From detection to response: a critical narrative review of infectious disease surveillance and outbreak preparedness in Somalia

Infectious disease surveillance and outbreak preparedness are essential to health security, yet maintaining these functions remains difficult in fragile and conflict-affected settings. Somalia has experienced prolonged conflict, recurrent epidemics, climate-related shocks, population displacement, and fragmented health system governance. This critical narrative review examines the evolution and current performance of infectious disease surveillance and outbreak preparedness in Somalia, with particular attention to progress against International Health Regulations (IHR) core capacities and WHO surveillance expectations. Evidence was synthesized from peer-reviewed literature, WHO and other international technical documents, and Somalia-specific surveillance and preparedness reports. The review shows that Somalia has made important progress through the transition from the Early Warning Alert and Response Network to integrated disease surveillance and the expansion of electronic reporting. However, progress has been uneven across the surveillance-to-response pathway. Facility-level reporting has improved, while verification of alerts, laboratory confirmation, outbreak investigation, community-based surveillance, and response capacity remain substantially weaker. These gaps are amplified by fragmented governance, limited domestic financing, workforce shortages, insecurity, displacement, and weak integration of human, animal, and environmental surveillance. Compared with other fragile settings, Somalia’s distinctive challenge is the interaction between prolonged institutional disruption, federalized governance, humanitarian dependence, population mobility, and climate-sensitive disease transmission. The review argues that digital technologies should be used as enabling tools within a mature surveillance architecture rather than as substitutes for core capacities. Strengthening Somalia’s health security therefore requires sequencing investment from reliable detection and verification toward laboratory-supported investigation, community surveillance, rapid response, and eventually predictive One Health surveillance.