Critical care readiness in conflict and disaster-affected Somalia: mass-casualty response, emergency referral, and continuity of life-saving care special collection: critical care in war and disaster areas

Abstract Critical care readiness during war and disasters is often judged by intensive care unit capacity, yet preventable mortality in fragile health systems may occur before, during, or after ICU-level care. In Somalia, recurrent mass-casualty events, emergency referral constraints, limited oxygen and blood readiness, constrained operative access, and weak post-resuscitation monitoring expose a critical gap between first contact and sustained life-saving care. This Comment addresses that gap by reframing critical care readiness in conflict and disaster-affected Somalia as a pathway problem rather than an ICU-capacity problem alone. Its novelty lies in integrating domains often treated separately—mass-casualty response, emergency referral, essential emergency and critical care inputs, ethical triage, and non-punitive system learning—into one practical readiness agenda for fragile health systems. The article argues that training and hospital preparedness are necessary but insufficient unless supported by referral communication, command structures, oxygen systems, blood readiness, ward monitoring, and clear escalation criteria. Strengthening this emergency-to-critical-care pathway can improve continuity of life-saving care, support fair resource allocation, and enhance accountability in health systems exposed to conflict and disasters.