-Saharan Africa,” the Lancet report said.

It says there is concern among experts about how to support those countries to develop their vaccine programs, cleanliness, and access to antibiotics.

The study says that the world is facing an antibiotic emergency, with devastating human costs for families and communities across the world.

Refugee camps or places where there has been significant human displacement and resultant humanitarian crises, which typically see a lack of healthcare and poor infection control, may become hot spots for AMR, experts say.

AMR has long been a growing problem outside of disasters too.

An outbreak in India 2022 stemmed from an overdependence on antimicrobial drugs, which are sometimes acquired by ill people themselves and not actually prescribed by a doctor.

Developing countries also often have shortages of diagnostic equipment and trained medical professionals, the Lancet report said.