MOGADISHU, Somalia – To rescue his severely malnourished 3-year-old son, farmer Yusuf Bulle journeyed from a remote southern region to the capital Mogadishu, where a specialized health unit offered the sole prospect. After 15 days at Banadir Hospital, the boy was declared out of immediate peril.
“Where I come from, there is no hospital. That’s why I am here,” Bulle said.
One of the world’s poorest nations confronts a healthcare crisis intensified by the Trump administration’s elimination of the U.S. Agency for International Development (USAID) this year. The withdrawal of USAID funds has discouraged numerous Somalis who feel they cannot rely on their government, which concentrates primarily on battling the Al-Qaida-aligned Al-Shabaab.
Somalia’s deputy health minister, Mohamed Hassan Bulaale, informed The Associated Press that the U.S. reductions caused over 6,000 health workers to lose employment while up to 2,000 health facilities suffered major disruptions in a nation that the Center for Global Development this year identified as highly vulnerable to donor retreats.
Attacks by the militants using bombs and guns, including on health centers, have decreased in number and severity lately, prompting some to view progress in President Hassan Sheikh Mohamud’s “total war” against Al-Shabaab.
However, hospital managers, community leaders and others indicate that the recent offensive to eliminate Al-Shabaab has sacrificed healthcare and other public services.
Somalia’s Ministry of Health received $91 million from a national budget surpassing $1 billion this year, with most funds linked to externally supported initiatives. This marks a notable rise from last year’s $52 million, though nearly all the growth stemmed from donors, according to Mahad Wasuge of the Somali Public Agenda think tank.
As the United States has demonstrated, donor contributions fluctuate.
Despite substantial declines in foreign aid this year, including from major supporters like Britain, “security remains the top priority” for Somali officials, Wasuge told the AP.
Numerous regions beyond Mogadishu lack operational public hospitals, forcing residents to traverse hazardous zones to access the few that remain active.
In the capital, these include Banadir Hospital, constructed with Chinese aid in 1977, and De Martino Hospital, founded by Italian colonial authorities in 1922.
During a visit by The Associated Press, staff at both hospitals stated that most operations would cease without aid from the United Nations and global organizations.
Even at Banadir, Mogadishu’s primary public referral hospital, reliance on the Somali government is minimal. The malnutrition unit for children relies completely on donor money routed via the humanitarian organization Concern Worldwide, according to supervisor Dr. Mohamed Haashi.
Following the layoff of 37 staff in the unit due to this year’s U.S. aid reductions, Concern Worldwide continues funding salaries for 13 remaining workers plus milk and food for mothers and infants, Haashi noted.
At De Martino Hospital, director Dr. Abdirahim Omar Amin expressed concern over expiring contracts with two humanitarian organizations at the close of 2025.
The facility was treating many children with diphtheria, a throat infection preventable by vaccines but now emerging in rural zones. Parents avoid routine immunizations fearing militant assaults, Amin explained.
In the laboratory, Amin indicated the equipment and noted it was all obtained through donor financing.
“Now it seems donors are weary,” he said.
Most hospital services are free, owing mostly to support from the International Rescue Committee and Population Services International. Non-urgent cases may incur partial fees.
“The Ministry of Health should support this hospital since it belongs to the Ministry of Health. I hope, even if those humanitarian groups depart, the Ministry of Health will fill their role,” Amin said.
Bulaale, the deputy health minister, stated the government is collaborating with partners on a “contingency plan” following the USAID funding loss. He provided no further details.
De Martino Hospital’s past echoes Somalia’s wounds. It housed displaced persons after the 1991 ouster of dictator Siad Barre, whose downfall ignited clan-based warlord clashes. Civil war devastated many public sites nationwide.
Somalia’s federal government, located in a secure zone near Mogadishu’s airport, fights to establish authority amid backing from African Union peacekeepers, U.S. strikes on Al-Shabaab and security experts from countries seeking sway in this strategically vital nation bordering the Indian Ocean and Gulf of Aden.
Turkiye is among them, funding a Mogadishu hospital with intensive care.
“Even the few public hospitals recently operating effectively depend heavily on donor funds. They receive no direct government allocation for improved healthcare,” said Wasuge, the community figure.
Banadir and De Martino serve as key referral points for the most desperate cases. De Martino, Mogadishu’s main COVID-19 referral site during the outbreak, treats the “most vulnerable” regardless of origin, Amin said.
Amina Abdulkadir Mohamed, an unemployed woman who recently delivered at De Martino, chose it knowing no payment would be demanded.
“I was told there is free medication,” she added.
Mohamed Adam Dini, Puntland state’s representative in Somalia’s national assembly, called the federal government’s focus “deficient” due to its fixation on quelling “anarchy.”
“A lot of diseases have been spreading without control. There is no national health care plan, as we don’t have a national political plan,” Dini said.
