“We are heading with our eyes open toward disaster”: The devastating impact of US health funding cuts on Somalia

Last July, a woman arrived at Bay Regional Hospital in Somalia, carrying two of her children who were sick with measles. The youngest, two years old, died shortly after arriving at the emergency room. Her 10-year-old daughter was hospitalized in isolation. When medical staff asked if she had other sick children at home, the woman agreed. However, because she lived far from the main road, she was only able to take the two most seriously ill children with her.

This mother was from Buurhakaba, a town about 60 kilometers away. The district hospital had ceased operations due to US funding cuts, and patients had to travel long distances to receive care. “These situations force them to choose even between their own children,” Yusra Shariff, humanitarian coordinator for Médecins Sans Frontières (MSF) in Somalia, told EL PAÍS. She met this mother during a visit to the hospital supported by the NGO.

Her story is just one example of the profound impact that the abrupt cuts in development aid funding from the US , Somalia's main humanitarian donor, as well as from other countries and international actors, have had in recent months.

Mohamed Farah, Head of Operations in Somalia for the Norwegian Refugee Council (NRC), believes the country is experiencing “ a toxic mix of conflict , drastic cuts in international funding, and climate injustice .” All of this, coupled with an extremely weak, fragmented, and almost 100% aid-dependent health system, has led to increased outbreaks of infectious diseases, a risk of child malnutrition, and a further deterioration in medical care.

"We are heading into disaster with our eyes wide open." These words from Dr. Binyam Gebru, deputy director of Save the Children in Somalia, during an interview with this newspaper, reflect the concern of humanitarian organizations about the coming months. "When we look ahead to 2026, we see that the country will be in a very precarious situation , if not a full-blown crisis, if current trends continue," warns Dr. Millhia Kader, head of health for UNICEF Somalia, in another interview.

In July, Save the Children warned in a statement that the closure of hundreds of clinics had contributed to a doubling of cases of measles, diphtheria, whooping cough, cholera, and severe respiratory infections since mid-April, rising from around 22,600 to more than 46,000. Of these, around 60% were in children under five years of age.

As for diphtheria , a vaccine-preventable disease, more than 1,600 cases and 87 deaths had been recorded by August 2025 , compared to 838 cases and 56 deaths in all of 2024, explained Hussein Abdukar Muhidin, director general of the Somali National Institute of Health.

Although immunization rates have improved in Somalia over the past decade, hundreds of thousands of children are not fully vaccinated. These immunization gaps are what lead to outbreaks like the current one, which is primarily affecting children between 5 and 15 years old. “There is no vaccination program targeting this age group,” explains UNICEF. “Traditionally, what we would do is make resources available for emergency response. Right now, the financial situation is quite tight, so there is no flexibility of resources,” adds Kader.

The cuts have affected the healthcare system's ability to treat and implement recovery campaigns to boost immunity and stem the outbreak, according to Save the Children. "Vaccines require healthcare personnel and a properly functioning healthcare system. If this is disrupted, those vaccines are lost," Gebru points out.

Closed centers

Hundreds of health centers have closed due to funding cuts. Some remain open, but lack services. And in others, Shariff explains, the cuts have resulted in some departments functioning while others have not, as the same center was funded by different donors.

In the case of Save the Children, 72 centers have been directly affected by the cuts. “We are trying to maintain at least 30% of them with other sources of funding, but these are very short-term opportunities and are not sustainable beyond six months, and in some cases, a year,” says Gebru.

Malnutrition and lack of drinking water

Recently, the NRC warned that more than 300,000 people , mostly displaced families living in settlements and rural communities, have lost access to safe drinking water due to the reduction or closure of water and sanitation systems. "Not having water means more disease spread," Farah summarizes.

From January to August, the WHO recorded more than 7,200 cases of cholera and acute watery diarrhea, including nine deaths, with more than 870 new cases recorded in the last month alone. “You can't solve the health crisis without addressing the water crisis,” emphasizes NRC's head of operations in Somalia. “If a clinic closes and there's a contaminated well, they're two sides of the same deadly coin. And funding cuts are affecting both.”

If a clinic closes and you have a contaminated well, they're two sides of the same deadly coin. And funding cuts are affecting both.

Mohamed Farah, Head of Operations in Somalia for the Norwegian Refugee Council

Another pressing problem is malnutrition. According to Kader, severe malnutrition is responsible for 50% of deaths among children under five in Somalia. "On average, we have around 500,000 children estimated to have severe acute malnutrition," he says.

In late March, the Somalia Technical Working Group for the Integrated Phase Classification (IPC), the globally recognized index measuring food security, concluded that between April and June, 713,000 people faced acute food insecurity (IPC Phase 3 or higher), up from an estimated 553,000 in January. Furthermore, the estimated number of children under five experiencing acute malnutrition between January and December 2025 increased to 1.8 million.

“One of the biggest crises facing Somalia is the potential disruption to the supply of Ready-to-Use Therapeutic Foods (RUTF), which risk running out before the end of the year,” explains UNICEF’s Kader. “According to our latest estimates, around 466,000 children would be at risk of severe malnutrition if current stocks were depleted.” Last week, Save the Children warned that Somalia could run out of these vital food supplies within the next three months if the gaps are not filled.

Due to the cuts, Save the Children has withdrawn support for various nutrition services serving 55,000 children in the country. "That's a huge figure for a single agency," acknowledges the NGO's deputy director in Somalia. In addition to nutrition, these clinics offered services such as immunizations, and their closure leaves families without these essential programs.

A “catastrophic” situation

Somalia has one of the highest maternal and infant mortality rates in the world, a problem exacerbated by poor access to health services. MSF's Shariff explains that the normal number of births they attend is now what used to be its peak. "More women are coming because there are no services in their places of origin and they have to travel long distances, sometimes up to 140 kilometers. Most of them come with obstructed labors and more complications because they arrive very late," she summarizes.

She recounts the case of a pregnant woman who went to the Mudug Regional Hospital in Galkayo, where MSF supports maternity care, but the operating room is under the Ministry of Health's control. Because it was occupied, she was transferred to another hospital, whose operating room lacked supplies, so she returned to the first health center. She had to wait, and when she was taken to the operation, the baby had already died.

Today, the world looks inward and is not necessarily willing to fill those voids.

Binyam Gebru, deputy director of Save the Children in Somalia

For Shariff, harmonizing the healthcare system is a priority to ensure the population has access to basic care. “It's not sustainable for each donor to support only part of the hospital. It doesn't help the healthcare system or the patients, because they can only access what is funded at that time.” “We also need to push for guaranteed national funding. It wouldn't meet the needs, but, in my opinion, it would encourage donors,” he adds. In 2024, Amnesty International reported that Somalia's health budget fell from 8.5% in 2023 to 4.8% the following year.

NRC's Farah emphasizes the "moral responsibility" of states, especially the largest carbon emitters , to support countries like Somalia affected by the climate crisis. Save the Children's Gebru asserts that without adequate resources, the situation "is catastrophic." "In the past, when a donor announced an aid cut, we always hoped someone else would pick up the slack," she explains. "Today, the world is inward-looking and not necessarily willing to fill those gaps."