Somalia´s child malnutrition crisis: why nutrition treatment alone is not enough

¹Department of Public Health, Horseed International University, Mogadishu, Somalia, ²Department of Research and Policy Development, Somali Social Research, Mogadishu, Somalia

^&Corresponding author
Zakaria Abdullahi Adam, Department of Public Health, Horseed International University, Mogadishu, Somalia

To the editors of the Pan African Medical Journal    

Somalia continues to face one of the world's most persistent child malnutrition crises. Recent estimates indicate that approximately 1.84 million children aged 6-59 months were projected to experience acute malnutrition by early 2026, reflecting the combined effects of conflict, climate shocks, displacement, food insecurity, infectious disease, and fragile health services [1]. Although community-based management of acute malnutrition and therapeutic feeding remain essential and life-saving, treatment alone cannot provide durable protection when children return to the same adverse household and environmental conditions. We therefore argue that Somalia's nutrition response must move beyond repeated treatment cycles toward an integrated prevention-and-recovery model.

Evidence from Somalia shows that treatment programmes can achieve good short-term outcomes. A recent systematic review and meta-analysis reported pooled recovery rates of 95.39% in outpatient therapeutic programmes and 80.81% in stabilization centres, confirming the value of existing treatment platforms [2]. However, a prospective cohort study found that 22% of Somali children who recovered from severe acute malnutrition relapsed within six months [3]. This gap between clinical recovery and sustained nutritional well-being should be regarded as an important policy warning: successful discharge does not necessarily mean that the underlying drivers of malnutrition have been resolved.

Those drivers are multiple and interconnected. Somali time-series evidence found that armed conflict, food-price inflation, and climatic variability were associated with increased acute malnutrition [4]. Displacement further concentrates vulnerability; a 2025 community-based study in selected internally displaced-person camps in Kaxda District, Mogadishu, reported a very high burden of acute malnutrition among children aged 6-59 months [5]. Environmental and infectious-disease conditions also undermine recovery. Recent Somali evidence describes how climate shocks, limited access to safe water and sanitation, and recurrent infectious diseases interact to increase children's nutritional vulnerability [1]. Similarly, a 2026 case-control study in Benadir found that unprotected water sources and comorbid illness were independently associated with severe acute malnutrition among children aged 6-23 months [6].

These findings suggest that nutrition services should not operate as isolated therapeutic programmes. Treatment should be systematically linked with primary healthcare, immunization, maternal and child health services, water, sanitation and hygiene interventions, early management of childhood illness, infant and young-child feeding support, and household food-security measures. Somalia-specific experimental evidence also supports integrated social protection: a cluster-randomized trial found that combining cash assistance with complementary interventions could improve child-nutrition outcomes [7].

Therapeutic feeding will remain indispensable in Somalia, but it should be regarded as one component of a broader child-survival strategy rather than the final solution. Sustainable reductions in recurrent malnutrition require simultaneous action on the social, environmental, and health-system conditions that repeatedly place children at risk. Somalia should therefore prioritize an integrated model that protects children not only during nutritional treatment, but also after recovery.

Competing interests    

The author declares no competing interest.

Authors' contributions     

The author conceived the manuscript, reviewed the evidence, drafted and critically revised the manuscript. He also read and approved the final version of this manuscript.

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