The State of Anesthesia and Critical Care Services in Somalia: Challenges and Opportunities.

Anesthesia and critical care are indispensable to safe surgery, obstetric care, trauma management, and emergency response, yet they remain underdeveloped in Somalia. This commentary provides a policy-oriented narrative synthesis of available peer-reviewed literature and institutional reports describing workforce capacity, service readiness, and critical care infrastructure. Evidence consistently indicates a very low density of physician anesthesiologists (approximately 0.2 per 100,000), limited availability of functional intensive care unit (ICU) beds, and gaps in essential resources such as monitoring, oxygen, medications, and reliable electricity. In many settings, care relies on non-physician anesthesia providers with variable access to structured training, supervision, and regulation, particularly outside major cities. These system constraints contribute to avoidable perioperative and critical illness risk pathways, including delayed access to emergency interventions, hypoxemia, medication errors, and limited rescue capacity for complications. Despite these challenges, feasible opportunities exist. Priorities include strengthening governance and standards for safe anesthesia practice, expanding training and supervised task-sharing models, improving oxygen and power reliability, and implementing low-cost safety systems such as checklists and standard protocols. Coordinated national planning aligned with global benchmarks and universal health coverage agendas is essential to guide investment and accountability.