article · Critical Care
In conflict and disaster-affected settings such as Somalia, critical care readiness is frequently evaluated only by intensive care unit capacity. However, preventable deaths in fragile health systems often take place before, during, or following intensive care. Ongoing challenges include frequent mass-casualty events, restricted emergency referrals, shortages of oxygen and blood, constrained operative access, and poor post-resuscitation monitoring. Critical care preparedness must therefore be treated as an entire pathway problem rather than an isolated facility capacity issue. A unified readiness agenda links mass-casualty response, emergency referrals, essential critical care inputs, ethical triage, and non-punitive system learning. Hospital training and preparedness alone remain insufficient without referral communication, command structures, functional oxygen systems, blood readiness, ward-level monitoring, and defined escalation criteria to safeguard life-saving care.
During crises and armed conflict, life-saving care often fails due to systemic breakdowns rather than a simple shortage of intensive care beds. Reframing emergency preparedness as a continuous pathway helps fragile health systems direct limited resources where they save the most lives, from initial field response through to post-resuscitation recovery.
The abstract does not indicate an application pathway or commercialisation potential, as it outlines a conceptual health systems framework rather than a product or technology.
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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-mass-casualty response, emergency referral, essential emergency and critical care inputs, ethical triage, and non-punitive system learning-into 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.
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DOI: 10.1186/s13054-026-06258-5
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