Cross-border health care seeking among Somali nationals: a multi-country rapid evidence synthesis of determinants, outcome domains, economic burden and health-system implications, 2014–2026

Background Somali nationals travel abroad for care that the domestic health system cannot supply, yet the scale, clinical drivers, costs and outcomes of this movement have not been synthesised. We aimed to consolidate the available evidence on outbound medical travel from Somalia to India, Türkiye, Ethiopia and Egypt, to distinguish what is measured from what is not, and to draw implications for health financing and governance. Methods We conducted a rapid evidence synthesis of evidence from 2014 to 2026. Sources were Indian parliamentary and ministerial series, peer-reviewed studies, country-of-origin reports, health-financing documents and consular guidance. Synthesis was narrative because heterogeneity precluded pooling. Every statement was assigned to one of three evidence tiers: directly measured, credibly inferred or unquantifiable. Movement indicators count episodes, not unique patients, and expenditure envelopes are planning scenarios, not accounts. Results India is the only corridor with a nationality-specific public series: 13,585 medical-purpose arrivals in 2015–2017 and 47,880 medical visas in 2019–2024 (2018 unavailable), a minimum of 61,465 episodes. Medical visas peaked at 16,411 in 2023, 4.8 times the 2019 level, and fell to 12,261 in 2024. Türkiye offers a single anchor (2,742 Somali patients in 2019); Ethiopia and Egypt lack nationality-specific series. Demand concentrates in oncology, cardiovascular and renal disease, advanced diagnostics, reproductive medicine and orthopaedics. A snowball survey of 106 medical travellers in Garowe reported a mean direct cost of US$8,543 per episode. Out-of-pocket payments met 30.8% of current health expenditure in 2023. Applying published per-patient benchmarks to Indian visas gives US$88–105 million for 2024; a four-corridor central scenario gives approximately US$219 million, about 1.8% of projected gross domestic product. No pooled morbidity, complication or mortality rate can be derived, because outbound episodes are not linked to treatment or outcome. Conclusions Outbound travel functions as an unregulated, privately financed parallel tertiary-care system that is substantial in scale, financially consequential and largely unmeasured in outcome. We propose a minimum outbound-referral dataset, pooled catastrophic-illness protection linked to authorised referral, facilitator licensing, bilateral referral compacts and sequenced domestic investment in oncology diagnostics, chemotherapy, dialysis and imaging.