Combating infectious disease outbreaks in Somalia's fragile health system: the impact of climate change-narrative review.

introductionSomalia, the 44th largest country in the world by land area, struggles with a heavy burden of infectious diseases. Since 1991, populations have lacked essential health services, exacerbated by recurring infectious-disease outbreaks. Recurrent outbreaks of measles, cholera, and polio have devastated public health, generating significant morbidity and mortality. Despite improvements through new graduates, these issues remain unresolved. This study examines the impact of climate change on infectious-disease outbreaks in Somalia focusing on cholera, measles, and polio-to fill a gap in the literature by linking climate variability with outbreak dynamics and identifying weaknesses in Somalia's health system. The findings will inform targeted public-health strategies.

methodFollowing PRISMA guidelines, we undertook a narrative review of English-language literature (1990 - March 2025). Searches in PubMed, Scopus, Web of Science and Google Scholar combined terms for infectious-disease outbreaks, climate change and Somalia/Horn of Africa. Of 202 records identified, 74 met inclusion criteria. Two reviewers independently screened, extracted data and applied six-step inductive coding in NVivo 12, synthesizing findings into thematic domains.

resultsFour interlinked themes emerged. (1) Fragile health system: < 0.4 doctors, nurses and midwives per 10 000 population, poorly equipped facilities and patchy surveillance. (2) Control measures: routine immunization completeness ≈20%; limited oral-cholera-vaccine and WASH coverage sustain transmission. (3) Political instability and conflict: insecurity, decentralized coordination and ≥ 2.6 million IDPs hamper rapid response. (4) Impact of climate change: drought-induced water scarcity and flood-related latrine breaches create year-round face-oral exposure, while climate shocks divert resources and swell susceptibility pools.

conclusionOutbreak control in Somalia now hinges on integrating climate adaptation with health-system strengthening. Climate-proofed WASH infrastructure, mobile vaccination and surveillance linked to hydro-meteorological alerts, a National Outbreak Operations Centre, and ring-fenced financing are urgent priorities. Without such measures each extreme-weather event will erase hard-won gains; with them, Somalia can break the climate-outbreak feedback loop.