Factors Affecting Utilization of Healthcare Services Among Nasahablood and Ayah 4 Internally Displaced Persons in Hargeisa, Somaliland.

Background: Globally, 4.5 billion people lack full coverage of essential health services, and displaced populations are disproportionately affected. Understanding the specific barriers they face is critical for designing effective health interventions. Objective: To identify the factors affecting the utilization of healthcare services among internally displaced persons (IDPs) in Hargeisa, Somaliland. Design: A community-based, cross-sectional study. Site: The Nasahablood and Ayah 4 IDP camps in Hargeisa, Somaliland. Participants: A proportionate stratified sample of 271 households. Main Measures: The primary outcome was the level of healthcare utilization (low, moderate, and high), analyzed using ordinal logistic regression (OLR). Predictor variables included accessibility, affordability, and socioeconomic factors. Results: A majority of respondents (73.5%) reported low healthcare utilization, with only 14.4% reporting high utilization. OLR revealed that affordability was the most significant barrier to care (p < 0.001), followed by physical accessibility (p = 0.025). Both factors were associated with substantially lower odds of health service utilization. Additionally, after controlling for other variables, gender emerged as a significant predictor, with male respondents having lower odds of utilizing healthcare services compared to female respondents (p = 0.030). Conclusion: Healthcare underutilization in these IDP camps is primarily driven by powerful structural barriers of cost and distance, compounded by gender-specific factors. We recommend targeted interventions, including fee-exemption policies and mobile health clinics, to address these critical gaps and improve health outcomes for this vulnerable population.