Somalia: MSF calls for treatment for malnutrition to be restored across Mudug as children reach hospital too late

As healthcare and nutrition services close across Mudug region in central Somalia, and children arrive at hospital in critical condition after treatment closer to home has failed them, Médecins Sans Frontières (MSF) is calling on donors, UN agencies and health authorities to restore and scale up nutrition treatment at primary healthcare level across the region. ​

The inpatient malnutrition ward MSF supports at Mudug Regional Hospital in Galkayo has 28 beds. Since early April 2026 it has been running beyond that capacity. Due to the overwhelming need for care, the team has continued to admit children despite the ward being full, and at its peak in late May almost twice that number of children were being treated in it. Between January and July, MSF admitted 1,389 children for inpatient treatment of acute malnutrition and medical complications, 809 of them severely malnourished. Between May and July, 1,322 children were admitted to outpatient malnutrition treatment, compared with 788 over the same three months in 2025—an increase of nearly 60 per cent.

The caregivers of most of these children have already sought care somewhere else first. Of eleven children newly admitted over one week in June, ten had already attended a health facility closer to home. Their caregivers brought them to the MSF-supported hospital because there was no medication or therapeutic milk, or because their child was not getting better. ​

Sabrin Ahmed travelled 12 hours by car from Abudwak, around 270 kilometres away, after a doctor in a local hospital there told her he could not treat her 11-month-old, and after she learned that the therapeutic milk the child needed was out of stock in the town.

"By the time these children reach us, they are not only malnourished. They have pneumonia, or measles, or diphtheria on top of it, which is much harder to treat and increases the risk of death, " says Emmanuel Omale, MSF project coordinator in Somalia. "They are not arriving late because their families waited. They are arriving late because there was nothing left closer to home. An inpatient ward is the last step in a chain. It cannot replace the rest of it, and it is already full."

Somalia’s humanitarian response plan was reduced to US$852 million for 2026 and was still less than one third funded by July, according to UNOCHA, the United Nations Office for the Coordination of Humanitarian Affairs. Meanwhile, the World Food Programme has cut emergency food assistance from more than two million people to just over 600,000, and more than 70 health facilities in Puntland, one of Somalia’s federal member states, which covers the northern part of Mudug region have closed. Rainfall has been substantially below average across Mudug through 2026, and pastoral families have moved in search of water and pasture, taking them further from facilities that are still functioning.

MSF calls on donors, UN agencies and health authorities to restore and scale up nutrition treatment at primary healthcare level across Mudug. That means functioning inpatient and outpatient treatment for acute malnutrition close to where families live, and uninterrupted supplies of ready-to-use therapeutic food and essential medicines that enable that. Children treated early for acute malnutrition, in their own district, can avoid getting sicker, and the need for a hospital bed.

MSF will continue to admit and treat every acutely malnourished child who reaches Mudug Regional Hospital and will keep looking for ways to add capacity. But an emergency ward cannot substitute for a health system, and the severely sick children arriving now are the measure of what significant access to care has already been lost.

4 Personal Stories:

Twelve Hours to Galkayo

Sabrin Ahmed reached Mudug Regional Hospital in Galkayo with her sick child after twelve hours on the road. Her child was 11 months old. By then the child had been ill for 12 days, and every attempt to obtain treatment closer to home had failed.

Sabrin came from Abudwak, around 270 kilometres away. Nine people live in the family home, including her mother and her father. They run a small tea shop. Her youngest had not started solid food and was still breastfeeding. But 12 days before the journey, the child stopped feeding and began vomiting and passing diarrhoea. ​

Severe acute malnutrition develops when a child goes without the nutrition their body needs for long enough that it begins to break down its own tissue. The immune system weakens, and infections a well-nourished child would recover from become dangerous. A child who is still eating and has no medical complications can be treated at home, on ready-to-use therapeutic food collected from an outpatient centre. Once complications set in, or a child can no longer eat, they have to be hospitalised, medically stabilised and fed therapeutic milk before therapeutic food can begin. The earlier a child is reached, the simpler the treatment. In Abudwak, none of this care was available to Sabrin.

Sabrin’s family first took their child to a private clinic, but saw no improvement. Days passed on medical tests. At the clinic the child was given intravenous fluids and syrups and became sicker rather than better, so they stopped. "When we were in Abudwak, it was not possible for us to get the required medication and therapeutic milk," she says.

She was told the therapeutic milk her child needed was out of stock in the town. A doctor in Abudwak eventually told her he could not treat the child and that she should take them somewhere else. By then the child was severely malnourished. The journey to Galkayo cost close to US$50. "It is difficult for people living in Abudwak to afford US$50," says Sabrin. The effects of drought had already reached the family’s tea shop: most of its customers used to come in from rural areas around the town, but have now mostly moved on, towards Mudug.

After the long journey, Sabrin’s child was admitted to Mudug Regional Hospital and treated for severe acute malnutrition and the medical complications that came with it. The bed and the medicines were free.

MSF supports the inpatient malnutrition ward at Mudug Regional Hospital, along with emergency, maternity and newborn care, pediatrics, surgery, tuberculosis care, isolation for infectious diseases and mental health services, and runs outpatient care for acutely malnourished children who do not need to be hospitalized. All of it is free.

The inpatient malnutrition ward has 28 beds, and since April 2026 it has been running beyond that capacity, at times with almost twice that number of children in it. Across Mudug, funding shortfalls have closed health and nutrition facilities, and families are travelling further to reach treatment that used to be available closer to home. As Sabrin prepared to leave the hospital with her recovered child, she reflected on the journey.

"If this kind of healthcare service were available in Abudwak," she says, "our people would not have had to undertake this long and expensive journey."

When the Herd’s Milk Ran Out

Hawa Abdisalam has four children. Two of them are in hospital in Galkayo. One is being treated for malnutrition. The other is in the diphtheria ward. Hawa and her husband are pastoralists in a rural area near Balibusle. They keep goats and camels. For most of the children’s lives the family’s food came from the animals: milk from the herd, and whatever the adults were eating. She gave the children no other meals. Then the rains stopped. For five or six months no rain fell. The animals grew thin and stopped producing. "The livestock has no milk. [They] became weak and malnourished," she says.

Where a herd is the food supply, a drought becomes a nutritional problem for children before it becomes anything else. Young children need frequent, energy-dense feeding, and when milk disappears from the diet with nothing to replace it, weight loss quickly follows. Malnutrition also weakens a child’s ability to fight infection, which is why diphtheria and measles are far more dangerous in a drought-affected community with limited access to healthcare.

When the children fell ill, Hawa and her husband set out for Galkayo. They travelled through Burtinle, around 105 kilometres from the hospital, and the last stretch of a longer route. They stopped at a health centre on the way and were given paracetamol. They kept going. They sold some of the animals they had left to pay for the journey. "I did not calculate the cost," she says, "but it was a lot of money." At the hospital one of the children was diagnosed with ​ diphtheria. The other was confirmed to be malnourished.

MSF supports the inpatient malnutrition ward at Mudug Regional Hospital, along with emergency, maternity and newborn care, paediatrics, surgery, tuberculosis care, isolation for infectious diseases and mental health services, and runs outpatient care for children who do not need to be hospitalised. All of it is free. ​ The inpatient malnutrition ward has 28 beds, and since April 2026 it has been running beyond that capacity, at times with almost twice that number of children in it. Rainfall has been substantially below average across Mudug through 2026, and pastoral families have moved out of the south and east of Mudug region in search of water and pasture, taking them further from the health facilities that are still working.

The Clinic That Closed: Halima’s Six Days in Galkayo

Halima Hassan Hussein gave birth to her son at Mudug Regional Hospital. This year she brought him back to the same hospital, too weak to sit up and no longer feeding. She had tried two other facilities first. Both had closed.

She lives with her father. She does not have a husband, and the household depends on what her father earns as a daily labourer. They eat twice a day. Her son had been vomiting and passing diarrhoea, had no appetite, and had stopped breastfeeding. The paediatric clinic nearest to them had shut when the organisation supporting it left. She went to another hospital and faced a similar story. "I took him to another hospital, but I was told that it is closed and the supporting organisation left," she says.

A child who is losing weight and refusing food is on a short timeline. Severe acute malnutrition is treatable, but without treatment it advances, and the further it advances the more intensive the care a child needs. What often decides the outcome is not the severity of the illness but the distance to the nearest place supplied with therapeutic food, medicines and staff trained to use them. The two facilities closest to Halima’s home had none of it.

Before Halima could travel with her sick son, fighting broke out where the family was staying and they had to move. She waited two weeks. She had no money for the journey. Her father paid the US$20 price. "Life is hard," she says. "Sometimes we get [food], sometimes we don’t." After finally making it to Mudug Regional Hospital, Halima’s son was admitted to the malnutrition ward and treated for six days.

MSF supports the inpatient malnutrition ward at Mudug Regional Hospital, along with emergency, maternity and newborn care, paediatrics, surgery, tuberculosis care, isolation for infectious diseases and mental health services, and runs outpatient care for children who do not need to be hospitalised. All of it is free. ​ The inpatient malnutrition ward has 28 beds, and since April 2026 it has been running beyond that capacity, at times with almost twice that number of children in it. Across Mudug, funding shortfalls have closed health and nutrition facilities, and most of the children now admitted have already been taken somewhere else first. Before leaving the ward, Halima said she had not expected her son to recover.

"When I brought him here, I did not think he would live," she says. "Now he is healthy and playful."

Sixteen Days: Iqra and Her Daughter

Iqra had been looking for treatment for her daughter for a long time before she reached Mudug Regional Hospital. She had taken her to several health facilities but each time the child improved, she then got worse again.

Iqra is from Tawakal village, where she lives with her grandmother and her two children. The household depends on what Iqra’s brother provides. Her daughter, her youngest child, is ten months old. She fell sick with diarrhoea, vomiting, and fever. Although she was treated and recovered, she developed the same symptoms again. "I have been looking for treatment for her for a long time, but she did not become healthy," she says.

Repeated episodes of diarrhoea are one of the most common routes into severe acute malnutrition in young children. Each episode costs nutrients and fluid faster than a small child can replace them, and each one leaves the child less able to withstand the next. When treatment is delayed or incomplete, the cycle continues until the child is acutely malnourished, at which point the diarrhoea itself becomes harder to treat. In Iqra’s case the cycle ran through several rounds of treatment.

At one point Iqra went to a pharmacy and was given medicine for her daughter to stop the diarrhoea. Yet the diarrhoea and vomiting continued for seven more days. The child became very weak, with a dry mouth, no appetite and a cough. Her malnutrition worsened as her medical complications progressed.

Iqra says she has received no assistance from any organisation where she lives. The hardest point came before they travelled, when her daughter had developed severe diarrhoea and a high fever. "I did not have anything to reduce her fever," she says. "At that moment, I was alone. That was terrible for me."

She hired a private car to Galkayo and paid US$10 for the journey. Her daughter was admitted and treated for severe acute malnutrition and the complications that came with it. At the time of this interview they had been in the hospital for sixteen days.

Her daughter was still in the ward when we spoke. "I hope she will be discharged when the doctors manage her condition and tell me my baby is well," Iqra says. "I wish for my daughter to be healthy, to be treated, and never to get sick again."

MSF supports the inpatient malnutrition ward at Mudug Regional Hospital, along with emergency, maternity and newborn care, paediatrics, surgery, tuberculosis care, isolation for infectious diseases and mental health services, and runs outpatient care for children who do not need to be hospitalised. All of it is free. ​ The inpatient malnutrition ward has 28 beds, and since April 2026 it has been running beyond that capacity, at times with almost twice that number of children in it. Between January and July 2026, MSF admitted 1,389 children for inpatient treatment of acute malnutrition and complications at the hospital, 809 of them severely malnourished.

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