Working as the Medical Coordinator for Médecins Sans Frontières (MSF) in Somalia, I see every day how conflict and poverty damage people’s lives. One of our biggest challenges is Tuberculosis, which affects many children. Tuberculosis is not just an illness—it takes away energy, health, and sometimes lives. I see its impact on children like Ahmed*, a 5-year-old I met recently at Mudug Regional Hospital.
Ahmed arrived with a weak cough, fever, and significant weight loss—all clear signs of Tuberculosis. In Somalia, the Tuberculosis rate is very high, with about 246 cases for every 100,000 people. Diagnosing Tuberculosis in children is difficult because they often cannot produce the sputum needed for tests. In our limited-resource setting, we rely on basic clinical exams, X-rays, and skin tests. Waiting for a perfect test isn’t an option when Tuberculosis can progress quickly. In Somalia, about 68 people per 100,000 lose their life from Tuberculosis.
Patients testimonies at the Mudug TB Hospital in regards to TB cure
Over 2.6 million people in Somalia have been displaced, forcing them to live in overcrowded camps where Tuberculosis spreads easily. Children, already vulnerable due to hunger and limited healthcare, face the highest risk. Many families undertake long and perilous journeys to access medical care. Sadly, only about 43% of Tuberculosis cases are detected, leaving many children without treatment. Moreover, while the preventative tuberculosis treatment is available, the uptake among the population is relatively low and the implementation of new shorter regimen is very slow.
Since 2002, MSF has been fighting Tuberculosis in areas like Galkayo, Middle Shabelle, and Somaliland by running mobile clinics and supporting hospitals like Mudug. In 2023 and 2024, we treated 777 Tuberculosis patients in Galkayo, and 645 of them completed their treatment—an 81% success rate. However, this is not enough as the number of patients having multidrug-resistant Tuberculosis is growing. Somalia is among 30 high burden DR TB countries in the world.
Our TACTiC initiative (Test, Avoid, Cure Tuberculosis in Children), started in 2024, has improved and simplified how we diagnose Tuberculosis in kids Since it relies on systematic screening of the symptoms and scoring, it is very relevant to use among children. For example, it helped us correctly diagnose Amina*, a girl who was mistakenly treated for pneumonia for months. Today, she is finally getting the right treatment.
Dr Ahmed Hassan and Dr Mohamed Abdihamid From the Mudug TB Hospital talk about the BPaLM TB treatment
Prevention is also crucial. The BCG vaccine can protect children from severe Tuberculosis, but only 42% to 57% of babies receive it because many are born at home without access to healthcare. Moreover, 1.8 million children under five suffer from acute malnutrition, making them even more
vulnerable to Tuberculosis. At MSF, we combine Tuberculosis drugs with nutritional support to give children the best chance at recovery.
Our work will become even more challenging in 2025 as USAID reduces funding for Tuberculosis programs in Africa, including in Somalia. Nutrition support, which is an important part of TB treatment and influencing the outcomes, is generally not provided for patients with tuberculosis. These cuts are expected to lead to fewer tests, incomplete treatments, and a higher spread of Tuberculosis. We are preparing to respond by educating communities about Tuberculosis, encouraging patients to complete their treatment, and working to reduce the stigma surrounding the disease.
With Tuberculosis Day approaching on March 24, 2025, I think of Ahmed, Amina, and countless other children battling Tuberculosis. They need early diagnosis, vaccines, proper nutrition, and consistent care to overcome this disease. By expanding programs like TACTiC and raising awareness, we can help protect Somalia’s children from the grip of Tuberculosis.
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