Working as the medical coordinator for Doctors Without Borders/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 (TB), which affects many children. TB 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 in Somalia.
Ahmed arrived with a weak cough, fever, and significant weight loss—all clear signs of TB. In Somalia, the TB rate is very high, with about 246 cases for every 100,000 people. Diagnosing TB 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 TB can progress quickly. In Somalia, about 68 per every 100,000 people lose their lives from TB.
Displacement and hunger raise TB risk
Over 2.6 million people in Somalia have been displaced, and are forced to live in overcrowded camps where TB spreads easily. Children, already vulnerable due to hunger and limited health care, face the highest risk.
Many families undertake long and perilous journeys to access medical care. Sadly, only about 43 percent of TB cases are detected, leaving many children without treatment. Moreover, while preventative TB treatment is available, the uptake among the population is relatively low and the implementation of new shorter regimens is very slow.
Since 2002, MSF has been fighting TB in areas like Galkayo, Middle Shabelle, and Somaliland by running mobile clinics and supporting hospitals like Mudug. In 2023 and 2024, we treated 777 TB patients in Galkayo, and 645 of them completed their treatment—an 81 percent success rate. However, this is not enough as the number of patients having multidrug-resistant TB is growing. Somalia is among 30 high-burden drug- resistant TB countries in the world.
Our TACTiC initiative (Test, Avoid, Cure Tuberculosis in Children), which started in 2024, has improved and simplified how we diagnose TB in kids. Since it relies on systematic screening of 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.
Prevention is also crucial. The BCG vaccine can protect children from severe TB, but only 42 percent to 57 percent of Somali babies receive it because many are born at home without access to health care. Moreover, 1.8 million children under age 5 suffer from acute malnutrition, making them even more vulnerable to TB. At MSF, we combine TB drugs with nutritional support to give children the best chance at recovery.
Freezing US foreign aid will result in humanitarian disaster
View the timelineUSAID cuts will reduce TB testing and treatment abilities
Our work will become even more challenging in 2025 as USAID cuts will reduce funding for TB programs in Africa, including in Somalia. Nutrition support, which is an important part of TB treatment and influences outcomes, is generally not provided for patients with TB. These cuts are expected to lead to fewer tests, incomplete treatments, and a higher spread of TB. We are preparing to respond by educating communities about TB, encouraging patients to complete their treatment, and working to reduce the stigma surrounding the disease.
On World Tuberculosis Day, March 24, 2025, I think of Ahmed, Amina, and countless other children battling TB. 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 TB.
*Names changed for privacy
