Eritrea operates a centralized, government-led healthcare system structured into three tiers: primary, secondary, and tertiary levels. The Ministry of Health (MoH) is the primary government body responsible for overseeing the national health and disability system, public health initiatives, and healthcare delivery. The system is designed to provide universal healthcare coverage to residents, primarily funded through taxation, with a strong emphasis on primary healthcare and preventive services. Since its independence, Eritrea has made significant strides in improving its health services, particularly in areas like maternal and child health, and the control of communicable diseases such as malaria and HIV/AIDS. While public healthcare is generally free or available at a very low cost, especially for essential services, expats should be aware of the limitations in specialized care and infrastructure, particularly outside the capital, Asmara.

Eritrea's public healthcare system is organized into a three-tier structure: community-based services, primary healthcare facilities (health centers and community hospitals), and referral hospitals (regional and national). The system prioritizes primary health care, focusing on health promotion, disease prevention, and management of common conditions. Immunizations, growth monitoring, pre- and postpartum care, nutritional supplementation, and health education are universally free. Management of chronic diseases like tuberculosis, HIV/AIDS, hypertension, diabetes, and mental disorders is also provided at no cost to patients.

For foreigners with a residence permit and employment, enrollment in the public system is generally available. Registration typically involves visiting a local health office and presenting your residence permit, passport, and proof of address. Employers may assist with this process. While the public system has achieved notable successes in public health outcomes, especially in reducing infectious diseases, the quality of care can vary. Public hospitals in Asmara, such as Orotta National Referral Hospital, are the most advanced, but facilities in other towns are often under-equipped, and rural areas have very limited medical access. Waiting times for non-urgent procedures are not explicitly documented but can be expected due to resource constraints and a low doctor-to-patient ratio.

As a matter of government policy, there are generally no private health facilities operating independently in Eritrea. However, a system of private practice exists within government health facilities through partnerships between the government and health workers. While some sources from 2025 mention that private hospitals and medical facilities might offer slightly higher standards of care, they are very few, potentially expensive, and not widely accessible. For instance, Sembel Hospital, once a private option, has reportedly shifted towards COVID-related care and is not generally accessible. This means expats should not rely on a robust private healthcare sector for their medical needs. For any complex or specialized medical conditions, the standard of care in Eritrea's public facilities may be insufficient, necessitating medical evacuation.

Foreigners and expats primarily access healthcare in Eritrea through the public system, especially if they hold a residence permit and are employed locally. Registration typically requires a residence permit, passport, and proof of address, with employers often facilitating the process. For tourists or those without formal residency, access to public facilities is generally on a pay-per-service basis, though costs are usually low.

There are no reciprocal health agreements with European Health Insurance Card (EHIC) or Global Health Insurance Card (GHIC) countries; these cards are not valid in Eritrea. It is crucial for all foreigners, regardless of their status, to carry comprehensive international health insurance that includes emergency medical evacuation. This is particularly important given the limitations of local medical facilities, especially outside Asmara, and the potential need for advanced treatment abroad. Expats are also advised to bring translated copies of their medical history, prescriptions, and vaccination records, and to carry a sufficient supply of any necessary prescription medications, as local availability can be limited.

For expats in Eritrea, securing appropriate health insurance is paramount due to the limitations of the local healthcare system. The primary options include:

• Employer-Sponsored Insurance: If locally employed, your employer may enroll you in the public system or provide private coverage.
• International Health Insurance: Global plans from providers like Cigna, Allianz, or Bupa are highly recommended. These plans are ideal for comprehensive coverage, especially for the first year or if you anticipate further international moves. They often include critical benefits like medical evacuation and repatriation.
• Local Private Insurance: While generally cheaper than international plans, local private insurance options are very limited, and there may be language barriers in claims processing. Given the lack of private facilities, the utility of such plans for direct treatment within Eritrea is questionable.
• Public System Enrollment: Available once you have a residence permit and employment. This provides access to the free or low-cost public healthcare services.

Medical Evacuation is Essential: Due to the limited access to advanced medical care in Eritrea, particularly for serious complications, medical evacuation coverage to a better-equipped hospital abroad (e.g., in Nairobi, Dubai, or Europe) is considered a must-have for all expat insurance plans. Typical monthly premiums for international private insurance for expats can range from €100 to €500 per month, depending on age and the level of coverage.

Public healthcare services in Eritrea are generally provided free of charge or at a very low cost, especially for primary care, maternal health, and child immunizations. For basic consultations at clinics in Asmara, expats can expect out-of-pocket costs to be around $10–$20 USD. Dental care is also basic and can cost approximately $5–$20 USD.

However, for more complex treatments, specialized care, or hospital stays, costs can escalate, and the availability of such services within Eritrea is limited. Medications can be scarce, and many items may be unavailable, requiring expats to bring their own supply. Foreign prescriptions are generally not valid; a local GP visit is needed to reissue prescriptions.

For those with international private insurance, out-of-pocket costs will depend on the plan's coverage, deductibles, and co-payments. As mentioned, private insurance premiums for expats typically range from €100–€500 per month. The government's healthcare spending is approximately €28 per capita per year, indicating a system with significant resource constraints.

Emergency medical services in Eritrea are available, but expats should manage expectations regarding response times and equipment. The primary emergency number for an ambulance is 122244. Other important numbers include 113 for Police and general emergencies, and 116 for Fire services. The universal emergency number 112 may also be used.

Upon calling, be prepared for potential language barriers as call handlers may not speak English. Ambulance services are not widely available, and those that exist may have minimal equipment, with emergency responders' training potentially below international standards. In serious situations, injured or critically ill individuals might find it quicker to take a taxi or private vehicle to the nearest major hospital rather than waiting for an ambulance.

Treatment in public emergency facilities is generally free for residents. For foreigners, it is advisable to contact your insurance company quickly if referred to a medical facility for treatment. For any serious medical emergency, particularly those requiring advanced care, medical evacuation to a neighboring country or further abroad is strongly recommended and should be covered by comprehensive international health insurance.

Eritrea's healthcare system has made commendable progress in certain public health areas, particularly in reducing infant and child mortality, improving maternal health, and controlling communicable diseases like malaria and HIV/AIDS. The country's healthcare quality index is rated at 38/100, indicating room for improvement by international standards.

Strengths:

• Strong Primary Healthcare: The system emphasizes community-based services and preventive care, which has led to significant public health achievements.
• Maternal and Child Health: Eritrea has achieved high antenatal coverage (98%) and has multiple referral hospitals specializing in maternal care.
• Infectious Disease Control: Notable successes in reducing malaria, tuberculosis, and HIV/AIDS.

Weaknesses:

• Limited Resources and Infrastructure: Public hospitals outside Asmara are often poorly equipped, and rural areas have very limited medical access.
• Shortage of Skilled Workforce: Deficits in financing, basic technology, medicines, and a lack of skilled health personnel, particularly for non-communicable diseases, are significant challenges.
• Specialized Care: Limited ICU care and drug shortages are common, meaning complex medical conditions often cannot be adequately treated within the country.

Compared to some neighboring countries, Eritrea has shown strong commitment to universal access and public health outcomes, but still faces substantial challenges in providing advanced and specialized medical care. For expats, the quality of care available locally is generally considered below Western standards, making international health insurance with medical evacuation a critical necessity.