A visit to Somalia's crumbling hospitals shows the toll of aid cuts and war

MOGADISHU, Somalia (AP) — To save the life of his badly malnourished 3-year-old son, farmer Yusuf Bulle had to travel from a remote area of southern Somalia to the capital, Mogadishu, where a rare health unit presented the only hope.

After 15 days at Banadir Hospital, the child was deemed out of danger.

“Where I come from, there is no hospital,” Bulle said. “That’s why I am here.”

One of the world’s poorest countries faces a crisis of health care exacerbated by the Trump administration's dismantling of the U.S. Agency for International Development this year. The loss of USAID funding has disheartened many Somalis who believe they can’t depend on their own government, which focuses mostly on defeating the al-Qaida-linked al-Shabab.

Somalia's deputy health minister, Mohamed Hassan Bulaale, told The Associated Press that the U.S. cuts led to over 6,000 health workers losing their jobs while up to 2,000 health facilities were affected — a massive hit in a country that the Center for Global Development this year said was among the world's most likely to suffer as donors draw back.

Bomb and gun attacks by the militants — including against health centers — have reduced in frequency and intensity in recent months, leading some to see success in President Hassan Sheikh Mohamud’s “total war” against al-Shabab.

But hospital administrators, civic leaders and others say the latest push to defeat al-Shabab has come at the expense of health care and other public services.

Somalia's Ministry of Health was allocated $91 million of a national budget exceeding $1 billion this year, with those funds tied mostly to projects backed by outside groups. That's a significant improvement from last year's $52 million, but almost all of that increase came from donors, said Mahad Wasuge, who runs the Somali Public Agenda think tank.

And as the United States has shown, donor money comes and goes.

Even with major setbacks in overall foreign support this year, including from other key benefactors such as Britain, “security remains the first priority” for Somali authorities, Wasuge told the AP.

Many areas outside Mogadishu don’t have functioning public hospitals, he said, with people forced to trek through often insecure areas to receive care at the ones still functional.

Such facilities in the capital include Banadir Hospital, built with Chinese support in 1977, and De Martino Hospital, established in 1922 by Italian colonialists.

During an AP visit, officials at those hospitals said much of their work would stop without assistance from the United Nations and international groups.

Even at Banadir, Mogadishu’s main public referral hospital, expectations of the Somali government aren’t high. The unit looking after malnourished children depends entirely on donor funds channeled through the humanitarian group Concern Worldwide, said supervisor Dr. Mohamed Haashi.

After 37 people employed in the unit lost their jobs with this year's U.S. aid cuts, Concern Worldwide still pays the salaries of 13 others in addition to milk and food for mothers and babies, Haashi said.

At De Martino Hospital, director Dr. Abdirahim Omar Amin said he worries what will happen when contracts with two other humanitarian groups expire at the end of 2025.

The hospital was looking after dozens of children suffering from diphtheria, an infectious disease of the throat preventable by vaccination but now spreading in rural areas. Parents are not taking their kids for routine vaccinations because they are afraid of militant attacks, Amin said.

In the medical lab, Amin pointed to the equipment and said everything was acquired with donor funds.

"Now it looks like donors are fatigued,” he said.

Most services at the hospital are provided free of charge, thanks largely to funding from the International Rescue Committee and Population Services International. Patients with conditions not deemed urgent are asked to cover some costs.

“The Ministry of Health is supposed to give support to this hospital because this hospital belongs to the Ministry of Health,” Amin said. “I hope, even if (the humanitarian groups) left, the Ministry of Health will replace their position.”

Bulaale, the deputy health minister, said the government is working with some partners in "developing a contingency plan” after the loss of USAID funding. He didn't elaborate.

In some ways, De Martino Hospital's history mirrors Somalia's scars. It once sheltered displaced people after the fall in 1991 of Siad Barre, a dictator whose removal triggered fighting by warlords from different clans. Many public facilities across Somalia were destroyed in years of civil war.

Somalia’s federal government, now based in a heavily fortified area near the airport in Mogadishu, struggles to assert itself despite support from African Union peacekeepers, U.S. airstrikes targeting al-Shabab and security consultants from nations jockeying for influence in a country with strategic access to the Indian Ocean and Gulf of Aden.

The countries include Turkey, which bankrolls a hospital with intensive care capabilities in Mogadishu.

“Even the limited number of public hospitals that started functioning properly lately are heavily dependent on donor money,” said Wasuge, the civic leader. “They don’t get direct government budget that allows them to provide better health care services.”

The Banadir and De Martino hospitals are where the most needy people are referred for care. De Martino, Mogadishu’s main referral hospital for COVID-19 patients during the pandemic, receives the “most vulnerable” wherever they come from, director Amin said.

Amina Abdulkadir Mohamed, a jobless woman who was at De Martino recently to give birth, said she went there because she knew she would not be asked for money.

“I was told there is free medication,” she added.

Mohamed Adam Dini, who represents Somalia's Puntland state in the national assembly, described the federal government’s priorities as “deficient” because of its overwhelming focus on ending “anarchy."

“A lot of diseases have been spreading” unchecked, Dini said, adding: ”There is no national health care plan, as we don’t have a national political plan.”

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Armored personnel carriers (APCs) belonging to the Somalia National Army move on a road in Sabiid Canole, Somalia, Tuesday, Nov. 11, 2025. (AP Photo/Jackson Njehia)

A mother sits with her malnourished baby at Banadir Hospital in Mogadishu, Somalia, Tuesday, Nov. 11, 2025. (AP Photo/Farah Abdi Warsameh)

Patients sit at the entrance of Banadir Hospital in Mogadishu, Somalia, on Tuesday, Nov. 11, 2025. (AP Photo/Farah Abdi Warsameh)

Somalia National Army (SNA) soldiers walk along the frontline in Sabiid, Canole, Somalia, Tuesday, Nov. 11, 2025. (AP Photo/Jackson Njehia)

A mother sits with her malnourished baby at Banadir Hospital in Mogadishu, Somalia, Tuesday, Nov. 11, 2025. (AP Photo/Farah Abdi Warsameh)

TENERIFE, Spain (AP) — The head of the World Health Organization sought Saturday to reassure residents of the Spanish island where passengers of a hantavirus-stricken cruise ship are expected to be evacuated, issuing them a direct message that the virus was “not another COVID.”

The Dutch-flagged MV Hondius, with more than 140 passengers and crew on board, is headed to Spain's Canary Islands, off the coast of West Africa, and is expected to arrive at the island of Tenerife early Sunday.

WHO Director-General Tedros Adhanom Ghebreyesus, along with Spain’s Health Minister Monica Garcia and Interior Minister Fernando Grande-Marlaska, were due on the island Saturday to coordinate the disembarkation of passengers and some crew.

“I know you are worried. I know that when you hear the word ‘outbreak’ and watch a ship sail toward your shores, memories surface that none of us have fully put to rest. The pain of 2020 is still real, and I do not dismiss it for a single moment,” Tedros said in a message to the people of Tenerife.

“But I need you to hear me clearly: This is not another COVID. The current public health risk from hantavirus remains low. My colleagues and I have said this unequivocally, and I will say it again to you now,” Tedros added.

The WHO, Spanish authorities and cruise company Oceanwide Expeditions said nobody on the Hondius is currently showing symptoms of the virus.

Hantavirus can cause life-threatening illness. It usually spreads when people inhale contaminated residue of rodent droppings and isn’t easily transmitted between people. But the Andes virus detected in the cruise ship outbreak may be able to spread between people in rare cases. Symptoms usually show between one and eight weeks after exposure.

Three people have died since the outbreak, and five passengers who left the ship are infected with hantavirus.

Some on Tenerife say they are worried. On board the cruise ship, some Spanish passengers have voiced concern about being stigmatized.

“I tell you, I don’t like this very much,” said 69-year-old resident Simon Vidal. “Anyone can say what they want. Why did they have to bring a boat from another country here? Why not anywhere else, why bring it to the Canary Islands?”

Others said they empathized with the boat's passengers, but were still concerned.

“The truth is that it is very worrying,” said 27-year-old Venezuelan immigrant Samantha Aguero. She added: “We feel a bit unsafe, we don’t feel as there are 100% security measures in place to welcome it. This is a virus after all and we have lived this during the pandemic. But we also need to have empathy.”

Spanish Health Minister Monica Garcia said passengers and some crew would disembark in Tenerife “under maximum safety conditions.”

The ship will not dock but will remain at anchor. Everyone disembarking will be checked for symptoms and won't be taken off the ship until a flight is already in Tenerife waiting to fly them off the island, Garcia said during a news conference in Madrid. There are currently people of more than 20 different nationalities on board.

Both the U.S. and the U.K. have agreed to send planes to evacuate their citizens. Americans are to be quarantined at a medical center in Nebraska.

All Spanish passengers will be transferred to a medical facility and quarantined, Garcia said. Oceanwide has listed 13 Spanish passengers and one Spanish crew member on board.

Those disembarking will leave behind their luggage, Garcia said, and will be allowed to take only a small bag with essential items, a cellphone, charger and documentation.

Some crew, as well as the body of a passenger who died on board, will remain on the ship, which will sail on to the Netherlands, where it will undergo disinfection, the minister added.

According to a letter sent by the Dutch foreign and health ministers to parliament late Friday, Spain has activated the EU civil protection mechanism for a medical evacuation plane equipped for infections diseases to be on standby in case anyone on the ship becomes ill. That person would then be transported by air to the European mainland.

The Dutch government will work with Spanish authorities and the ship company to arrange repatriation of Dutch passengers and crew as soon as possible after arrival in Tenerife, subject to medical conditions and advice from the European Centre for Disease Prevention and Control, the letter said. Those without symptoms will go into home quarantine for six weeks and be monitored by local health services.

As the ship is Dutch-flagged, the Netherlands may also temporarily accommodate people of other nationalities and monitor them in quarantine, it said.

Health authorities across four continents were tracking down and monitoring more than two dozen passengers who disembarked before the deadly outbreak was detected. They were also scrambling to trace others who may have come into contact with them.

On April 24, nearly two weeks after the first passenger had died on board, more than two dozen people from at least 12 different countries left the ship without contact tracing, Dutch officials and the ship’s operator have said.

It wasn’t until May 2 that health authorities first confirmed hantavirus in a passenger.

Dutch public health authorities have been monitoring people who were on a flight that was briefly boarded by a Dutch ship passenger who later died and was confirmed to have hantavirus. Three people who were on the flight and had symptoms have all tested negative for hantavirus, Dutch National Institute for Public Health spokesperson Harald Wychgel told The Associated Press on Saturday.

Becatoros reported from Sparta, Greece. Associated Press reporters Angela Charlton in Paris and Helena Alves in Tenerife contributed to this report.

A Spanish Civil Guard officer inspects the area where passengers from the MV Hondius cruise ship are expected to arrive at the port of Granadilla in Tenerife, Canary Islands, Spain, Saturday, May 9, 2026. (AP Photo/Manu Fernandez)

Media crew members stand in the area where passengers from the MV Hondius cruise ship are expected to arrive at the port of Granadilla in Tenerife, Canary Islands, Spain, Saturday, May 9, 2026. (AP Photo/Manu Fernandez)

Workers set up temporary shelters in the area where passengers from the MV Hondius cruise ship are expected to arrive at the port of Granadilla in Tenerife, Canary Islands, Spain, Saturday, May 9, 2026. (AP Photo/Manu Fernandez)

Passengers on the hantavirus-stricken cruise ship, MV Hondius, scan the horizon with binoculars during their voyage to Spain's port of Tenerife, May 6, 2026. (AP Photo)

Passengers on the the hantavirus-stricken cruise ship, MV Hondius, watch epidemiologists board the boat in Praia, during their voyage to Spain's port of Tenerife, May 6, 2026. (AP Photo)

A passenger checks his camera inside his cabin on the hantavirus-stricken cruise ship, MV Hondius, during the voyage to Spain's port of Tenerife, May 6, 2026. (AP Photo)

Crew members of the hantavirus-stricken cruise ship, MV Hondius, wait their turns for a first interview with epidemiologists, during the voyage to Spain's port of Tenerife, May 6, 2026. (AP Photo)

A passenger on the the hantavirus-stricken cruise ship, MV Hondius, takes a photo of the ship's weighing anchor in Praia, during the voyage to Spain's port of Tenerife, May 6, 2026. (AP Photo)