Tuberculosis in Somalia: A preventable crisis in a fragile state

Somalia ranks among the world's 30 high-burden tuberculosis countries, with 246 cases per 100,000 and 43,000 new annual cases. Despite 87% treatment success for drug-sensitive TB (Tebeje et al., 2025), the case detection rate remains critically low at 42% (Ahmed et al., 2026a) as estimated by WHO comparing notified cases to modeled incidence, leaving over half of all cases undiagnosed. Over 3.9 million internally displaced persons live in overcrowded camps, and acute food insecurity affects nearly half of households—conditions that fuel transmission and undermine treatment adherence. The private sector delivers 60% of health services but contributes only 15.4% of national notifications, and MDR-TB care is limited to 11 specialized centers. Drawing on health systems strengthening and syndemic theory, which recognizes that diseases like TB do not occur in isolation but interact with social and environmental factors—such as malnutrition, displacement, and poverty—to amplify their impact, this analysis synthesizes epidemiological data, programmatic reports, and peer-reviewed literature to identify systemic failures perpetuating Somalia's TB epidemic. Fragmented surveillance, private sector disconnection, food insecurity, catastrophic health expenditures affecting 68% of households, and donor-dependent financing undermine TB control. Addressing this preventable crisis requires decentralized community-based detection, integrated nutritional support, formal private sector engagement, expanded MDR-TB management, and sustained multi-year financing. TB is curable; collective action is imperative.