Somalia’s Collapsing Hospitals Expose the Human Cost of Aid Cuts and Endless War.
MOGADISHU — When Yusuf Bulle carried his severely malnourished 3-year-old son from a remote village in southern Somalia to Mogadishu, Banadir Hospital was his only hope. “Where I come from, there is no hospital,” he said, standing in a crowded pediatric ward. After fifteen days, his child survived — but in much of Somalia, thousands of others are not as fortunate.
A nationwide collapse of Somalia’s already fragile health system is accelerating after the Trump administration’s dismantling of the U.S. Agency for International Development earlier this year, a decision that wiped out critical funding for clinics and frontline medical staff.
The result is a health crisis layered atop an ongoing war against al-Shabab and deep donor fatigue that is eroding the last functioning institutions in one of the world’s poorest countries.
Somalia’s deputy health minister, Mohamed Hassan Bulaale, said the cuts eliminated more than 6,000 health workers and affected up to 2,000 facilities — a devastating blow in a nation where basic care is already scarce. “Wherever you go, it’s donors that keep the hospitals alive,” he said.
Security Gains, Social Collapse
While deadly al-Shabab bombings have decreased under President Hassan Sheikh Mohamud’s “total war” campaign, the government’s overwhelming focus on security has drained attention from collapsing public services.
Civic leaders warn that the cost of military gains is becoming painfully clear in Mogadishu’s hospitals, where wards depend almost entirely on UN agencies and humanitarian groups to function.
Somalia’s Ministry of Health received $91 million in this year’s national budget — nearly double last year’s allocation — but analysts say the apparent increase masks a grim reality: almost all of the funding came from external donors. As Mahad Wasuge of the Somali Public Agenda put it, “Security remains the first priority. Everything else is an afterthought.”
In rural areas, “everything else” often means nothing at all.
Hospitals Held Together by Foreign Funding
At Banadir Hospital, the main public referral hospital in Mogadishu, even the unit for severely malnourished children depends entirely on donor money funneled through Concern Worldwide. Dr. Mohamed Haashi says 37 employees lost their jobs when U.S. aid was cut; only 13 remain, all funded by Concern. The milk, food, and medicine keeping children alive come from the same pipeline.
Across the city at De Martino Hospital — a century-old facility established during Italian colonial rule — administrators worry their lifeline will soon snap. Contracts with two humanitarian groups expire in late 2025. “Now it looks like donors are fatigued,” said the hospital’s director, Dr. Abdirahim Omar Amin, gesturing toward laboratory equipment purchased almost entirely through aid.
De Martino’s pediatric wing was treating dozens of children with diphtheria, a disease easily prevented by routine vaccination. But rural parents, fearing militant attacks on clinics, have stopped bringing their children in.
“Even the limited public hospitals that function rely almost entirely on donors,” said Wasuge. “The government gives no direct budget to keep them alive.”
A State Adrift
The story of Somalia’s hospitals mirrors the story of the state itself: structures shattered by decades of civil war, partially rebuilt by foreign funds, and perpetually one crisis away from collapse. After the fall of Siad Barre in 1991, many public buildings became shelters for the displaced. Some never reopened.
Today, the federal government operates from a heavily fortified enclave near Mogadishu’s airport, reliant on African Union peacekeepers, U.S. airstrikes, and foreign advisers in a country where multiple powers — from Turkey to Gulf states — compete for influence on the Indian Ocean and the Gulf of Aden.
Despite that geopolitical attention, Somalia has “no national healthcare plan,” said Mohamed Adam Dini, a parliamentarian from Puntland. “A lot of diseases are spreading unchecked. There is no political plan — so how can there be a health plan?”
For Somalis like Amina Abdulkadir Mohamed, who recently gave birth at De Martino because she knew she wouldn’t be asked to pay, the crisis is already personal. “I was told there is free medication,” she said. How long that remains true depends entirely on donors who are, increasingly, leaving.
