Somalia’s medical marketplace: Where profit bleeds patients dry

[Deeq A.]

Mogadishu, Somalia – Once a beacon of hope for a nation scarred by decades of conflict, Somalia’s healthcare system has morphed into a chilling testament to the perils of unchecked privatization. The promise of accessible, life-saving care has been brutally subverted by a profit-driven model, leaving the most vulnerable to languish in the shadows of a system that prioritizes wealth over well-being. The question hangs heavy: in a nation where survival is already a daily struggle, has healthcare become a luxury only the affluent can afford?

The statistics paint a grim portrait. Somalia’s health indicators are among the world’s lowest, a stark reality underscored by alarmingly high infant and maternal mortality rates. While the government’s Health Sector Strategic Plan 2022-2026 (HSSP III) promises a path towards Universal Health Coverage (UHC), the chasm between policy and practice yawns wider with each passing day. The very foundation of a functioning healthcare system—access, affordability, and quality—is crumbling under the weight of financial exploitation.

Healthcare for Sale: A Morbid Transaction

The surge of private healthcare facilities, ostensibly filling the void left by a dilapidated public system, has instead created a two-tiered reality. These institutions, operating with near-total impunity, demand exorbitant upfront payments, transforming emergency care into a cold, calculated transaction. Abdiqani’s heart-wrenching testimony, a lament for his wife who bled to death outside a hospital door, echoes the silent screams of countless others.

“They didn’t care that she was pregnant. They only cared about the money,” he seethes, a raw indictment of a system that has betrayed its fundamental purpose.

This is not an isolated incident. Hospitals, both private and public, routinely prioritize wealthier patients, leaving the majority to fend for themselves. As medical costs spiral, Somalis are forced to navigate a labyrinth of underfunded public facilities, unregulated private clinics, and the often-desperate recourse of traditional healers.

The Privatization Boom: A Mirage of Progress?

The influx of wealthy investors, drawn by the lucrative potential of a largely unregulated market, has birthed state-of-the-art hospitals in urban centers. These opulent facilities, equipped with cutting-edge technology, cater exclusively to Somalia’s elite and the diaspora, charging thousands for specialized treatment. This stark contrast to the deplorable state of public hospitals, where “lack of medicine, equipment, and trained personnel means we are unable to save lives,” as Dr. Hodan Ali poignantly observes, highlights the systemic inequality.

This “progress” is a mirage, a gilded cage for the privileged few, while the masses are left to grapple with a system starved of resources and compassion. The Damal Caafimaad Project, a World Bank initiative aimed at strengthening public finance, offers a glimmer of hope, but its impact remains to be seen.

Foreign Medical Tourism: Draining the Nation’s Lifeblood

The exodus of Somalia’s elite to Turkey, India, and Kenya for medical treatment further exacerbates the crisis. This trend not only drains vital revenue but also fuels a devastating brain drain. Skilled Somali doctors, lured by better salaries and working conditions, abandon their homeland, leaving public hospitals critically understaffed. This hemorrhage of talent, a direct consequence of governmental inaction, accelerates the system’s descent into chaos.

Counterfeit Catastrophe: Poison in the Pharmacy

The proliferation of counterfeit and expired medications, a direct result of Somalia’s weak regulatory framework, adds another layer of horror to the healthcare crisis. “We see patients who have taken fake medicines that worsen their conditions,” laments Dr. Mohamed Ahmed, a Mogadishu pharmacist. “Some people are literally dying from preventable illnesses because they received the wrong treatment.”

This is not merely negligence; it is a calculated gamble on human life, a testament to the unchecked greed that permeates the system. The government’s failure to enforce quality control has turned pharmacies into potential death traps, where profit trumps patient safety.

Government Silence: A Betrayal of the People

Despite widespread condemnation, the Somali government’s response has been woefully inadequate. While policies like the HSSP III and the Somali Universal Health Coverage (UHC) Roadmap articulate noble aspirations, implementation lags far behind. International aid agencies, including the World Health Organization (WHO), UNICEF, International Medical Corps, ICRC, and Doctors Without Borders, provide critical emergency relief, but long-term solutions remain elusive.

The National Development Plan (NDP) and Essential Package of Health Services (EPHS) aim to align sector plans, yet the fundamental issue persists: a lack of political will to prioritize the health of its citizens.

The Path to Redemption: Reform or Ruin?

To reclaim its healthcare system from the clutches of profit-driven interests, Somalia must undertake a radical overhaul.

• Strict Regulation: Impose stringent price controls and mandate that all facilities prioritize emergency care over payments.
• Public Hospital Revitalization: Invest massively in infrastructure, equipment, and staffing.
• Counterfeit Crackdown: Implement rigorous pharmaceutical monitoring.
• Doctor Retention: Offer incentives to stem the brain drain.
• Universal Health Coverage: Implement health insurance for all, shielding the vulnerable from financial ruin.

Somalia’s healthcare system should be a sanctuary, not a battleground where the wealthy thrive and the poor perish. The choice is stark: reform or ruin. Will Somalia finally choose its people, or will it remain a nation where survival hinges on the size of one’s wallet? The world watches, waiting for an answer.

About the Author

Prof. Abdinasir Ali Osman is a highly respected senior researcher, consultant, and trainer with over 35 years of experience in the humanitarian, development, and institutional capacity-building sectors. His career spans across the private, public, and non-profit sectors, where he has played a critical role in shaping policies, building institutions, and implementing large-scale programs in Somalia and beyond.

As a leading expert in humanitarian, governance, peacebuilding, and development, Prof. Osman has dedicated his life to advancing local capacity, institutional resilience, and sustainable development. His work has influenced policy decisions, empowered young professionals, and strengthened governance frameworks in fragile and conflict-affected environments.

You can reach him through email: ipi2024@hotmail.com