Provision of Surgical Care for Children Across Somaliland: Challenges and Policy Guidance

  • Tessa L. Concepcion
  • Emily R. SmithEmail author
  • Mubarak Mohamed
  • Shugri Dahir
  • Edna Adan Ismail
  • Andrew J. M. Leather
  • Dan Poenaru
  • Henry E. Rice
  • the Global Initiative for Children’s Surgery
Original Scientific Report



Existing data suggest a large burden of surgical conditions in low- and middle-income countries (LMICs). However, surgical care for children in LMICs remains poorly understood. Our goal was to define the hospital infrastructure, workforce, and delivery of surgical care for children across Somaliland and provide policy guidance to improve care.


We used two established hospital assessment tools to assess infrastructure, workforce, and capacity at all hospitals providing surgical care for children across Somaliland. We collected data on all surgical procedures performed in children in Somaliland between August 2016 and July 2017 using operative logbooks.


Data were collected from 15 hospitals, including eight government, five for-profit, and two not-for-profit hospitals. Children represented 15.9% of all admitted patients, and pediatric surgical interventions comprised 8.8% of total operations. There were 0.6 surgical providers and 1.2 anesthesia providers per 100,000 population. A total of 1255 surgical procedures were performed in children in all hospitals in Somaliland over 1 year, at a rate of 62.4 surgical procedures annually per 100,000 children. Care was concentrated at private hospitals within urban areas, with a limited number of procedures for many high-burden pediatric surgical conditions.


We found a profound lack of surgical capacity for children in Somaliland. Hospital-level surgical infrastructure, workforce, and care delivery reflects a severely resource-constrained health system. Targeted policy to improved essential surgical care at local, regional, and national levels is essential to improve the health of children in Somaliland.



We want to thank the Global Initiative for Children's Surgery (GICS) for its support of this work. GICS ( is a network of children's surgical and anesthesia providers from low-, middle-, and high-income countries collaborating for the purpose of improving the quality of surgical care for children globally.

Supplementary material

268_2019_5079_MOESM1_ESM.docx (82 kb)
Supplementary file1 (DOCX 81 kb)


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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Tessa L. Concepcion
    • 1
  • Emily R. Smith
    • 1
    • 2
    Email author
  • Mubarak Mohamed
    • 3
  • Shugri Dahir
    • 3
  • Edna Adan Ismail
    • 3
  • Andrew J. M. Leather
    • 4
  • Dan Poenaru
    • 5
  • Henry E. Rice
    • 1
  • the Global Initiative for Children’s Surgery
  1. 1.Duke Global Health InstituteDuke UniversityDurhamUSA
  2. 2.Department of Public HealthBaylor UniversityWacoUSA
  3. 3.Edna Adan University HospitalHargeisaSomalia
  4. 4.King’s Centre for Global Health and Health PartnershipsKing’s College LondonLondonUK
  5. 5.McGill UniversityMontrealCanada

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