Climate change and infectious disease outbreaks in Somalia: strengthening climate-resilient public health responses

¹Faculty of Health Science and Tropical Medicine, Somali National University, Mogadishu, Somalia, ²Center for Health Research and Innovation, Somali National University, Mogadishu, Somalia, ³Faculty of Social Science, Salaam University, Mogadishu, Somalia

^&Corresponding author
Abdullahi Osman Mohamed, Faculty of Health Science and Tropical Medicine, Somali National University, Mogadishu, Somalia

To the editors of the Pan African Medical Journal    

Climate change is increasingly recognized as a major driver of infectious disease risk, extending beyond an environmental concern into a critical global health threat [1-3]. Somalia is among the world's most climate-vulnerable countries, experiencing recurrent droughts, flooding, and large-scale population displacement within a fragile and under-resourced health system [1-3]. Emerging evidence indicates that climate variability is directly influencing the timing, intensity, and geographic distribution of infectious disease outbreaks, making the climate-health nexus in Somalia an urgent public health challenge [1].

Recurrent droughts in Somalia reduce access to safe water, forcing communities to rely on unsafe sources and compromising hygiene practices. Conversely, flooding events damage sanitation infrastructure, contaminate water sources, and increase environmental exposure to pathogens. These alternating extremes sustain transmission of waterborne diseases such as cholera and acute watery diarrhea [1,2,4]. Only about one-third of the population has access to basic sanitation, and climate-related damage to WASH systems further increases transmission risks [1]. Furthermore, climate shocks have displaced large populations, with an estimated 2.6 million internally displaced persons (IDPs) living in overcrowded settlements with limited access to clean water, sanitation, and healthcare [1,5,6]. These conditions increase transmission of diarrheal diseases, respiratory infections, and malaria, while also worsening malnutrition, particularly among children and pregnant women [1,2].

Somalia's health system remains severely constrained, with limited healthcare workforce density, weak surveillance systems, and inadequate diagnostic capacity [1]. Routine immunization coverage remains low, leaving large populations vulnerable to vaccine-preventable diseases such as measles [1,5]. As a result, climate shocks such as droughts and floods frequently escalate into large-scale outbreaks of cholera, acute watery diarrhea, measles, and malaria, particularly among displaced populations [1,2,5,7]. Certain populations are disproportionately affected, including internally displaced persons, children under five, pregnant women, and rural or conflict-affected communities. These groups face overlapping risks of malnutrition, poor healthcare access, low immunization coverage, and exposure to unsafe environments [1,3,7,8].

To address these challenges, several policy and programmatic responses are vital. Integrating meteorological and hydrological data with disease surveillance systems can strengthen early warning systems for outbreaks such as cholera and malaria [1,3,7,8]. Key interventions for climate-resilient WASH systems include flood-resistant sanitation infrastructure, climate-resilient water supply systems, and the protection of water sources during droughts, which collectively reduce environmental contamination and disease transmission [1,4,5,8]. Additionally, mobile and outreach-based vaccination strategies are essential during climate shocks, with priority given to measles and cholera vaccination campaigns, particularly in displaced populations [1,3]. Broad health system strengthening priorities include establishing national outbreak response centers, strengthening health workforce capacity, expanding laboratory and diagnostic systems, and securing dedicated financing for climate-resilient health systems [1,7,9].

Somalia's recurrent droughts, floods, and population displacement can amplify infectious disease risks through disruptions in water, sanitation, vaccination, surveillance, and access to essential health services [1,6]. Strengthening climate-informed disease surveillance, climate-resilient WASH infrastructure, mobile vaccination and outreach services, laboratory capacity, and integrated outbreak preparedness should therefore be prioritized [7,8]. Linking climate and health data within early-warning systems and directing resources toward climate-vulnerable and displaced populations could improve the country's capacity to anticipate and respond to climate-sensitive outbreaks [2,3]. A coordinated climate-health approach is essential to strengthen resilience and reduce the infectious disease burden associated with future climate shocks [1].

Declarations: ethical approval was obtained from the relevant institutional review board of Somali National University.

Competing interests    

The authors declare no competing interests.

Authors' contributions     

Abdullahi Osman Mohamed conceived the manuscript and drafted the initial version; Mohamed Adam Abdihashi, Abdinasir Mohamed Abdi, Yusuf Hassan Muhumed, Abshir Hassan Samaan, and Anas Abdulkadir Warsame contributed to the literature review, interpretation of evidence, and critical revision of the manuscript. All the authors read and approved the final version of this manuscript.

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