10 November 2024 – My first visit to Somalia as Regional Director took place as the country stands at a crossroads. On the one hand, Somalia is reeling from more than 3 decades of conflict and instability, extreme weather events, disease outbreaks and regional fragility. On the other, the country is poised for change. Somalia’s leaders are committed to transformation and the Somali people — many of them born during the civil war — are eager to contribute to the progress of their country.

My 3-day visit to Mogadishu included discussions with senior government officials, humanitarian partners and donors during which we focused on strengthening coordination and support to address some of the most critical health issues facing the people of Somalia and the health system that serves them.

In many parts of the country the health infrastructure has been devastated. More than 40% of Somalis lack access to basic health services. More children under the age of 5 and women giving birth die from preventable causes than anywhere else in the world, mainly as a result of limited infrastructure and the shortage of skilled health workers, particularly midwives, in remote and rural areas.

The country is increasingly impacted by extreme weather events such as drought and floods. While coordinated preparedness and response efforts by WHO and partners were able to avert famine during the 2022–2023 drought, tens of thousands of children lost their lives and millions of people remain vulnerable to hunger and disease.

More than 1.5 million children have yet to receive a single vaccine dose against polio, tetanus, diphtheria and measles. Deprived of access to essential health services, these children face not only the possibility of contracting deadly diseases but multiple other health risks.

At De Martino Hospital in Mogadishu, one of the flagship facilities supported by WHO, I administered polio drops to a baby boy, symbolizing WHO’s commitment — alongside the Ministry of Health, UNICEF and other Global Polio Eradication Initiative partners — to addressing the world’s longest-running polio outbreak of circulating variant poliovirus type 2. The outbreak predominantly affects children in hard-to-reach areas where security challenges complicate our work, and major urban centres where large numbers of internally displaced persons are concentrated.

The polio programme has recently made strides in reaching unvaccinated children and improving the quality of polio vaccination campaigns which integrate critical health services, such as vitamin A and deworming pills, whenever feasible. The Big Catchup, rolled out with partners, maintains a laser focus on reaching children who missed out on lifesaving vaccines during the COVID-19 pandemic. But urgent and concerted efforts by national authorities and partners are still needed at all levels, including the district level in rural and nomadic communities — involving Somali communities themselves — to stop the debilitating poliovirus from robbing more children of their right to a healthy and productive life.

In my meeting with Somalia’s Prime Minister HE Mr Hamza Abdi Barre, I expressed appreciation for his commitment to ending the current polio outbreak in the central and southern parts of the country, including by establishing the Immunization and Polio Eradication Task Force which he personally leads. This political commitment is reverberating across the country, including at the state level with the inauguration of polio campaigns. With continued support from our teams, partners and Somalia’s indomitable health workers, I am optimistic the country will soon end poliovirus transmission, as it has done with previous outbreaks.

In extensive discussions with the Minister of Health HE Dr Ali Haji Adan, I was briefed on the preparatory work being done to reform Somalia’s health sector as part of the country’s National Transformation Plan 2025–2029. I visited the transformation hub which was buzzing with activity as experts worked on data analytics and evidence to identify priorities within the plan, feasibility of implementation and financing sources. I was also pleased to see that many of the health priorities identified in the first phase of the plan align with my regional flagship initiatives, including scaling up the specialized health workforce and expanding access to safe and effective medicines.

Restoring health infrastructure — destroyed during the civil war in many parts of Somalia — is essential to restoring the health system. During my visit, I emphasized the importance of national health authorities strengthening governance, regulations and oversight functions across the health sector in line with Somalia’s federal system. Applying regulatory standards for medicines, vaccines and medical supplies is critical to maintaining the quality of health services. Building the capacity of health workers, expanding maternal and child health services, developing accreditation for health care facilities and expanding the health workforce are urgently needed.

So, too, is a coordinated, multisectoral approach. Many public health risk factors — including food, agriculture, water and sanitation — fall outside the remit of health governance. Only by addressing these issues together can Somalia build a sustainable health system that meets the needs of its population.

Multisectoral coordination must be enhanced by humanitarian partners. In my meeting with representatives of United Nations agencies in Mogadishu, we discussed changes in the national planning process and their alignment with the new UN Cooperation Framework for Somalia. We agreed that these changes present an opportunity to strengthen coordination and synergy across sectors, particularly in addressing cross-cutting challenges such as maternal mortality and food insecurity.

My time in Somalia allowed me to witness not only the challenges faced by the people of Somalia but the enormous obstacles facing aid workers as they help others in a complex and insecure environment. To them, I express my sincere respect and admiration.

WHO is committed to standing shoulder to shoulder with Somalis to deliver the Essential Package of Health Services despite the challenges facing the country. WHO’s decentralized presence in Somalia facilitates the delivery of technical assistance to states so they can effectively expand and deliver health services and helps ensure that we reach larger parts of the population, bringing health services to where they are most needed.

Somalia’s evolving situation demands ongoing commitment from the international community and adaptability from all partners to sustain health services, protect public health gains and build a resilient health system that can withstand future challenges and promote the health and well-being of all Somalis.