Qurraisha Mukhtar faced unimaginable heartbreak when her two youngest children, Salman (1) and Hassan (2), succumbed to a mysterious illness in early September. Both developed fevers, coughs, and agonizing gasping breaths, their throats turning white and necks swelling. Despite seeking help from a local healer, their condition worsened rapidly, leading to their tragic deaths within days of each other.
Living in a humble stick-and-tin shack on the outskirts of Mogadishu, Somalia’s capital, Ms. Mukhtar had no time for grief. Two more of her children began exhibiting the same terrifying symptoms. Desperate, she and her husband gathered what little money they could from friends and family to rush them to a hospital in a three-wheeled taxi.
Upon arrival at Demartino Hospital in central Mogadishu, they were directed to a facility originally built during the early days of the COVID-19 pandemic. This building now serves a critical new purpose: battling diphtheria, a formidable, vaccine-preventable illness that is now rampant, affecting thousands of children and some adults.
Diphtheria is a bacterial infection that unleashes a potent toxin, aggressively destroying cells primarily in the throat and tonsils. This destruction forms a dense, grayish membrane of dead tissue, which can expand to obstruct the airway, leading to suffocation. It poses a grave threat, especially to young children due to their narrow airways. While early detection allows for effective antibiotic treatment, delays can rapidly prove fatal.
Once thought largely eradicated, diphtheria is now alarmingly re-emerging, joining other ancient diseases in a global comeback. This disturbing trend is largely fueled by widespread population displacement due to climate change and armed conflicts. Compounding the problem are significant disruptions to routine immunization programs caused by the COVID-19 pandemic and a concerning rise in vaccine skepticism, all contributing to the rapid spread of these preventable illnesses.
Massive diphtheria outbreaks are currently ravaging Somalia, Sudan, Yemen, and Chad. These nations, plagued by civil wars and housing vast refugee populations, struggle with minimal vaccination coverage, inadequate disease surveillance, and severely weakened health infrastructures, leading to delayed diagnoses and treatments that often come too late for affected children.
Historically, diphtheria was a leading cause of childhood mortality in the United States and other developed nations. However, widespread vaccination efforts starting in the 1940s dramatically reduced its incidence, making it a rarity by the 1970s. In fact, after 1996, the U.S. reported only about one case per year for two decades, with only a handful of isolated cases thereafter.
Even in developing countries, diphtheria was largely disappearing at the turn of the 21st century. Yet, roughly 15 years ago, a worrying resurgence began. Venezuela experienced a significant outbreak as its robust public health infrastructure collapsed under political turmoil. Bangladesh saw a major outbreak starting in 2017, predominantly affecting Rohingya refugees in overcrowded camps. More recently, Nigeria has reported nearly 30,000 cases in just two years, primarily in its northern regions where vaccination rates are exceptionally low.
Europe, too, has not been immune, with recent cases primarily identified among unimmunized young immigrants from Syria and Afghanistan.
In the U.S., the handful of diphtheria cases recorded have been linked to international travelers. Alarmingly, national diphtheria vaccination rates among American kindergarteners have been slowly but consistently falling over the past five years. In the 2024-25 school year, only 92% of kindergarten students were fully vaccinated against diphtheria, a decline from 95% in 2020. Experts stress that at least 85% coverage is crucial for robust community immunity.
Children typically receive diphtheria vaccination as part of a five-in-one combination vaccine, administered in three doses at 6, 10, and 14 weeks of age. Incomplete vaccination leaves a child vulnerable, a common challenge for displaced and vulnerable families like Ms. Mukhtar’s, where continuity of care is difficult.
Katy Clark, a diphtheria specialist at Gavi, an international organization supporting vaccine access for low-income nations, warns that up to one in four children infected with diphtheria may die in regions with limited diagnostic and treatment capabilities. In contrast, health systems with greater resources see a lower fatality rate, closer to one in 20.
Somalia has become the first nation to seek new funding from Gavi to implement diphtheria booster shots for children in affected areas. These crucial boosters are intended for children in their second year of life, then again between ages 4-7, and finally between 9-15, targeting regions hit hardest by the escalating outbreak.
“We never even had a specific diphtheria support mechanism because, frankly, we didn’t need one,” explained Ms. Clark. “Now, we’re compelled to construct an entirely new framework to assist countries in tackling this crisis.”
Somalia’s ongoing diphtheria outbreak has seen a relentless increase since its onset in 2023, with over 2,000 cases officially reported nationwide this year alone. However, Ms. Clark notes that due to severe weaknesses in surveillance and reporting systems, this figure is almost certainly a substantial undercount.
Demartino Hospital in Mogadishu has witnessed a staggering surge, admitting nearly 1,000 diphtheria patients to its dedicated ward this year—a dramatic jump from just 49 admissions in 2024. A heartbreaking 80% of these patients are children.
Decades of civil war have left Somalia’s health system severely weakened, a situation compounded by significant cuts in U.S. government assistance under the previous administration. This has created a perfect storm where diphtheria and other infectious diseases are proliferating, exacerbated by a drastic reduction in food aid, which has led to a critical increase in childhood malnutrition.
Ms. Mukhtar and her family were among countless others displaced from Baidoa, southern Somalia, driven from their homes by years of relentless, brutal drought. They found refuge on a relative’s land in Mogadishu, where they constructed their modest shack.
With twelve children, Ms. Mukhtar explained that while some had received at least a few vaccinations during their early years, keeping track of each child’s immunization schedule proved impossible for her, especially as she is unable to read.
Fortunately, the two children Ms. Mukhtar managed to bring to the hospital—her 3-year-old daughter and a severely malnourished 10-year-old son—successfully recovered from their diphtheria infections. However, their treatment came at a cost: approximately $200 for tests and medications. This is a significant burden for families, as the hospital operates on a ‘cost-recovery’ model, receiving only a fraction of its operational funding from Somalia’s health ministry.
The sprawling diphtheria ward at Demartino was a scene of relentless struggle: all 34 beds were occupied, some even shared by two children. Dr. Mohamud Omar, a dedicated pediatrician, moved from bed to bed, vigilantly monitoring airways and ensuring that the menacing, lumpy obstructions in children’s throats did not cut off their vital breath. He prescribed supplemental oxygen where needed. Beside the beds, exhausted parents slumped, many juggling the care of four or five infected children simultaneously.
Amina Hassan brought three of her children to the diphtheria ward in mid-September. While her oldest and youngest showed improvement within days, her 4-year-old daughter’s condition remained critical, requiring oxygen and revealing an allergy to standard diphtheria antibiotics. Dr. Abdirahim Omar Amin, the hospital’s director, noted that while the hospital occasionally receives antitoxin—a crucial treatment used for severe cases in wealthier nations—supplies are often dangerously scarce.
Ms. Hassan revealed that none of her children were vaccinated. She expressed a desire for them to be immunized, but explained that her husband forbade all subsequent vaccinations after their oldest child developed an infection at the tuberculosis vaccine injection site shortly after birth.
As she cradled her 4-year-old in her lap and supported her 1-year-old, whose neck remained severely swollen, against her back, Ms. Hassan voiced a renewed hope. “After this,” she said, referring to the harrowing experience, “I am going to try to convince him to get them vaccinations, and I think he will agree.”
A few beds away from Ms. Hassan, Hawa Mahmoud sat vigil, flanked by three of her own children. She awaited the arrival of her husband, bringing three more of their children who had begun showing symptoms at home. Ms. Mahmoud recounted how the illness had recently swept through her older children’s school, leaving many students sick. Now, six of her seven children were infected. Though her oldest had yet to show signs, she remained grimly realistic. “They’re coming, one after the other,” she lamented.