Obstetric and Emergency Anesthesia in Somalia: Patient Safety Challenges in a Fragile Health System

Abstract: Somalia continues to face an exceptionally high burden of maternal mortality within a fragile health system shaped by prolonged conflict, infrastructure constraints, workforce shortages, and uneven access to emergency obstetric services. Safe obstetric and emergency anesthesia is a critical but often underexamined component of this challenge. This article is an evidence informed commentary based on published literature, organizational reports, and contextual clinical experience in anesthesia practice in Somalia. Key concerns include shortages of trained anesthesia personnel, inconsistent access to oxygen, monitoring, blood products, drugs, and postoperative critical care, as well as weak governance and limited standardization of practice. In obstetric emergencies, these gaps may amplify the risks associated with difficult airway management, aspiration, spinal hypotension, delayed transfusion, hemorrhagic shock, and perioperative deterioration. This commentary argues that anesthesia safety should be treated as an essential component of maternal and emergency care quality in fragile settings. Practical priorities include strengthening nonphysician anesthesia training with supervision, continuing professional development, expanding access to minimum monitoring and oxygen systems, improving preparedness for airway and hemorrhage emergencies, and embedding anesthesia within national surgical and maternal health planning. Nationally compiled Somalia-specific data remain limited in the accessible published literature, but the available evidence is sufficient to support urgent, evidence-informed action. Keywords: obstetric anesthesia, patient safety, maternal mortality, fragile health systems, Somalia, emergency anesthesia