Diphtheria Outbreak in Somalia: An Alarming Public Health Crisis, Challenges, and Solutions.

Diphtheria, known in Somalia as Gawracato, has re-emerged in 2023, highlighting growing vulnerabilities in the country's health system. The first case reported in the Mahaday District of Hirshabelle state. Then, immediately, the outbreak spread south to Banadir and north to Puntland, resulting in widespread transmission. In August 2025, Somalia had reported 1811 suspected cases and 89 deaths, with a case fatality rate (CFR) of 5%. More than 80% of cases occurred in children under fifteen years of age, and the majority of patients had no history of diphtheria vaccination. Although immunization campaigns such as the Big Catch-Up improved national coverage, PENTA 3 coverage remained below the herd immunity threshold required to halt transmission. However, contributing factors include limited laboratory confirmation capacity, under-reporting in IDP camps, inadequate surveillance system, and delayed case detection and response to emerging outbreaks. Therefore, the ongoing outbreak underscores the urgent need for strengthened vaccination systems, sustainable financing, laboratory expansion, and community engagement to prevent future resurgences of vaccine-preventable diseases.