A visit to Somalia’s crumbling hospitals shows the toll of aid cuts and war

Somalia’s Healthcare Crisis Deepens Amid Funding Cuts and Security Challenges

To save his severely malnourished 3-year-old son’s life, farmer Yusuf Bulle had no choice but to make the arduous journey from a remote area of southern Somalia to Mogadishu. The capital’s Banadir Hospital offered the only viable treatment option.

“Where I come from, there is no hospital,” Bulle explained after his son spent 15 days receiving life-saving care. “That’s why I am here.”

His story illustrates the healthcare crisis gripping one of the world’s poorest nations—a situation dramatically worsened by the Trump administration’s dismantling of the U.S. Agency for International Development earlier this year. The loss of USAID funding has dealt a crushing blow to Somalia’s already fragile healthcare system.

Mohamed Hassan Bulaale, Somalia’s deputy health minister, revealed that the U.S. cuts resulted in over 6,000 health workers losing their jobs and affected up to 2,000 health facilities nationwide. The Center for Global Development had previously identified Somalia as among the countries most vulnerable to donor withdrawal.

While the government of President Hassan Sheikh Mohamud celebrates some success in its “total war” against the al-Qaida-linked militant group al-Shabab, with bomb and gun attacks decreasing in recent months, critics say this security focus comes at a steep cost to public services, particularly healthcare.

The Somali government allocated just $91 million to the Ministry of Health this year from a national budget exceeding $1 billion. Though this represents an improvement from last year’s $52 million, almost all of the increase came from international donors rather than domestic funding, according to Mahad Wasuge, director of the Somali Public Agenda think tank.

“Security remains the first priority,” Wasuge explained, even as major foreign supporters like the United States and Britain have reduced their aid contributions this year.

The consequences of this prioritization are stark. Many areas outside Mogadishu lack functioning public hospitals, forcing residents to travel through often dangerous territory to reach operational facilities. The few functioning hospitals in the capital—including Banadir Hospital, built with Chinese support in 1977, and De Martino Hospital, established during the Italian colonial period in 1922—depend heavily on international organizations for survival.

At Banadir Hospital, which serves as Mogadishu’s main public referral facility, the unit treating malnourished children relies entirely on donor funds channeled through the humanitarian group Concern Worldwide. Dr. Mohamed Haashi, the unit’s supervisor, noted that 37 staff members lost their jobs due to the U.S. aid cuts, while Concern Worldwide continues to pay the salaries of 13 remaining workers and provides essential supplies like milk and food for patients.

The situation at De Martino Hospital reflects similar concerns. Director Dr. Abdirahim Omar Amin worries about what will happen when contracts with two humanitarian organizations expire at the end of 2025. During a recent visit, the hospital was treating dozens of children suffering from diphtheria—a preventable disease spreading in rural areas where parents avoid routine vaccinations due to fear of militant attacks.

“Now it looks like donors are fatigued,” Dr. Amin observed, pointing out that virtually all the hospital’s equipment was acquired with donor funds. Most services at De Martino are provided free of charge, thanks largely to funding from the International Rescue Committee and Population Services International.

The healthcare crisis reflects Somalia’s broader challenges in rebuilding after decades of conflict. Many public facilities were destroyed during years of civil war following the 1991 fall of dictator Siad Barre. Today’s federal government, operating from a heavily fortified zone near Mogadishu’s airport, struggles to assert authority despite support from African Union peacekeepers, U.S. airstrikes targeting al-Shabab, and security consultants from various nations seeking influence in the strategically located country.

Some international partners, like Turkey, have stepped in to support healthcare, funding a hospital with intensive care capabilities in Mogadishu. However, as Wasuge notes, “Even the limited number of public hospitals that started functioning properly lately are heavily dependent on donor money. They don’t get direct government budget that allows them to provide better health care services.”

For ordinary Somalis, the consequences are deeply personal. Amina Abdulkadir Mohamed, who recently gave birth at De Martino Hospital, chose the facility because she knew she wouldn’t be charged. “I was told there is free medication,” she explained.

Mohamed Adam Dini, representing Somalia’s Puntland state in the national assembly, criticized the government’s priorities as “deficient” due to its overwhelming focus on security. “A lot of diseases have been spreading unchecked,” he said. “There is no national health care plan, as we don’t have a national political plan.”