A call to action to address four decades of stagnant tuberculosis case detection in Somalia

Tuberculosis (TB) remains a leading cause of death of infectious diseases globally, with progress towards elimination slowest in fragile and conflict-affected settings. In Somalia, tuberculosis case detection has stagnated at approximately 40–45% for over 4 decades, representing one of the most persistent case-detection gaps worldwide. TB incidence and mortality remain among the highest in the World Health Organization Eastern Mediterranean Region, despite substantial donor investment and the scale-up of advanced diagnostic technologies. TB care delivery remains highly fragmented, with limited or no integration into primary care services. Rural, remote, displaced, pastoralist and conflict-affected populations face persistent barriers to essential health services, including TB care, hampering sustained community transmission. This editorial examines four decades of TB control in Somalia, shaped by protracted instability, humanitarian substitution, donor-dependency, and vertically organised programming. It argues that achieving meaningful, impactful, equitable and sustainable progress requires repositioning tuberculosis control as a core public health priority. This requires anchoring TB services in integrated primary healthcare, supported by community-based delivery models.