From Outbreak Response to System Resilience: Tropical Medicine in Somalia

A demanding context

The Federal Republic of Somalia is one of the most operationally challenging, resource-constrained and epidemiologically dynamic environments for tropical medicine and infectious disease (TMID) practice. Decades of protracted conflict, political fragmentation and recurrent climatic shocks have undermined the country’s health infrastructure. The universal health coverage index stands at 27 out of 100, well below global and regional averages.

The population, estimated at 15.6 million, is young (about 75% are under 30), fertility is high at 6.4 to 6.9 children per woman, and 2.6 million internally displaced people live in dense informal settlements. Lower respiratory infections, diarrhoeal diseases, tuberculosis and measles remain leading causes of death, made worse by widespread malnutrition.

Several outbreaks at once

Current epidemiological data show multiple major outbreaks of vaccine-preventable, vector-borne and waterborne disease happening at the same time.

What specialists do

• Manage complex and neglected pathogens, including the neglected tropical diseases, malaria and arboviral infections for which no specific antiviral therapy exists.
• Work the water, sanitation and hygiene disease matrix: waterborne, water-washed, water-based and water-related vector-borne diseases, each needing its own clinical and public-health response.
• Turn diagnostics into intelligence, balancing rapid diagnostic tests with PCR and feeding clinical data into the Early Warning Alert and Response Network and Integrated Disease Surveillance and Response.

The systemic challenges

Antimicrobial resistance is a silent emergency, driven by unregulated antibiotic sales, empirical prescribing, self-medication and weak diagnostic microbiology; reported MRSA prevalence reaches 97%. Infection prevention is fragile: assessments found only 24% of facilities enforcing standard precautions and 26% with functional sterilising equipment.

Climate is now a clinical variable. Droughts concentrate people around contaminated water sources and floods destroy sanitation, triggering cholera surges. For specialists, climate change is an immediate clinical determinant, not a distant future risk.

Above all, there are too few people. Somalia has fewer than one skilled health worker per 1,000 people and about 0.03 physicians per 1,000. Health workers carry the risk: 61% of tested health workers were COVID-19 positive in the first 180 days of the outbreak.

What is working

• The Essential Package of Health Services (EPHS 2020) makes communicable disease programmes core at primary-care level, and the Health Sector Strategic Plan III emphasises integrated disease surveillance.
• COVID-19 transformed laboratory capacity: RT-PCR arrived at the National Public Health Reference Laboratory in 2020, and by 2022 facilities in Mogadishu, Garowe and Hargeisa had genomic sequencing capability.
• At De Martino Hospital, specialist-led isolation wards, stabilisation centres and IPC protocols supported the management of 485,670 clinical cases over three years, including COVID-19 cases during the national response, with daily training for 287 staff.
• The Field Epidemiology Training Programme, launched in 2021, investigated 95 outbreaks between 2021 and 2023, with 51% responded to within 48 to 72 hours.
• Trained female community health workers reached 18,983 households and more than 104,000 people, generating 1,426 referrals for suspected diphtheria, tuberculosis and severe diarrhoeal disease.

Building the specialist pipeline

Benadir University’s Postgraduate School offers a two-year Master of Tropical and Infectious Diseases that trains physicians, pharmacists, nurses, epidemiologists and biologists to anticipate outbreaks, run surveillance and control epidemics. Hybrid routes, such as the MSF Academy and Stellenbosch University postgraduate diploma and the James Lind Institute’s advanced diploma in tropical medicine, surveillance and immunisation, serve clinicians who cannot leave field assignments. Diaspora programmes such as IOM’s MIDA FINNSOM bring specialists home for assignments that transfer skills and build institutional partnerships.

TMID specialists are the indispensable architects of Somalia’s transition from reactive, fragmented humanitarian crisis management toward a sovereign, resilient paradigm of sustained national and global health security.

Adapted from Dr Ahmed’s 2026 review, Tropical Medicine and Infectious Disease Management in Somalia: Operational Roles, Systemic Challenges, Epidemiological Priorities, and Capacity Building Pathways. Figures are drawn from the WHO, GTFCC, Africa CDC, Ministry of Health and peer-reviewed sources cited in that review.