In July 2025, a diphtheria outbreak swept through Puntland, claiming 27 lives and infecting 482 people. Save the Children and the Puntland Ministry of Health, with funding from Gavi, launched a rapid emergency response deploying 35 mobile vaccination teams across four hotspot districts. The intervention reached over 48,000 individuals, immunising more than 40,000 children and successfully containing the outbreak. This is the story of the health workers, parents, and communities who came together to protect their children from a deadly but preventable disease.
When diphtheria began spreading through Puntland in July 2025, fear travelled faster than the disease itself.
Across the regions of Mudug, Nugal, and Bari, the highly contagious bacterial infection was claiming children's lives and placing immense pressure on an already overstretched health system.
By mid-July, 482 confirmed cases and 27 deaths had been reported, with Galkacyo in Mudug recording 178 cases and seven deaths, and Iskushuban in Bari suffering a devastating fatality rate of nearly 30 percent with five deaths among just seventeen cases. For families across Puntland, these were not distant statistics. Diphtheria was in their neighbourhoods.
Amina*, a mother of four from the rural areas near Qardho, watched the outbreak unfold with growing dread. "We were scared for our children," she said. "Every time we heard of a new case, we wondered if our children would be next."
The timing could not have been more critical. Schools were preparing to reopen, and parents and teachers worried that crowded classrooms would accelerate the spread.
But as the crisis deepened, a response was already taking shape, driven by a simple conviction: no child should die from a disease that vaccines can prevent.
"This intervention was born out of urgency," said Dr. Abdirahman, the Ministry of Health representative in Mudug. "We saw diphtheria spreading fast and claiming children's lives, and we had to act quickly and reach every corner of the affected districts. Diphtheria is deadly but entirely preventable, and our goal was to make sure no child dies from a disease we can stop with a vaccine."
The response, led by the Puntland Ministry of Health and Save the Children with funding from Gavi, the Vaccine Alliance, became a race against time.
Save the Children deployed 35 outreach and mobile teams across four hotspot districts including Galkacyo, Jariban, Goldogob, and Gardo to deliver an integrated outbreak response combining vaccination, treatment, and awareness activities.
Health workers packed cool boxes with vaccines and began long journeys across Puntland's arid landscape. They rode in ambulances and minibuses mounted with loudspeakers, stationed themselves at health centres, schools, community halls, and under trees. In some places, they walked from hut to hut across hard-to-reach pastoralist areas. Their mission was clear: reach every child, no matter how far.
"We were traveling long distances in difficult weather with cool boxes full of vaccines, sometimes for hours without rest," said Rodo*, a health worker with one of the mobile teams working in Mudug region. "We set up in schools, health centres, under trees, anywhere families could gather. What kept us going was knowing that every vaccine we gave could save a child's life."
In a rural town 26 kilometres south of Qardho, families gathered under the shade of acacia trees as the mobile health teams arrived. Mothers carried infants wrapped in colourful shawls while older children played nearby. For these families, the relief was visible as vaccines arrived when they needed them most.
"We heard about the outbreak and how fast it was spreading, and I am very happy that the vaccine has come to our village without the need to travel," said Amina*, holding her six-month-old daughter while her second youngest clung to her dress and the two older ones played with other children.
As health workers administered vaccines, community mobilisers walked through villages with microphones, explaining the outbreak and urging parents to bring their children forward.
"We make sure parents understand why these vaccines matter," said Halima*, a community mobiliser with one of the mobile teams. "Once they know the danger diphtheria brings, they try to either sit with us for more information or will take their children to the vaccination. Many told us, 'We didn't know it spreads so fast.' Now, they help us spread the message to others."
In a village 130 kilometres from Galkacyo, Jamal*, a father of six, was sitting in his shop when he heard the team talking about the intervention. He had visited Galkacyo the previous week and witnessed the outbreak's toll firsthand.
"When we first heard about diphtheria in Galkacyo, we were worried it would reach us. We heard of children dying," he said. "I did not know about the vaccine or that it would come to us, so I was glad to hear this. I rushed home and took my youngest three to get vaccinated."
Ahmed*, another father living in a rural area, drove 30 kilometres to reach the nearest clinic. "I drove 30 kilometres to get my children vaccinated when I heard about this mobile team," he said.
The response prioritised children under five as the most vulnerable group, while also reaching adolescents up to fourteen years old as well as pregnant and reproductive-age women. Health workers provided an integrated response that included awareness, treatment, vaccination, and referrals.
Years of conflict, displacement, and weak health infrastructure had left large numbers of zero-dose and under-immunised children across the region. Some families had grown sceptical of vaccines. But as the outbreak spread, the benefits became painfully clear: immunised children stayed healthy while unvaccinated children fell ill.
Fathia*, a mother whose older son had contracted diphtheria weeks before the response reached her village, said she would never take chances again. "I have seen the sickness with my own eyes. I will not let it touch my children, I will vaccinate all my children," she said.
The response demanded extraordinary commitment. Health workers travelled for hours across rough terrain, sometimes to reach just a few scattered households. In one area, a team spent an entire day under the scorching sun to reach children who had never received a single vaccine dose.
"Every kilometre meant another child protected," said Rodo, wiping dust from her face after a long day in the field.
The response's strength lay in its speed and inclusivity. In urban centres, teams focused on administering second doses to children with partial coverage. In rural and hard-to-reach areas, they prioritised zero-dose children. Both groups received equal attention.
Across Puntland, elders and community leaders became powerful allies. In Galkacyo, elders encouraged families to bring children to vaccination sites. Teachers turned classrooms into temporary immunisation centres, knowing that with schools reopening, prevention was the most effective form of protection.
By the end of the intervention, 48,116 individuals had been reached by the integrated outbreak response. Among them, 13,590 children under five were immunised against vaccine-preventable diseases, while 26,808 children aged 5–14 received the tetanus-diphtheria vaccine. The response successfully reached thousands of previously zero-dose children, marking a critical step toward closing immunity gaps .
The outbreak, once feared to spiral beyond control, began to slow. In the weeks that followed, health workers reported fewer new cases and declining fatality rates. For parents who had feared losing their children, the relief was palpable.
"I am relieved that I could vaccinate my children, and I urge all parents to vaccinate their children against diseases, especially diphtheria and whooping cough," said Amina*, looking at the small vaccination mark on her child's arm. "It is for the protection of our children."
Save the Children, together with the Ministry of Health and partners, continues to build on this momentum, ensuring that vaccination is not just an emergency measure but a right every child can rely on. The diphtheria outbreak was a stark reminder of the cost of low coverage and a powerful demonstration of what communities can achieve when they work together.
*Names have been changed to protect identities.