Somalia’s pharmaceutical sector faces protracted challenges stemming from conflict, weak governance, and fragmented health systems. Its medicine policy landscape remains under-examined within an East African context, with direct implications for public health outcomes, particularly in obstetrics and gynaecology. This working paper critically reviews the development and implementation of national pharmaceutical policy in Somalia from a regional perspective. It aims to analyse the key barriers to medicine access and regulatory coherence, and to assess policy alignment with broader East African Community health goals. The study employs a critical review methodology, synthesising data from grey literature, policy documents, and relevant reports. A thematic analysis was conducted to identify patterns and gaps in policy frameworks and their operationalisation. The review finds a highly fragmented and under-resourced regulatory environment, heavily reliant on the private sector and external aid. A dominant theme is the critical lack of domestic manufacturing capacity, leading to a near-total dependency on imported medicines. Policy implementation is consistently hindered by weak institutional capacity and inadequate financing. Somalia’s pharmaceutical policy framework remains in a formative stage, characterised by systemic weaknesses that severely constrain reliable access to essential medicines. This undermines equitable healthcare delivery and regional health security aspirations. Prioritise the development of a comprehensive, funded national medicines policy. Strengthen the national regulatory authority through regional technical collaboration. Explore pooled procurement mechanisms with East African Community partners to improve affordability and supply security. Pharmaceutical policy, access to medicines, health systems, Somalia, East Africa, regulation, maternal health This paper provides a consolidated critical analysis of Somalia’s pharmaceutical policy landscape, offering a specific contextual perspective often absent from broader regional studies. It highlights urgent priorities for policymakers and regional bodies.