Health in Somalia

The Federal Ministry of Health and Human Services (FMoH) leads national health policy, universal health coverage planning, the EPHS, public health, family health, medical services, health workers and disease surveillance. Federal Member State Ministries of Health manage planning, supervision and programmes within their states, while regional and district health authorities oversee facilities, staff, supplies and reporting. Somaliland and Puntland operate more separate and decentralized structures. The Benadir Regional Administration has responsibilities in the capital area. NGOs, United Nations agencies, community organizations, private hospitals, clinics, laboratories and pharmacies provide a substantial share of actual services. The usual public service structure moves from community support to a primary health unit (PHU), health centre, district hospital and then regional or national hospital. Referral and counter-referral are part of the EPHS model, but transport, security, staff, medicines and specialist capacity often determine whether a referral can be completed. Mobile clinics and outreach services may be needed for rural, nomadic, displaced or conflict-affected communities. Access is generally better in urban centres, especially Mogadishu, than in many rural and insecure areas. Roadblocks, administrative restrictions, floods, drought, supply shortages and facility closures can increase travel and waiting times. Prevention and early care include health education, vaccination, antenatal care, family planning, nutrition screening and treatment, water and sanitation activities, outbreak surveillance and community-based services. Community health workers, including Marwo Caafimaad, support links between households and facilities. In 2024, reported coverage was 83% for the first diphtheria, tetanus and pertussis vaccine dose, 76% for the third dose, 75% for the third polio dose and 71% for the first measles-containing vaccine dose. UNICEF reported in 2025 that about 70% of children were fully vaccinated. Distance, transport costs, conflict and displacement leave many children without doses. Health facilities provide outpatient care, child illness management, treatment for pneumonia, diarrhoea and malaria, tuberculosis, HIV, hepatitis, neglected tropical diseases, non-communicable diseases, mental health conditions, nutrition problems, rehabilitation and basic emergency care. Maternal and newborn care remains a major gap: the maternal mortality ratio is reported at 621 deaths per 100,000 live births, only 24% of women receive at least four antenatal visits, 32% of births involve a skilled attendant and postnatal care within two days reaches 11%. Caesarean births account for about 2%. Prematurity, birth complications, asphyxia and infections cause more than 80% of neonatal deaths. Communicable, maternal, neonatal and nutritional diseases remain central to the health burden, while non-communicable diseases accounted for about 40% of deaths in 2017. Lower respiratory infections are a leading cause of death. Tuberculosis incidence was 246 cases per 100,000 people in 2023, with 109 treatment centres reported that year. Malaria cases reached 12,847 in 2025, 59% more than in 2024. Measles, diphtheria and acute watery diarrhoea, including cholera risks, continue to require surveillance and response. Mental health services include support for depression, anxiety, stress, post-traumatic stress, psychosis, bipolar disorder and substance use, but stigma and limited specialist capacity restrict access. The EPHS provides for task-sharing and integration into primary care. Somalia had no separate national mental-health policy or corresponding law identified in the 2024 WHO Mental Health ATLAS, and no public financial protection for mental-health care was identified. Most people pay 51% to 100% of the cost of inpatient care, outpatient care, medicines and therapy when they use these services. Emergency care is uneven. The EPHS includes recognition of danger signs, first aid, triage and referral, but Somalia had no nationally coordinated ambulance system documented for 2026. Emergency rooms are expanding, yet geographical and quality gaps remain. In the 2022–2023 health facility assessment, 31% of facilities reported emergency services, including 69% of public hospitals, 23% of health centres and 53% of private facilities. Only 3% of all facilities had medicines available around the emergency unit for 24 hours. Transport often depends on relatives, private vehicles, local providers or NGOs. Medicines are supplied through a system heavily dependent on donors, the United Nations and NGOs. The Ministry of Health estimated that public supply covered about 30% of medicine needs, while private importers, pharmacies and other outlets supplied about 70%. The National Medicines Regulatory Authority (NMRA) is not yet fully established nationwide; registration, inspection, quality control and medicine-safety monitoring remain incomplete. Illegal or counterfeit medicines therefore remain a risk. Do not use antibiotics, injections or other medicines without appropriate clinical advice and a reliable source. There is no nationwide, uniformly delivered entitlement that guarantees the same health services everywhere. The EPHS aims to make essential services equitable, accessible, affordable and close to communities, but actual access is usually determined by the facility, programme, region and target group. Public, NGO and United Nations services may be free, while private care commonly charges for each service. In 2023, reported barriers included having no functioning facility nearby for 40% of respondents, unaffordable treatment or medicines for 20% and missing medicines or services for 14%. Somalia's health financing relies heavily on external funding and direct household payments; the 2026 Public Health Sector Assessment reported that 95% of the health budget came from external financing. The National Health Professions Council (NHPC), established under the NHPC Act 2020 No. 31, is responsible for registering and licensing health professionals and facilities, professional conduct and accreditation. Patient consent, complaints and remedies exist unevenly across regions and providers, and no reliable national ombudsman or complaint body was identified. Patients and relatives should clarify the diagnosis, referral destination, expected charges, available medicines and transport arrangements with the provider. Funding reductions in 2026 threaten the closure of about 618 facilities, including 51 district hospitals, 413 health centres and 154 PHUs. More than 20 facilities had already closed because of conflict or armed-group advances. When seeking care, verify the current opening status, staff availability, medicine supply, fees and referral arrangements with the facility or local health authority. Follow-up may be interrupted by funding, supply and security problems, especially for tuberculosis, chronic diseases, mental health, newborn care and rehabilitation.