Somalia has rebuilt much of its cancer diagnostic pathology capacity after more than three decades of instability, but advanced testing remains out of reach for most patients, according to a study published in Nature. The research, written from the perspective of a practising pathologist, examines how services evolved in southern Somalia between 1991 and 2025. It reports that the country moved from a single operational histopathology laboratory to nine over the decade to 2025, with 14 practising pathologists now handling an estimated 25,000 to 30,000 tissue samples each year.
The authors, I.M. Abdullahi and F.Y. Farah, based at the Department of Pathology at the Mogadishu Somali-Türkiye Training and Research Hospital, used a mixed-methods approach. They pulled standardised data from institutional records at every working histopathology laboratory and interviewed all 14 practising pathologists in semi-structured conversations about obstacles, diagnostic limits and priorities. The two strands of evidence were analysed separately and then combined when the researchers drew their conclusions.
Why it matters
Pathology underpins cancer diagnosis: without a reliable examination of tissue, clinicians cannot confirm whether a growth is malignant, what type of cancer it is, or how it should be treated. The study states that prolonged instability since 1991 badly disrupted these services, producing diagnoses that arrived late or were wrong. That gap sits behind every other stage of cancer care, from surgery to chemotherapy, and shapes how many patients are treated in time.
The findings also give Somali health planners a documented baseline for national cancer control, and the authors suggest the lessons could inform other countries coping with conflict or scarce resources.
A single hospital anchors the recovery
According to Nature, the expansion of laboratory services accelerated after the Mogadishu Somali-Türkiye Training and Research Hospital opened in 2015. That facility appears to have acted as a hub for training and service delivery, and the paper credits the Association of Somali Pathologists with supporting professional collaboration and training efforts.
Even so, the picture is uneven. Immunohistochemistry — a technique that identifies specific proteins in tissue and is routine in many cancer workups elsewhere — was offered in only one of the nine laboratories. Frozen section testing, used to examine tissue during surgery, and molecular diagnostics were not available anywhere in the country, the study reports.
The interviews produced four recurring themes: poor laboratory infrastructure and repeated shortages of reagents; gaps in staffing and specialist training; limited access to sophisticated diagnostic technology; and the need for stronger quality assurance, teamwork across disciplines and national coordination.
A registry takes shape
One development the study highlights is the creation in 2024 of the Banadir region's first histopathology-based cancer registry. The authors describe it as a foundation for systematic national surveillance, which would allow authorities to track how much cancer occurs, where, and in whom — data that has been largely absent.
The research was reviewed by the Association of Somali Pathologists Research and Ethics Committee. Formal ethical approval was waived because the work relied on aggregated, de-identified laboratory records and voluntary interviews with health professionals rather than identifiable patient information. Participants gave verbal consent before data collection, and the study followed the principles of the Declaration of Helsinki.
The authors also acknowledge the pathologists and laboratory technologists working in difficult conditions, saying their persistence is what makes cancer detection possible in such settings.
The paper's overall assessment is that Somalia has made real progress in restoring diagnostic pathology despite years of conflict, and that further gains depend on investment in advanced testing, workforce development, laboratory quality systems and cancer surveillance. Watch for whether the Banadir registry expands into a national system and whether immunohistochemistry and molecular testing spread beyond the single laboratory that currently offers them.
