Drought-attributable mortality in Somalia, 2015–2024: a retrospective and modelling study

Background Over the past 17 years Somalia and the Horn of Africa have experienced four droughts. We aimed to retrospectively estimate excess population mortality across Somalia during a period encompassing the last two droughts. Methods We estimated all-age and under 5 years old excess mortality by district and month by (i) reanalysing household mortality surveys; (ii) reconstructing population denominators from census records and displacement data; (iii) assembling predictors of mortality; (iv) fitting a model to predict death rates and tolls; and (v) subtracting counterfactual mortality levels, corresponding to non-drought periods. Findings Assuming pre-2017 levels as counterfactual, we estimated 71,100 excess deaths across Somalia during the 2022–2024 period, 64,500 (91%) of which were among children under 5 years. During the 2017–2019 period, an estimated 79,600 excess deaths occurred, 49,000 (61%) among children under 5 years. An alternative counterfactual based on 2020 trends yielded a higher number of excess deaths. Regional disparities were marked: north-eastern regions had relatively low mortality despite high food insecurity, while south-central areas (including Banadir, Bay, and Lower Shabelle) bore the majority of excess deaths. Interpretation The mortality impact of the latest drought crisis (2022–2024) in Somalia appears comparable to that witnessed during the 2017–2019 period. The combination of intensifying droughts attributable to climate change in the Horn of Africa, substantially declined global humanitarian assistance budgets, and steep population growth threaten to cause persistent and potentially worsened health impacts over the coming decades, including a large number of lives lost. Funding This study was funded by the United Nations Children's Fund (UNICEF) East Africa office, award number 2022/1291432-0.