The burden of tuberculosis in Somalia is driven by poverty displacement and overcrowding and a fragile health system

This narrative review aims to assess the current status of tuberculosis (TB) in Somalia and examine the key factors driving its continued burden, including poverty, displacement and overcrowding, malnutrition, humanitarian crises, conflict, and weak health infrastructure. A narrative review was undertaken using WHO Global Tuberculosis Report 2024, national surveys, and peer-reviewed literature. Data on incidence, mortality, service delivery, and treatment outcomes were synthesized alongside socioeconomic and structural determinants, including poverty, displacement, malnutrition, humanitarian crises, and health system fragility. Somalia recorded an estimated TB incidence of 246 cases per 100,000 population and a mortality rate of 63 per 100,000 in 2022. Between 2010 and 2023, incidence declined by 14%, while treatment success rates reached 87%. Diagnostic and treatment capacity expanded to 109 TB centers and 11 drug-resistant TB units. Nevertheless, multidrug-resistant TB is increasing, and 68% of affected households experience catastrophic health expenditures. More than 3.9 million internally displaced persons live in overcrowded camps with limited access to care. High levels of acute and chronic malnutrition compound vulnerability, while conflict and insecurity disrupt service delivery and restrict access in rural areas. The health system remains fragmented and heavily dependent on external aid, with persistent gaps in surveillance, referral pathways, and drug supply. TB in Somalia is driven by intertwined biomedical, social, and structural determinants. Despite improvements in case detection and treatment outcomes, progress is undermined by displacement, poverty, malnutrition, and weak infrastructure. Achieving End TB targets requires integrated approaches that combine strengthened diagnostic and treatment services with nutrition support, social protection, and targeted interventions for displaced populations, underpinned by sustained investment and international support.