Access to health care services in Somalia: Evidence from a qualitative study

Access to healthcare in fragile and conflict-affected contexts remains a critical public health challenge. This study aimed to explore how Somalia citizens experience and perceive access to health services in Mogadishu, focusing on barriers, trust dynamics, service utilization patterns, and evolving health expectations. A qualitative, case-based design was employed, and 54 in-depth interviews were conducted using a semi-structured guide developed through literature review. Thematic analysis revealed five major themes: low utilization of preventive care, financial and logistical access barriers, systemic fragility (including overcrowding, insecurity, and infrastructure deficits), demand for specialized services, and the centrality of trust in shaping health-seeking behavior. While the Somalia Mogadishu Recep Tayyip Erdoğan Training and Research Hospital was widely praised for its cleanliness, professionalism, and reliability, most participants reported relying on reactive care and avoiding check-ups due to costs, lack of awareness, and institutional shortcomings. Despite these challenges, participants expressed increasing aspirations for dignified, specialized services, indicating a shifting perception of health rights. The findings suggest that sustainable improvements in Somalia's health system will require a combination of health diplomacy, community engagement, digital innovation, and investment in inclusive infrastructure and governance.