Ebola virus disease (EVD) preparedness is tested long before any case is first confirmed. In countries with fragile health systems, as well as high population mobility, the decisive question is whether adequate surveillance, laboratories, frontline facilities, and public health coordination can competently detect and contain a single imported case before it even becomes a broader emergency. While Somalia has made important gains in epidemic surveillance, with an added diagnostic capacity in recent years, the available evidence suggests that readiness for a high-consequence threat such as EVD remains more incomplete than assured1.
Main Discussion
Somalia’s disease surveillance system has improved considerably over the past decade. Between 2016 and 2023, progress in Integrated Disease Surveillance and Response (IDSR) included stronger government commitment, the development of a three-year operational plan, improved coordination, and the integration of DHIS2 into the surveillance system. The earlier implementation of EWARN also provided a useful foundation for bringing different surveillance activities together. Despite these improvements, important challenges still remain to be reviewed. Limited funding continues to be the weakest area of IDSR performance, while shortages of trained personnel affect the country’s ability to detect outbreaks early and conduct timely field investigations2.
Laboratory capacity is another area where Somalia has made encouraging progress. Since 2020, the country has expanded molecular testing, adapted existing GeneXpert platforms for additional uses, introduced rapid diagnostic tests in hard-to-reach communities, and increased testing for major epidemic-prone diseases, including influenza, measles, cholera, rotavirus, and dengue. However, these improvements do not necessarily mean that Somalia is fully prepared to diagnose Ebola virus disease (EVD). Although the available evidence points to a stronger laboratory foundation for national health security, it does not confirm routine Ebola testing within the country, established referral pathways for viral hemorrhagic fever testing, or sustained biosafety systems specifically designed to support an EVD response4
Preparedness at healthcare facilities and border entry points remains a significant concern. A national assessment of infection prevention and control (IPC) across 307 healthcare facilities in Somalia recorded a mean score of 136 out of 800, highlighting major weaknesses across all states. The lowest-performing areas included IPC programs and the implementation of combined prevention strategies5. These gaps are particularly concerning in the context of Ebola, as failures in early screening, patient isolation, and safe clinical practices could increase the risk of transmission if an infected person enters the country. Similar challenges exist within the surveillance workforce.
Although many health workers have some exposure to IDSR, relatively few district surveillance officers have participated in the Field Epidemiology Training Program. Experience in investigating outbreaks of several priority diseases also remains limited, and the uneven distribution of trained personnel makes it harder to provide effective surveillance and response in remote and underserved areas3
Cross-border readiness and emergency coordination remain major concerns. Somalia’s points of entry require strong multisectoral coordination among health, customs, immigration, and transport sectors, yet the national review found weak infrastructure, staffing, and surveillance capacity at many ports and airports. The same review identifies community engagement as an operational strength when built through trusted local leaders, radio, and social media, all of which could improve risk communication and early reporting during an imported EVD alert2
Conclusion and Recommendations
Somalia has made meaningful progress in strengthening its disease surveillance and outbreak response systems, but current evidence suggests that important gaps remain in its readiness to detect, investigate, and respond to an imported Ebola virus disease (EVD) case. Challenges across surveillance, laboratory confirmation, infection prevention and control (IPC), border screening, and rapid response indicate that further investment is needed to ensure that these systems work effectively together. Key priorities include securing sustainable funding for Integrated Disease Surveillance and Response (IDSR), expanding advanced field epidemiology training, establishing clear specimen referral pathways for viral hemorrhagic fevers, improving IPC practices in frontline health facilities, and strengthening cross-border coordination through regular simulation exercises.
Ultimately, preparedness cannot be judged by the existence of policies and plans alone; it must be demonstrated through the ability to recognize, isolate, and investigate a suspected case quickly and safely. In the event of an Ebola introduction, delays in detection or response could increase the risk of transmission among healthcare workers and communities. For Somalia, strengthening preparedness before a suspected case arrives is therefore essential to closing existing response gaps, protecting public health, and reducing the risk of a wider outbreak.
About the Author
Sumaya Ahmed Ali
References
[1] Ssendagire S, Karanja MJ, Abdi A, Lubogo M, Azad Al A, Mzava K, et al. Progress and experiences of implementing an integrated disease surveillance and response system in Somalia; 2016–2023. Front Public Health 2023;11. https://doi.org/10.3389/FPUBH.2023.1204165.
[2] Hussein SA, Osman MM, Hassan YSA, Hussein AA, Adem R, Ali AN, et al. Strengthening Somalia’s health system: pathways to achieving International Health Regulations core capacities at points of entry by 2025. Trop Med Health 2025;53. https://doi.org/10.1186/S41182-025-00836-Z.
[3] Abdullahi AM, Mohamud AM, Osman MM, Abdi MA, Hassan GD, Abdi YH, et al. Core competency gaps among Somalia’s disease surveillance workforce: a cross-sectional study. Pan African Medical Journal 2026;54. https://doi.org/10.11604/PAMJ.2026.54.9.50073.
[4] Figuereo S, Mohamed SI, Takele D, Sheikh AM, Abera SC, Mohamed AM, et al. Laboratory capacity-building during COVID-19 in Somalia: improving access to essential diagnostics for national health security in a fragile setting. J Epidemiol Glob Health 2025;15. https://doi.org/10.1007/S44197-025-00350-9.
[5] Adam AA, Mohamed HD, Anyiam FE. Assessment of Infection Prevention and Control in Somali Healthcare Facilities using the WHO Infection Prevention and Control Assessment Framework. Antimicrob Resist Infect Control 2025;14. https://doi.org/10.1186/S13756-025-01584-9.
