Antimicrobial Resistance in Somalia: A Growing Public Health Crisis in a Fragile Health System-A Narrative Review of Challenges, Healthcare Gaps, and Policy Recommendations.

Background: Antimicrobial resistance (AMR) has emerged as one of the most serious global public health threats and represents a growing concern in fragile and conflict-affected countries such as Somalia. The increasing emergence of resistant bacterial pathogens threatens the effectiveness of commonly used antimicrobial therapies and contributes to increased morbidity, mortality, healthcare costs, and prolonged hospital stays. In Somalia, prolonged conflict, weak healthcare infrastructure, population displacement, limited diagnostic capacity, and widespread inappropriate antibiotic use have accelerated the development and spread of antimicrobial resistance. Unregulated over-the-counter access to antibiotics, self-medication practices, inadequate infection prevention and control (IPC) measures, and poor antimicrobial stewardship further compound the problem. Methods: This narrative review synthesizes evidence from peer-reviewed literature, international reports, and programmatic documents to examine the burden of antimicrobial resistance, key healthcare challenges, current response strategies, and policy priorities in Somalia. Literature searches were conducted using PubMed, Google Scholar, Scopus, and grey literature sources including reports from the World Health Organization (WHO), United Nations agencies, and humanitarian organizations. Publications published between 2010 and 2026 were considered. Results: The findings demonstrate that antimicrobial resistance in Somalia is driven by multiple interconnected factors, including irrational antibiotic prescribing, limited microbiological diagnostic services, weak surveillance systems, healthcare-associated infections, inadequate regulation of pharmaceutical distribution, and persistent humanitarian crises. Current interventions remain fragmented and under-resourced despite increasing global recognition of antimicrobial resistance as a major health security threat. Conclusion: Strengthening antimicrobial stewardship, improving laboratory and surveillance capacity, expanding infection prevention and control measures, regulating antibiotic sales, and supporting healthcare worker education are critical for reducing the growing burden of resistant infections in Somalia. Sustainable investment in healthcare infrastructure and coordinated national policy implementation will be essential to improving patient safety and protecting the effectiveness of antimicrobial therapies in fragile healthcare settings.