Without Al-Ictisaam b'il Kitaab wa Sunna (Al-I'tisaam), you cannot understand Al-Shabaab. The shadowy neo-Salafist movement is the 'big brother' of the violent Al-Qaeda affiliate, and it is no exaggeration to refer to it as the single most important, least understood force in Somali politics. The legitimate and licit ideological twin to Al-Shabaab, Al-I'tisaam is the silent partner that has peacefully advocated the jihadists' objectives for over two decades. At times, the two movements have clashed —particularly in the early 2010s —but today, they are engaged in a prickly competition for the same end goal: "to establish [in the words of Al-I'tisaam] the Religion of Allah on the earth and to rule by His Legislation." And while Al-Shabaab may have seized the headlines with its armed struggle, it is Al-I'tisaam's version of jihad that has earned the movement its place as the most influential neo-Salafi group in Somalia, operating a vast array of businesses, charities, madrassas, mosques, universities and much more besides. And with such wealth has come legitimacy and influence; Al-I'tisaam's sway extends to Hargeisa, Garowe, Mogadishu, and even Nairobi.
Since the collapse of the Somali state in the 1990s, the country's private sector has played a particularly prominent role in service delivery, flourishing in the cracks left by the absence of a central government. In this space of the ungoverned economy, those providing essential utilities — such as healthcare — were assumed by businesses and economic cartels, which have reaped immense profits in turn amid the vacuum. However, in the years since, as the state-building process has gradually attempted to deliver or centralise such services, the incestuous relationships between business cartels and rent-seeking politicians have persisted. And in the meantime, the fractured and uneven nature of healthcare providers in Somalia continues to pose severe dangers to the population.