Loading article content...
Loading article content...
“No child should ever lose their life to a disease we have known how to prevent for so many generations.” Dr. Mohamed Nur Ali
Imagine a mother arriving at a hospital with a child who has a fever, a painful throat and increasing difficulty breathing. What first appeared to be a common infection has become a medical emergency. A thick membrane in the throat may obstruct the airway, while toxins released by the infection can damage the heart and nerves.
The illness may be diphtheria, a disease largely preventable through routine childhood vaccination. Yet it remains a threat in Somalia. The World Health Organization’s Health Cluster identifies diphtheria as one of the infectious disease outbreak risks facing the country in 2026.
As a pediatric specialist working in Mogadishu, I believe cases like these demand more than a temporary outbreak response. They expose gaps in vaccination, early diagnosis and access to lifesaving treatment. Our priority must be to protect children before they become critically ill.
Diphtheria is caused by toxin-producing bacteria, usually affecting the nose and throat. A child may develop fever, a sore throat, difficulty swallowing, neck swelling and a greyish membrane at the back of the throat. Severe cases may cause noisy breathing or airway obstruction.
The toxin can also injure the heart muscle, producing myocarditis, or damage nerves, causing weakness and other neurological complications. Treatment becomes more difficult when patients arrive after these complications develop.
Vaccination with diphtheria-containing vaccines has dramatically reduced the disease in countries where routine immunization is sustained. Continuing cases in Somalia illustrate what happens when too many children remain susceptible. A vaccine may be available in principle, yet still fail to reach a child who needs it.
In a study published in July 2026 in Tropical Medicine and Health, my colleagues and I reported on 51 children admitted with clinically suspected diphtheria to a Somali tertiary hospital during 2025. Forty-six children, or 90.2%, had received no diphtheria-containing vaccine.
Many were already seriously ill. Nearly 88% had a characteristic throat membrane, and almost 59% had stridor, a harsh breathing sound suggesting narrowing of the airway. Ten children developed myocarditis, 24 had signs of neuritis and 11 required pediatric intensive care. Eight children died. All eight were unvaccinated.
These are findings from a single hospital, not estimates of the national burden. Laboratory tests to confirm the bacteria were unavailable, so diagnosis relied on established clinical criteria. We cannot use this small observational study to prove that vaccination status alone determined each outcome. Nevertheless, the combination of low immunization, severe complications and deaths is deeply concerning.
Each number represents a child whose illness affected an entire family. Our findings strengthen the case for preventing infection and recognizing dangerous complications early. The message is consistent throughout: prevention and early recognition must be part of the same response, particularly where rapid access to specialist care remains difficult.
It is easy to tell parents to vaccinate their children. Ensuring that every family can do so is much harder. Distance from health facilities, displacement, insecurity, disrupted services and unreliable access to supplies can interrupt a child’s vaccine schedule. Some caregivers may be uncertain when the next dose is due; others face misinformation or the practical costs of travelling for care.
Blaming families will not close these gaps in protection. The response should include dependable routine vaccination, outreach to displaced and remote communities, reliable supply chains and clear information in languages parents understand.
Children who have never received routine vaccines deserve special attention. So do children who started but did not complete the recommended doses or boosters. A successful programme should be measured not just by vaccines delivered, but by the number of children adequately protected. This also requires identifying missed doses, making follow-up easier and ensuring that children who move or are displaced do not fall out of care.
Related articles
Parents should seek urgent medical assessment when a child has a severe sore throat with difficulty swallowing, neck swelling, unusual weakness or breathing difficulty. Noisy breathing or signs of airway obstruction require immediate emergency care.
Healthcare workers should consider diphtheria in a child with compatible symptoms, especially when vaccination is incomplete. In settings with limited testing, a suspected case requires prompt clinical action rather than waiting for laboratory confirmation.
Management includes appropriate antibiotics, infection-control measures, airway assessment and diphtheria antitoxin when indicated. Antitoxin neutralizes circulating toxin but cannot undo injury already caused after toxin binds to tissues. Timely access matters. Children with cardiac, neurological or respiratory complications may need intensive monitoring and specialist support. Clear referral arrangements between facilities can help reduce dangerous delays when a child becomes critically ill.
Outbreak control also requires rapid reporting, contact tracing, assessment of close contacts and vaccination in line with public-health guidance. Vaccines prevent future disease; they do not replace treatment of an acutely ill child.
Somalia needs a response that links prevention with emergency care. Health authorities and partners should strengthen routine immunization, identify districts with large numbers of unvaccinated children and support targeted catch-up campaigns. Hospitals and clinics need training to recognize suspected cases and clear referral pathways for children who deteriorate.
Reliable access to antitoxin, antibiotics, laboratory diagnosis and pediatric critical care should be part of preparedness, not improvised after an outbreak has expanded. Surveillance data should track suspected and confirmed cases, vaccination status, complications and deaths, allowing resources to be directed where they are most needed.
Community leaders, schools, religious institutions and the media can help parents understand that diphtheria vaccination is safe, important and part of a complete childhood immunization schedule. Trustworthy information must be matched by services that are genuinely accessible.
Diphtheria reminds us that medical knowledge alone is not enough to save lives. Protection depends on whether children receive vaccines, whether danger is recognized promptly and whether treatment is available when needed.
We cannot promise that every child with severe diphtheria will survive. But we can prevent many infections, reduce avoidable delays and improve the care of children who become ill.
A child’s chance of protection should not depend on the distance to a clinic, family income or displacement from home. Closing Somalia’s vaccination gaps is a national responsibility—and one that cannot wait until another family loses a child to a preventable disease.
——-
Dr. Mohamed Nur Ali is a pediatric specialist, Mogadishu Somali–Türkiye Training and Research Hospital, Somalia
The views expressed in this article are those of the author and do not necessarily reflect the editorial position of Dawan Africa.