Somalia's Ebola preparedness and cross-border risk following the recent 2025 DRC outbreak

Dear editor,

The recent declaration of a new Ebola outbreak in the Democratic Republic of Congo (DRC), its 16th since the virus was first identified in 1976, underscores the persistent danger posed by this pathogen to global health. The World Health Organization (WHO) reported 64 cases (53 confirmed, 11 probable) and 45 deaths as of December 1, 2025, [1], and the DRC declared the outbreak over on November 30, 2025 [2]. Although the DRC has often been at the epicentre of Ebola crises, the implications extend far beyond its borders. For Somalia, a country marked by fragile institutions and ongoing humanitarian challenges, this outbreak serves as a critical warning and an urgent call for comprehensive preparedness [3].

Somalia faces unique vulnerabilities that magnify the risk of Ebola incursions. Decades of conflict and instability have left its health system under-resourced, fragmented, and heavily reliant on international support. The Ministry of Health and Human Services previously sought more than $31 million to fund Ebola preparedness [4]. Despite these efforts, diagnostic and surveillance gaps persist. Most notably, Somalia lacks sufficient evidence of in-country capacity to conduct polymerase chain reaction (PCR)-based diagnostic testing for Ebola [5]. In a fast-moving outbreak, the absence of reliable diagnostics can critically delay case confirmation, obstruct contact tracing and heighten transmission risks. These vulnerabilities are reflected in global preparedness benchmarks: Somalia's latest WHO International Health Regulations (IHR) State Party Self-Assessment Annual Reporting (SPAR) submission (2024) reports a low overall capacity score (33 %) [6,7], consistent with priority gaps highlighted in Somalia's Joint External Evaluation (JEE) mission report (2016) [8]. Somalia also ranks at the bottom of the Global Health Security Index (GHSI), with a 2021 overall score of approximately 16/100 [9].

Investment in diagnostic facilities must be viewed as a national and regional priority. Establishing PCR testing laboratories in Somalia would not only enable rapid Ebola detection but also build resilience against other epidemic-prone diseases, such as the Marburg virus and Lassa fever. Partnerships with the Africa Centres for Disease Control and Prevention (Africa CDC), the WHO, and regional health networks could accelerate the procurement of equipment, reagents, and training for laboratory personnel [3]. In addition, ensuring biosafety compliance and developing contingency supply chains for reagents are essential for the operational sustainability of the laboratory. Notably, the Africa CDC and Somalia's Federal Ministry of Health finalized inputs for Somalia's first national laboratory strategic plan in 2024 [10]. The WHO-supported implementation of Integrated Disease Surveillance and Response (IDSR) Phase 2 (since 2024) also emphasizes linking surveillance outputs with routine feedback for decision-making [10,11].

Health workers were also affected during the outbreak; WHO reported five infections among health workers (four nurses and one laboratory technician), with three deaths [1,3]. Somalia, with its limited and overstretched healthcare workforce, cannot afford such losses. Given recent regional viral haemorrhagic fever events, including Ethiopia's first reported Marburg outbreak in November 2025 [12], routine IPC readiness and protected referral pathways should be strengthened for high-consequence pathogens beyond Ebola virus [3].

The 2014 Ebola crisis exposed the dangers of weak surveillance but also catalyzed innovations. Digital surveillance platforms provide real-time data sharing and predictive analytics that can guide decision making [13]. Somalia should leverage mobile technology and geospatial mapping to strengthen its disease surveillance system. Integrating digital platforms with existing health reporting structures would enable earlier detection and faster responses to future outbreaks of infectious diseases. These tools can also help bridge Somalia's infrastructural gaps, particularly in hard-to-reach regions where traditional surveillance is limited. Somalia's ongoing IDSR scale-up provides a practical pathway to institutionalize multi-disease event-based surveillance and routine feedback loops for decision-making [11,13].

The Intergovernmental Authority on Development (IGAD) and Africa CDC could serve as platforms for coordinated planning and capacity sharing. By embedding Ebola preparedness within regional frameworks, Somalia not only protects itself but also contributes to the collective health security of the Horn of Africa. Cross-border coordination already occurs in practice (often outbreak-triggered): WHO reports that Somalia, Ethiopia, and Kenya convened cross-border coordination meetings to review the cholera response and plan reactive oral cholera vaccination [14], and IGAD–International Organization for Migration (IOM) training supports mobility-sensitive preparedness at borders [15].

Ebola preparedness cannot be separated from broader health-system strengthening efforts. Somalia's healthcare system remains severely underdeveloped, with limited infrastructure, workforce shortages, and heavy dependence on humanitarian assistance. Without addressing these foundational weaknesses, preparedness measures will struggle to be implemented effectively. Integrating epidemic preparedness into Somalia's National Health Strategy, strengthening primary healthcare, and improving the supply chain for essential medicines are crucial for long-term resilience. Furthermore, investing in community health worker programs can extend basic services and surveillance capabilities to underserved regions. This integrated approach is essential because Somalia faces multiple epidemic-prone threats beyond Ebola, including ongoing AWD/cholera transmission [16], a substantial measles burden (approximately 12,600 cases reported in 2024) [17], and recurrent vaccine-derived poliovirus events [18], alongside regional and continental risks such as mpox and yellow fever outbreak potential in parts of the Horn of Africa. Strengthening core IHR/IDSR capacities helps prevent both domestic amplification and cross-border exportation by enabling earlier detection, rapid containment, and timely cross-notification.

Preparedness is not only a technical or policy issue; it is also a moral imperative. Protecting healthcare workers, safeguarding vulnerable populations, and preventing unnecessary deaths should be viewed as humanitarian obligations. Somalia's fragility amplifies the potential devastation of uncontained outbreaks. Beyond national borders, the global community has a responsibility to ensure that fragile states are not neglected. In an interconnected world, failure to act in Somalia could lead to consequences far beyond its territory, including regional destabilization and increased global health insecurity.

The recent Ebola outbreak in the DRC is a sobering reminder that preparedness cannot wait until an outbreak occurs in the DRC. For Somalia, the threat of Ebola is not distant but imminent, magnified by systemic fragility and geographic vulnerability. By investing in diagnostics, protecting healthcare workers, engaging communities, adopting digital surveillance, and fostering regional collaboration, Somalia can transform its preparedness from aspiration to action. These measures are not merely optional; they are urgent priorities that must be implemented immediately. The time to act decisively is now, before Somalia is confronted with an outbreak that it is ill prepared to manage.

CRediT authorship contribution statement

Abdirasak Sharif Ali: Writing – review & editing, Writing – original draft, Conceptualization. Mohamed Mustaf Ahmed: Conceptualization.

Ethical approval

Not applicable.

Funding

The authors have not received any funding for this study.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.