Abstract
Antimicrobial resistance (AMR) is quietly becoming Somalia's next health catastrophe. While the world focuses on immediate crises, an estimated 8,400 deaths annually are directly attributed to AMR, with another 32,700 linked to AMR complications. These numbers place Somalia among the top 10 countries globally for AMR-related mortality, surpassing deaths from maternal disease, cardiovascular conditions, and infectious disease combined. Yet Somalia has a national action plan. The problem is not policy; it is implementation. Despite developing an AMR National Action Plan aligned with global strategies, Somalia's fragile health system, weak governance, limited laboratory capacity, and unregulated antibiotic markets have created a perfect storm for untreated resistance to flourish. Community-level drivers, including self-medication, over-the-counter antibiotic access, and incomplete treatment courses, remain unaddressed. This commentary argues that AMR in Somalia is fundamentally a governance failure, not a biomedical one. We identify critical barriers: absent laboratory surveillance systems, inadequate infection prevention and control, lack of Water, Sanitation, and Hygiene (WASH) infrastructure, and missing community engagement strategies. Addressing AMR requires integrated, system-level approaches including strengthening multisectoral coordination, investing in diagnostic capacity, embedding community voices into policy design, and securing sustainable financing. Without urgent action to bridge the policy-implementation gap, AMR will become an unmanageable health security emergency in Somalia.