Somalia’s recurring cholera outbreaks: a call for urgent investment in water, sanitation, and surveillance reform

Introduction Somalia experiences recurrent cholera outbreaks driven by fragile health systems, inadequate water and sanitation infrastructure, climate shocks, and conflict-related displacement, posing persistent threats to population health and regional health security.Theory Cholera persistence in Somalia reflects chronic structural vulnerabilities, including weak Water, Sanitation, and Hygiene (WASH) systems, fragmented disease surveillance, and climate-sensitive transmission pathways intensified by droughts, floods, and displacement.Method This Letter to the Editor critically examines recent evidence and public health literature on cholera epidemiology, WASH access, surveillance capacity, climate-related risks, and outbreak preparedness in Somalia and the wider Horn of Africa.Result Evidence indicates that inadequate safe water and sanitation access, weak laboratory and surveillance systems, limited oral cholera vaccination coverage, and displacement-related overcrowding sustain recurrent outbreaks. Climate variability and cross-border population movement further heighten transmission risks and delay outbreak containment.Discussion Sustainable cholera prevention in Somalia requires a shift from emergency response to long-term investment in climate-resilient WASH systems, integrated surveillance, community-based early warning mechanisms, and coordinated multisectoral preparedness to strengthen public health resilience.