Ten-year-old Absame* is embarking on the arduous journey of learning to walk again. Polio swept through his small body, stealing the use of his legs. Now, a prosthetic limb, a marvel of engineering shipped from Switzerland and painstakingly assembled by hand at a rehabilitation centre in Mogadishu, offers him a glimmer of a future he once believed was lost forever. He is, by all accounts, one of the fortunate few.
Somalia, a nation grappling with a population of approximately 18 million, boasts a mere three physical rehabilitation centres. This stark reality means that an estimated 200,000 to 250,000 individuals require long-term rehabilitation. Their need stems from a grim confluence of factors: persistent landmine threats, ongoing conflict, and preventable diseases that tragically leave children with lifelong disabilities.
Even before the recent wave of global aid cuts, notably from major contributors like the US and the UK, Somalia’s already strained healthcare system was teetering on the brink. Aid workers now describe it as being in a state of outright fracture. According to the United Nations Children’s Fund (Unicef), over the past year, more than 400 health and nutrition facilities have ceased operations across Somalia, including at least 125 sites dedicated to nutrition services. For the countless individuals who depended on these facilities, the closure leaves them with nowhere to turn. Many lack the mobility to travel, and some are entirely unable to move independently.
“If you live in a district and the clinic closes, you are just now forgotten,” states Alexandre Formisano of the International Committee of the Red Cross (ICRC). “They can’t compensate by going somewhere else.”
Those working on the ground paint a picture of a quietly deteriorating humanitarian landscape. A perfect storm of conflict, climate-induced crises, widespread displacement, and chronic underinvestment has created a crisis far more complex and challenging to manage than any single emergency.
The repercussions of this multifaceted crisis extend far beyond those directly injured by violence. Formisano outlines two primary patient groups: those suffering from conflict-related injuries and those impacted by the sheer absence of basic healthcare services.
“People who haven’t accessed vaccinations, who haven’t received proper maternal healthcare… that all translates into disability. It’s quite a big chunk of people in Somalia,” he explains. Compounding this are those who never even reach a point of care: “There’s a big population group who just doesn’t receive access to primary health just because they can’t move.”
Physical rehabilitation, a critical component of recovery, sits precariously at the very end of this fragile healthcare chain. A patient sustaining an injury in Somalia’s protracted civil conflict must first be evacuated, receive treatment at a primary health centre, undergo surgery at a regional hospital, and only then be referred for rehabilitation. Each step is inextricably linked to the one preceding it. When any link in this chain breaks, the entire process collapses. This chain is now exceptionally weak, a direct consequence of dwindling aid.
While the ICRC itself does not directly receive funding from the United States Agency for International Development (USAID) – an agency effectively shuttered by Donald Trump at the beginning of last year – the withdrawal of support from other avenues has exerted immense pressure across the entire system. The estimated 200,000 to 250,000 individuals in Somalia requiring physical rehabilitation are now facing an increasingly uncertain future. Funding has not only declined but has become alarmingly erratic. This unpredictability has led to programmes being paused, restarted, and then abruptly cut again, creating what aid workers describe as a stop-start system that is virtually impossible to plan for.
Formisano elaborates on this critical issue: “There hasn’t been an obvious trend… but now it’s so up and down. It’s not good for people. If you live in a district and the clinic closes, you are just now forgotten. They can’t compensate by going somewhere else. So much trust is lost.”
This volatility is particularly devastating for a system that fundamentally relies on continuity. Rehabilitation is not a quick fix; it is a long-term process demanding consistent staffing, reliable equipment, and ongoing follow-up care. When funding falters, the entire model crumbles.
Somalia’s capacity for physiotherapy is severely limited, with only 15 physiotherapists holding bachelor’s degrees, trained abroad. This equates to roughly one physiotherapist for every 1.3 million people. Crucially, there are no domestic physiotherapy schools. The ICRC has outlined plans to support the establishment of local training programmes, including partnerships with the Somali National University, to cultivate in-country expertise. However, the missing ingredient is funding. Simultaneously, humanitarian needs are escalating, with Unicef appealing for $121 million (£90m) to address the critical needs of children in Somalia this year. To date, less than $20 million has been secured, leaving nearly two million children at risk of severe malnutrition.
Rehabilitation, often perceived as less urgent than immediate threats like famine or disease outbreaks, risks being relegated further down the priority list. This is despite its profound impact on an individual’s ability to work, move, and live independently, or conversely, to remain perpetually dependent on others. The centres treat a diverse range of patients, including approximately 10 per cent who are war-wounded. However, they also provide vital care for children with conditions such as cerebral palsy or clubfoot.
“We see… the physical advantages they gain. But the dignity… that’s something we don’t always see. The sense of purpose,” Formisano remarks. For those fortunate enough to navigate the system and access its services, the transformation can be truly life-altering. Yet, the system itself remains precarious, held together by just three centres, 56 dedicated Red Crescent staff, and a donor base whose attention is increasingly diverted elsewhere.
Meanwhile, the relentless and ongoing conflict continues to generate a steady stream of new patients. “We are regularly evacuating weapon-wounded, displaced people every day. Disability is another layer which adds to those situations. It’s normal that a person being treated in one of those centres has already been displaced multiple times,” Formisano states.
Absame is diligently working to regain his mobility, but his recovery hinges on a chain of care that grows more fragile with each passing day. This is a system strained not only by war and disease but also by the slow erosion and inherent unpredictability of global aid.
Formisano asserts that solutions do exist, but they necessitate a level of commitment that the international community has, thus far, failed to provide.
“On one side, there is the need for governments to work on the root causes of conflict and instability in Somalia,” he argues. “This is a conflict that’s been going on for decades and doesn’t seem to have an exit any time soon.” His message to the international donor community is equally direct: “They need to understand the situation is not improving at all. It’s quite unstable. With a convergence of many different elements.”
