When health facilities close, outbreaks follow: the public health consequences of aid cuts in Somalia

Abstract

Somalia’s fragile health system is increasingly threatened by reductions in humanitarian financing, with potentially serious consequences for outbreak prevention and public-health preparedness. Recent funding cuts have already resulted in the closure of health and nutrition facilities and substantial reductions in service coverage, with further closures projected under severe funding scenarios. These disruptions extend beyond reduced access to curative care; they may interrupt routine immunization, nutrition screening and treatment, disease surveillance, referral pathways, and early outbreak detection. This is particularly concerning in Somalia, where recurrent measles, cholera, and diphtheria outbreaks occur amid persistent immunization gaps, displacement, conflict, and malnutrition. The 2025 diphtheria resurgence, alongside a substantial population of zero-dose children, demonstrates the risks associated with weak prevention systems. At the same time, the high burden of acute malnutrition increases vulnerability to infectious disease and places additional pressure on already constrained health services. Protecting health facilities should therefore be considered a core outbreak-prevention priority. Sustained financing for primary health care, routine immunization, nutrition, surveillance, and emergency preparedness is essential, particularly in underserved and high-risk communities. Strengthening domestic financing and contingency mechanisms will also be critical to maintaining essential services during future funding shocks and preventing avoidable deterioration in Somalia’s public-health resilience.