Strengthening Prehospital Emergency Care in Somalia: Current Barriers and Priorities for System Reform.

Effective prehospital emergency care is a core component of an emergency care system because assessment, initial stabilization, communication, and transport begin before definitive hospital treatment. In Somalia, prehospital services remain fragmented, with substantial reliance on informal transport and limited access to trained responders, standardized protocols, dispatch, and coordinated referral. Somalia-specific reports have documented major gaps in organized prehospital care, including limited ambulance capacity and a lack of a unified national system. This Perspective examines these barriers and proposes a pragmatic pathway for reform that prioritizes governance, workforce development, community first response, dispatch and communication, ambulance standards, and linkage with receiving hospitals. Rather than proposing an expensive high-resource model, the paper advocates phased development beginning with context-appropriate first-responder and basic ambulance-provider training, followed by regulated expansion of advanced prehospital care as workforce, financing, and clinical governance mature. Existing Somali experience with WHO-supported emergency-care training provides a foundation for local capacity building, while regional experience from Kenya illustrates the value of policy, regulation, data, and coordinated dispatch. Mobile communication technologies may offer a feasible bridge where conventional dispatch infrastructure is limited. The immediate priority should be to establish a nationally coordinated, measurable, and sustainable prehospital system that connects communities, responders, ambulances, and hospitals.