Dear Editor,In recent years, Somaliland has found itself in the grip of a recurring and escalating public health crisis: the unchecked spread of Dengue fever. Particularly during the “Xagaa” (the dry, windy summer season), major cities such as Hargeisa, Borama, Berbera, and Burao experience severe outbreaks of this mosquito-borne viral infection. The epidemiological snapshot is alarming, reflecting active community-level transmission with a demographic distribution that indicates widespread vulnerability. Hargeisa has emerged as the epicenter of this crisis, driven by high population density and a severe lack of proactive vector control.
Despite the predictable and cyclical nature of these outbreaks, the current disease management system is plagued by systemic shortcomings. A critical issue is the reliance on outdated epidemiological data. As observed across Sub-Saharan Africa, the absence of comprehensive surveillance systems leads to a substantial underestimation of the true disease burden, limiting policymakers and International Non-Governmental Organizations (INGOs) from understanding the real-time epidemiological situation.1
A major driver of this escalating crisis is the limited public awareness and clinical diagnostic capacity at the primary care and community levels. Citizens frequently fail to distinguish Dengue from malaria or other seasonal febrile illnesses.2 This knowledge deficit promotes widespread self-medication, with patients routinely bypassing clinical diagnosis and purchasing over-the-counter painkillers and antibiotics without proper prescriptions. Such practices may mask severe clinical warning signs, delay hospital admissions, and contribute to preventable fatalities while simultaneously straining an already fragile health system 1
Environmentally, the infrastructure in rapidly urbanizing cities such as Hargeisa, Borama, Berbera, and Burao is failing to protect the population adequately. Prolonged drought has caused severe water scarcity, forcing households to store water in open containers that inadvertently serve as prolific breeding sites for Aedes mosquitoes.3 Furthermore, poor waste management – particularly the accumulation of discarded plastics and tires in urban areas – creates highly productive mosquito habitats and increases the risk of Dengue transmission.4
Fundamentally, Somaliland remains chronically unprepared for infectious disease epidemics. This severe lack of outbreak preparedness and resilient healthcare infrastructure is the core reason why Dengue fever continues to recur with such devastating frequency. When outbreaks occur, the healthcare system quickly becomes overwhelmed. Recent global funding cuts have forced the closure or scaling down of critical health facilities, severely compromising early diagnosis and referral pathways. In major urban centers with populations exceeding 400,000, reliance on a single functioning government hospital creates a critical bottleneck, leaving a substantial proportion of the population without access to life-saving healthcare. Furthermore, the response remains predominantly reactive, lacking the community-based environmental management and routine source reduction measures required for sustainable control of Aedes populations.5
To avert a recurring humanitarian disaster, a substantial paradigm shift is required from the Somaliland government and international health partners. First, we strongly advocate for the decentralization of Dengue management by integrating it directly into Primary Health Care (PHC) systems, which must serve as the first line of defense in epidemic preparedness. Similar to malaria, Dengue should be prioritized at the PHC level through rapid diagnostic testing, standardized clinical protocols, and strengthened community-based care.
Second, the government and INGOs must urgently invest in expanding healthcare infrastructure and modernizing real-time disease surveillance systems. Active molecular surveillance is essential for understanding local transmission dynamics and designing effective, evidence-based interventions. Third, aggressive public awareness campaigns and stronger pharmacy regulations are needed to curb self-medication and improve health literacy.
Finally, policymakers must prioritize pre-emptive vector control measures, including targeted fumigation and community clean-up campaigns, before the onset of the “Xagaa” season. In addition, strategic planning for the future integration of Dengue vaccines into national immunization programs should begin. Dengue fever is a preventable disease, but overcoming it requires moving beyond outdated reporting systems and reactive measures toward a resilient, proactive, and PHC-centered healthcare system capable of delivering equitable community health outcomes.
AuthorshipHamze G. Dahir: Conceptualization, Writing – original draft, Policy analysis, Investigation. Abdisalam Jama Ibrahim: Literature review, Data curation, Writing – review & editing. Abdisalam Hassan Muse: Supervision, Critical revision of the manuscript for important intellectual content, Final approval.
Ethical considerationsThis article is based on publicly available data and published literature. It does not involve human participants, human biological materials, or animal experiments. Therefore, ethical approval from an Institutional Review Board (IRB) was not required.
Informed consentNot applicable. This article is a scientific letter based on publicly available data and published literature. It does not involve human participants, human biological materials, or patient data.
Declaration of generative AI and AI-assisted technologies in the writing processDuring the preparation of this work, the authors used ChatGPT (OpenAI) to improve the language, readability, and formatting of the manuscript. After using this tool, the authors carefully reviewed and edited the content as necessary and take full responsibility for the content of the published article.
FundingThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflicts of interestThe authors declare that they have no known competing financial or personal relationships that could have appeared to influence or bias the work reported in this paper.
