The future of healthcare in Africa requires the engagement of its youth. In Comoros, understanding young people’s views on medical careers is crucial for workforce planning and health system strengthening, but this perspective is largely absent from the literature. This study aimed to explore the perceptions, aspirations, and concerns of Comorian youth regarding careers in medicine and their vision for the future of the medical sector. A qualitative, exploratory study was conducted using semi-structured interviews and focus group discussions. Participants were purposively sampled Comorian nationals aged 18–25. Data were analysed using reflexive thematic analysis. Analysis identified four primary themes: the dual motivators of prestige and community service; significant perceived barriers including the financial cost of training and a lack of mentorship; a strong desire for local specialised training; and a vision for a more technology-integrated health system. A prominent finding was that approximately two-thirds of participants expressed a preference for working in urban centres unless rural postings were accompanied by substantial infrastructural investment. Comorian youth are motivated to contribute to their nation’s health but perceive systemic obstacles. Their insights reveal a tension between professional aspirations and the realities of the current health system, highlighting a risk of internal brain drain from rural to urban areas. Key recommendations include establishing targeted scholarship and mentorship programmes, developing plans for postgraduate medical specialisation within Comoros, and integrating health technology training into medical education to align with youth aspirations. Medical careers, health workforce, youth engagement, qualitative research, Comoros, medical education This study provides empirically derived insights into the perspectives of Comorian youth on medical futures, offering evidence to inform national health workforce and education policy.