Operationalising the One Health Approach in a Fragile State: A Framework for Sustainable Health Security in Somalia  

Somalia, a quintessential fragile and conflict-affected state (FCAS), grapples with a poly-crisis where protracted conflict, extreme climate vulnerability, and profound health system weaknesses create a self-reinforcing cycle of instability and disease. The One Health (OH) approach, which integrates human, animal, and environmental health, is globally recognized as critical for health security, yet its operationalization in such complex environments remains poorly understood and documented. This paper aims to analyze the current OH landscape in Somalia and propose a context-engineered framework for building sustainable health security. A scoping review of peer-reviewed and grey literature published between 2010 and 2025 was conducted, supplemented by a qualitative policy analysis of national and international strategic documents. The systematic search included academic databases such as PubMed, Web of Science, and Scopus, alongside repositories of key organizations including the World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), World Organisation for Animal Health (WOAH), United Nations Environment Programme (UNEP), World Bank, and International Livestock Research Institute (ILRI). Data were systematically charted and synthesized using a thematic framework aligned with core OH operational domains: governance, finance, surveillance, human resources, and community engagement. The reporting of this scoping review adheres to the principles of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines to ensure methodological transparency. The analysis reveals a landscape of nascent OH structures hindered by systemic gaps. Governance is fragmented by political divisions and the absence of a legally-backed national OH strategy. The health sector is over 90% dependent on donor funding, undermining sustainability and national ownership. Critical infrastructure for integrated surveillance, laboratory diagnostics (particularly for animal and environmental health), and data sharing is largely non-existent. A persistent "brain drain" and lack of standardized OH training depletes human capital. However, the analysis also identified significant opportunities, including a strong economic case for OH based on protecting the livestock sector (which contributes 60% of GDP), the high degree of legitimacy and functionality of traditional community governance systems (Xeer), and innovative community-based service delivery models. Key threats include a severe burden from prioritized zoonoses (e.g., Rift Valley Fever, brucellosis), an unchecked "silent pandemic" of antimicrobial resistance (AMR), and the cascading impacts of climate change on health and livelihoods. Operationalizing One Health in Somalia requires a paradigm shift from a top-down, donor-driven model to a nationally-owned, community-governed system. This paper proposes an innovative five-pillar framework focused on: (1) institutionalizing governance by integrating traditional structures; (2) building financial resilience through economic framing and diversified funding; (3) creating an integrated intelligence and response system; (4) investing in cross-sectoral human capital, including a new cadre of Community Environmental Workers; and (5) empowering communities as the foundation of resilience, with cross-cutting integration of mental health and gender equity. This systems-thinking approach aims to disrupt the poly-crisis cycle, offering a potential roadmap for achieving sustainable health security in Somalia and other FCAS.