No outbreak. No alarm. Just medicines that stop working—and lives that quietly slip away.
By Dr. Fadumo Abdi, PhD
Antimicrobial resistance does not arrive with sirens. It does not trigger emergency press conferences or overwhelm hospitals overnight. Instead, it creeps in quietly—through infections that no longer respond, wounds that refuse to heal, and doctors forced to hesitate before prescribing medicines that once worked with certainty.
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Across the world, health leaders now rank antimicrobial resistance (AMR) among the most serious threats to modern medicine. Yet in Africa—and particularly in Somaliland and the wider Somali region—it remains a hidden crisis. Not because it is rare, but because it is poorly measured, weakly regulated, and often ignored until treatment fails.
This is the invisible breach in our health system.
A Crisis Without a Headline
At its core, antimicrobial resistance is biology responding to misuse. Bacteria adapt. Pathogens evolve. Medicines lose their power. What was once routine care becomes a gamble.
According to World Health Organization, hundreds of thousands of deaths in Africa each year are linked to drug-resistant infections. The burden falls hardest where laboratory surveillance is weakest. In Somaliland, this reality plays out daily—recurrent urinary tract infections that defy first-line treatment, post-partum infections that escalate dangerously, and rising cases of sepsis that reflect not poor doctors, but failing tools.
Resistance here is not low. It is simply undocumented.
Why AMR Is Accelerating in Somaliland
The drivers of resistance in Somaliland are structural, not accidental.
Antibiotics are widely available without prescription, turning life-saving drugs into consumer goods. Informal pharmacies often serve as the first—and only—point of care for communities far from clinics. Treatment courses are cut short once symptoms fade, allowing the strongest bacteria to survive and multiply.
Compounding this is a diagnostic vacuum. Many facilities lack even basic laboratory capacity to identify pathogens or test drug sensitivity. Clinicians are forced to prescribe broad-spectrum antibiotics blindly—a practice that unintentionally fuels resistance.
Livestock adds another layer of risk. In a country where animals far outnumber people, antibiotics are heavily used in veterinary care, often without oversight. Resistant organisms move easily between animals, humans, and the environment—a classic One Health failure. The circulation of substandard and falsified medicines, degraded by heat and poor storage, further weakens treatment and accelerates resistance.
A Regional Pattern of Fragility
In 2019 alone, antimicrobial resistance was associated with more than one million deaths across Africa. It is quietly eroding progress against tuberculosis, pneumonia, and bloodstream infections.
In Somaliland, official data understates the problem. The absence of laboratory surveillance creates an illusion of safety. But clinicians know better. Resistance is present in wards and clinics—it is simply uncounted.
This is not just a medical issue. It reflects governance, regulation, education, water access, and supply chains. AMR threatens every newborn delivery, every surgical procedure, and the long-term credibility of our health system.
A Narrow Window to Act
Somaliland still has an opportunity—precisely because its health system is still evolving. Reform does not require dismantling entrenched bureaucracies. It requires focus.
The response must be clear and disciplined:
Regulatory oversight: End the unchecked sale of antibiotics and treat them as clinical tools, not retail items.
Diagnostic investment: Expand basic laboratory capacity so clinicians can treat with evidence, not guesswork.
One Health integration: Link human, animal, and environmental surveillance to close the loop through which resistance spreads.
Antimicrobial resistance is a test of leadership in the absence of spectacle. It demands coordination, foresight, and attention to details the public rarely sees.
The bacteria are adapting—silently and relentlessly. Whether Somaliland adapts in time will determine not just the future of its health system, but the safety of generations yet to come.
