Antimicrobial Resistance in Somalia: A Silent Public Health Crisis Demanding Immediate Action

Abstract: Antimicrobial resistance (AMR) is a critical global public health threat, particularly in fragile and conflict-affected settings. In Somalia, decades of armed conflict, large-scale displacement, and limited healthcare infrastructure have created conditions conducive to the emergence and spread of resistant pathogens. Available evidence indicates alarmingly high resistance rates, including reports of up to 97% methicillin resistance among Staphylococcus aureus isolates and over 90% resistance in Escherichia coli to commonly used antibiotics. These findings suggest that many standard treatment regimens may already be compromised. Despite these risks, AMR remains insufficiently prioritized within national health strategies, overshadowed by acute emergencies such as cholera outbreaks, drought, and malnutrition. This commentary synthesizes available evidence on the extent, drivers, and public health implications of AMR in Somalia and highlights its potential regional and global consequences. Urgent and coordinated action is required to strengthen surveillance, improve antimicrobial stewardship, and enhance governance within a One Health framework. Without decisive intervention, Somalia risks becoming a regional reservoir for highly resistant infections. Keywords: drug resistance, conflict, antibiotic stewardship, health systems, one health, Somalia