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By Dr Fatumo Abdi PhD
Antimicrobial resistance rarely announces itself as a crisis. There are no sirens, no sudden outbreaks, no single moment that signals something has gone wrong. Instead, it appears in small, easily missed ways. A child whose infection does not clear. A wound that takes longer than expected to heal. A doctor who pauses before prescribing a medicine that once worked without hesitation.
Global health leaders now recognise antimicrobial resistance as one of the defining health threats of our time, yet across much of Africa it remains a hidden problem, rarely measured, poorly understood and too often ignored until treatment no longer works. In Somaliland and across the wider Somali region, this quiet crisis is already shaping everyday healthcare, even if it is rarely named.
Antimicrobial resistance happens when bacteria and other disease causing organisms change in ways that allow them to survive medicines designed to kill them. Over time, treatments lose their power. Infections linger. Recovery becomes uncertain. What was once routine care begins to feel fragile.
Across Africa, the scale of the problem is already clear. The World Health Organization estimates that hundreds of thousands of deaths on the continent each year are associated with drug resistant infections, with the heaviest burden falling on countries where health systems are least equipped to detect and respond.
What resistance looks like in daily life
The first signs of antimicrobial resistance are often subtle. A urinary infection that returns again and again. A chest infection that does not respond to the usual treatment. A mother who develops an infection after childbirth that no longer improves with standard antibiotics. These are not rare stories. They are becoming more common across health facilities in the Somali region.
As resistance grows, ordinary medical care begins to change. Doctors weigh imperfect choices, aware that the medicines they rely on may no longer work as expected. Surgeries once considered routine carry added risk because antibiotics used to prevent infection are less reliable. What used to feel predictable becomes uncertain.
Why antimicrobial resistance hits Somaliland harder
The Somaliland faces a unique set of pressures that allow antimicrobial resistance to spread. Antibiotics are widely available without prescription. Pharmacies and informal drug sellers often provide the first point of care, especially where clinics are far away, overcrowded or expensive. Medicines are shared. Courses are stopped early when symptoms improve.
Diagnostic testing is limited. Many facilities lack laboratories that can confirm which infection a patient has or which medicine will work. Clinicians are forced to treat based on symptoms alone. Broad spectrum antibiotics become the safest guess.
Livestock is central to life and livelihoods across Somaliland, where animals far outnumber people. The sheer scale of animal health care means that antibiotics used in livestock play an important role in shaping antimicrobial resistance. Without consistent veterinary oversight, resistant organisms can move quietly between animals, people and the environment.
Another, less visible driver is the quality of medicines themselves. The World Health Organization estimates that up to one in ten medical products in low-and-middle income countries is substandard or falsified. In hot climates and long supply chains, antibiotics can lose strength through poor storage or weak manufacturing. When medicines are too weak to fully clear an infection, resistant bacteria survive and spread.
Water and sanitation challenges add another layer of risk. Where clean water is scarce and overcrowding common, infections spread more easily. Resistant infections spread fastest of all.
A pattern across Africa
Across Africa in 2019, antimicrobial resistance was linked to over one million deaths each year in recent global estimates, with hundreds of thousands of those deaths directly caused by resistant infections themselves.
Antimicrobial resistance is undermining progress against pneumonia, bloodstream infections, urinary infections and tuberculosis. Yet surveillance remains uneven. In many countries, resistance appears low on paper not because it is absent, but because it is not being measured.
Somaliland faces the same challenge. Without laboratory surveillance, resistant infections remain largely invisible even as treatment failure becomes more common.
More than just a medical issue
Antimicrobial resistance reflects how societies organise care. Regulation of medicines, training of health workers, access to clean water, community health litercy and coordination across sectors all shape resistance patterns.
For Somaliland, the consequences extend beyond individual patients. Resistant infections increase the risk of death for mothers and newborns, undermine tuberculosis treatment and raise the danger and cost of surgery.
Figure1. Using antibiotics the wrong way makes bacteria harder to kill and medicines stop working
What can still be done?
It is not too late for Somaliland to take effective action. Its health system is still evolving, allowing change without dismantling large structures. Strengthening oversight of antibiotic sales, expanding basic laboratory services and supporting health workers with practical guidance would make a real difference.
Linking animal and human health surveillance is essential in a region where livestock plays such a central role. Aligning with regional African initiatives can bring shared learning while maintaining national ownership.
A quiet test of leadership
Antimicrobial resistance does not demand dramatic speeches. It demands attention, coordination and foresight. The bacteria are already adapting. The question is whether our systems will adapt too.
This is a quiet test of leadership that will shape the resilience of the health system for generations to come.
About the Author
Dr Fatumo Abdi is a global public health and policy specialist and the Founder of Nexora Global Strategies. She has developed and led strategic health and humanitarian programmes in both the UK and across Africa. Dr Abdi has advised governments, academia and regional institutions, and worked with international media to spotlight issues affecting local communities. Her work centres on diplomacy, equity, systems strengthening and shaping evidence-based policy. She is also the first Somali woman to earn a PhD in the United Kingdom.
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