Since the collapse of Somalia’s central government in 1991, the pharmaceutical sector has operated with little to no regulation. Nearly all medicines are imported, yet there is no robust oversight to ensure safety or quality. The Ministry of Health lacks the capacity to enforce existing laws, leaving pharmacies and distributors largely unchecked. This gap has allowed counterfeit, expired, and low‑quality drugs to enter the market, often with labels in foreign languages that most Somalis cannot read. Prescription medicines, including powerful painkillers and antibiotics, are frequently sold without prescriptions. Misuse of drugs like Tramadol is linked to rising crime, while unregulated use of antibiotics is contributing to growing antibiotic resistance. Some imported male enhancement products have been linked to severe health risks, yet remain widely available due to public demand. The lack of public awareness about drug interactions, combined with the popularity of combining pharmaceuticals with traditional herbal medicines, increases the risk of harmful side effects. Experts warn that densely populated displacement camps, poor sanitation, and disease outbreaks could amplify the crisis.