{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:18:43Z","timestamp":1787653123901,"version":"build-2736575974"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Critical care readiness during war and disasters is often judged by intensive care unit capacity, yet preventable mortality in fragile health systems may occur before, during, or after ICU-level care. In Somalia, recurrent mass-casualty events, emergency referral constraints, limited oxygen and blood readiness, constrained operative access, and weak post-resuscitation monitoring expose a critical gap between first contact and sustained life-saving care. This Comment addresses that gap by reframing critical care readiness in conflict and disaster-affected Somalia as a pathway problem rather than an ICU-capacity problem alone. Its novelty lies in integrating domains often treated separately\u2014mass-casualty response, emergency referral, essential emergency and critical care inputs, ethical triage, and non-punitive system learning\u2014into one practical readiness agenda for fragile health systems. The article argues that training and hospital preparedness are necessary but insufficient unless supported by referral communication, command structures, oxygen systems, blood readiness, ward monitoring, and clear escalation criteria. Strengthening this emergency-to-critical-care pathway can improve continuity of life-saving care, support fair resource allocation, and enhance accountability in health systems exposed to conflict and disasters.<\/jats:p>","DOI":"10.1186\/s13054-026-06258-5","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:59:14Z","timestamp":1787029154000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Critical care readiness in conflict and disaster-affected Somalia: mass-casualty response, emergency referral, and continuity of life-saving care"],"prefix":"10.1186","volume":"30","author":[{"given":"Ahmed Omar","family":"Siyad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdukadir Mohamed","family":"Hassan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"6258_CR1","unstructured":"World Health Organization. Emergency care systems for universal health coverage: ensuring timely care for the acutely ill and injured. WHA72.16. Seventy-second World Health Assembly, Geneva, 28 May 2019. Geneva: World Health Organization. 2019. Available from: https:\/\/www.who.int\/publications\/i\/item\/WHA72.16. Accessed 22 Jun 2026."},{"key":"6258_CR2","unstructured":"World Health Organization. Integrated emergency, critical and operative care for universal health coverage and protection from health emergencies. WHA76.2. Seventy-sixth World Health Assembly, Geneva, 30 May 2023. Geneva: World Health Organization. 2023. Available from: https:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/WHA76\/A76_R2-en.pdf. Accessed 22 Jun 2026."},{"key":"6258_CR3","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1186\/s12873-025-01234-8","volume":"25","author":"HN Njiru","year":"2025","unstructured":"Njiru HN, Relan P, Malik SMMR, Abdullah A, Shube M, Abubakar AHA, Nur I, Osman AY, Sonenthal P, Rouhani S, Olayo B, Ohno N, Sindani IS, Osman AA, Hossain MS, James N, Alabesat M, Derow M. Emergency and critical care services in Somalia: a cross-sectional nationwide hospital assessment using the WHO Hospital Emergency Unit assessment tool. BMC Emerg Med. 2025;25:89. https:\/\/doi.org\/10.1186\/s12873-025-01234-8.","journal-title":"BMC Emerg Med"},{"key":"6258_CR4","unstructured":"World Health Organization Regional Office for the Eastern Mediterranean. Building a strong health system in a fragile setting: importance of integrated service delivery to provide emergency and critical care in Somalia. Cairo: World Health Organization Regional Office for the Eastern Mediterranean. 2021. Available from: https:\/\/www.emro.who.int\/images\/stories\/somalia\/documents\/policy_brief_6_building_a_strong_health_system_in_a_fragile_setting.pdf. Accessed 22 Jun 2026."},{"key":"6258_CR5","doi-asserted-by":"publisher","first-page":"17213","DOI":"10.1038\/s41598-022-22276-z","volume":"12","author":"E Arslan","year":"2022","unstructured":"Arslan E, Mohamed AH, Cetinkaya O. Terror-related injuries in Somalia: a retrospective cohort of 2426 hospitalized cases along 7 years. Sci Rep. 2022;12:17213. https:\/\/doi.org\/10.1038\/s41598-022-22276-z.","journal-title":"Sci Rep"},{"issue":"2","key":"6258_CR6","doi-asserted-by":"publisher","first-page":"323","DOI":"10.3329\/bjms.v22i2.64989","volume":"22","author":"MA Nor","year":"2023","unstructured":"Nor MA, Sonmez RE, Hassan MY, Ozsoy MS, Alimoglu O. Patterns of injury and death in mass casualty incidents from 2013 to 2018 in Mogadishu, Somalia. Bangladesh J Med Sci. 2023;22(2):323\u20138. https:\/\/doi.org\/10.3329\/bjms.v22i2.64989.","journal-title":"Bangladesh J Med Sci"},{"key":"6258_CR7","unstructured":"World Health Organization Regional Office for the Eastern Mediterranean. Saving lives and limbs: WHO scales up its trauma response in Somalia. Cairo: World Health Organization Regional Office for the Eastern Mediterranean. 2022. Available from: https:\/\/www.emro.who.int\/media\/news\/saving-lives-and-limbs-who-scales-up-its-trauma-response-in-somalia.html. Accessed 22 Jun 2026."},{"key":"6258_CR8","doi-asserted-by":"publisher","DOI":"10.1596\/978-1-4648-0527-1_ch13","volume-title":"Disease Control Priorities: Improving Health and Reducing Poverty","author":"TA Reynolds","year":"2017","unstructured":"Reynolds TA, Sawe H, Rubiano AM, Shin SD, Wallis L, Mock CN. Strengthening health systems to provide emergency care. In: Jamison DT, Gelband H, Horton S, Jha P, Laxminarayan R, Mock CN, Nugent R, editors. Disease Control Priorities: Improving Health and Reducing Poverty. 3rd ed. Washington, DC: International Bank for Reconstruction and Development\/The World Bank; 2017. Chapter 13. https:\/\/doi.org\/10.1596\/978-1-4648-0527-1_ch13.","edition":"3"},{"issue":"1","key":"6258_CR9","doi-asserted-by":"publisher","first-page":"100948","DOI":"10.1016\/j.afjem.2026.100948","volume":"16","author":"MM Ali","year":"2026","unstructured":"Ali MM, Ismail BM, Hussein M, Sydlowski MM, Michaeli N. Enhancing emergency response in Somalia: evaluating the WHO Mass Casualty Management course in trauma hospitals. Afr J Emerg Med. 2026;16(1):100948. https:\/\/doi.org\/10.1016\/j.afjem.2026.100948.","journal-title":"Afr J Emerg Med"},{"issue":"9","key":"6258_CR10","doi-asserted-by":"publisher","first-page":"e006585","DOI":"10.1136\/bmjgh-2021-006585","volume":"6","author":"CO Schell","year":"2021","unstructured":"Schell CO, Khalid K, Wharton-Smith A, Oliwa J, Sawe H, Roy N, Sanga A, Marshall JC, Rylance J, Hanson C, Kayambankadzanja RK, Wallis LA, Jirwe M, Baker T, EECC Collaborators. Essential emergency and critical care: a consensus among global clinical experts. BMJ Global Health. 2021;6(9):e006585. https:\/\/doi.org\/10.1136\/bmjgh-2021-006585.","journal-title":"BMJ Global Health"},{"issue":"1","key":"6258_CR11","doi-asserted-by":"publisher","first-page":"105","DOI":"10.5334\/aogh.3377","volume":"87","author":"LI Losonczy","year":"2021","unstructured":"Losonczy LI, Papali A, Kivlehan S, Calvello Hynes EJ, Calderon G, Laytin A, et al. White paper on early critical care services in low resource settings. Annals Global Health. 2021;87(1):105. https:\/\/doi.org\/10.5334\/aogh.3377.","journal-title":"Annals Global Health"},{"issue":"3","key":"6258_CR12","doi-asserted-by":"publisher","first-page":"e387","DOI":"10.1016\/S2214-109X(24)00482-0","volume":"13","author":"T Baker","year":"2025","unstructured":"Baker T, Khalid K, Mohammed AD, Wharton-Smith A, Lundeg G, Mitchell R, Argent A, Convocar PF, Schell CO. Realising the benefits of oxygen through essential emergency and critical care. Lancet Global Health. 2025;13(3):e387\u20138. https:\/\/doi.org\/10.1016\/S2214-109X(24)00482-0.","journal-title":"Lancet Global Health"},{"issue":"2","key":"6258_CR13","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1080\/13623699.2022.2081056","volume":"38","author":"Q Mian","year":"2022","unstructured":"Mian Q, Malik SMMR, Alinor MA, Hossain MS, Sharma JK, Hassan OM, Ahmed AM, Jama AA, Okello AJ, Namasopo S, Opoka RO, Conradi N, Saleh A, Conroy AL, Hawkes MT. Implementation of solar powered oxygen delivery in a conflict zone: preliminary findings from Somalia on feasibility and usefulness. Med Confl Survival. 2022;38(2):140\u201358. https:\/\/doi.org\/10.1080\/13623699.2022.2081056.","journal-title":"Med Confl Survival"}],"container-title":["Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13054-026-06258-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13054-026-06258-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13054-026-06258-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T09:24:07Z","timestamp":1787649847000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13054-026-06258-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["6258"],"URL":"https:\/\/doi.org\/10.1186\/s13054-026-06258-5","relation":{},"ISSN":["1364-8535"],"issn-type":[{"value":"1364-8535","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]},"assertion":[{"value":"23 June 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 August 2026","order":5,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":6,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The collection title was incorrectly included as part of the title in the original publication, this article has been updated.","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable. This Comment does not report a study involving human participants, human data, human tissue, or animals.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. This manuscript does not contain any individual person\u2019s data in any form.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"429"}}