Somaliland Should Build Dialysis Hubs, Not Scatter Unsupported Machines
Dialysis Beyond Hargeisa
A dialysis machine without clean water, reliable electricity, reagents and trained staff is not a service. It is expensive furniture.
Somaliland’s expansion of dialysis care should reduce dangerous travel while avoiding a common health-planning failure: distributing machines to hospitals that cannot operate them safely.
Public dialysis capacity already exists in Hargeisa, Burao and Borama. The government has added 12 machines at Hargeisa Group Hospital and announced further support for Burao and Borama, with a new unit planned for Erigavo. Taiwan has also announced $1 million in assistance for dialysis services across the country.
Erigavo is the clearest next hub
Erigavo should be the next fully supported regional centre because of the distance between Sanaag and existing western facilities. A functioning unit there could reduce repeated journeys to Hargeisa or Burao and create a referral centre for surrounding districts.
But “functioning” requires more than machines. Hemodialysis needs treated water, dependable electricity, infection control, laboratory support, a continuous supply of filters and reagents, technicians and clinicians able to manage complications.
The Ministry of Health’s own assessment identified poor dialysis-machine functionality in Borama because of inadequate technical staff and insufficient reagents. This is a warning against expansion without operating finance.
Use a hub-and-spoke network
Hargeisa should remain the national tertiary and training hub. Burao and Borama should serve as established regional hubs, with Erigavo developed as the next complete centre. Berbera should receive a formal demand-and-access assessment for a smaller satellite service, particularly because of its port workforce, transport links and distance from scheduled treatment.
Aynabo and other eastern locations should initially receive kidney screening, laboratory capacity, referral transport and tele-nephrology rather than stand-alone dialysis unless patient volumes, security and staffing justify a unit.
WARYATV Assessment
Somaliland should allocate dialysis by travel time, documented patient demand and operational readiness—not regional politics. Every proposed unit should pass a readiness test covering water, power, workforce, maintenance, consumables, waste disposal and annual financing.
The correct objective is not equal numbers of machines in every region. It is equitable access to safe treatments that operate every scheduled day.
