Purpose: This study set out to evaluate the state of the School Health Services SHS in primary schools across the Southwest Districts of Mogadishu, Somalia. Methods: The Southwest Districts of Mogadishu City, which are made up of the four districts "Wadajir, Dharkenley, Kahda, and Deyniile," served as the study site. In Mogadishu, these four districts rank among the biggest. The population was estimated around a million. A cross sectional descriptive study conducted from January to July 2024. A School Health Evaluation Scale Questionnaire was completed for each school by direct interview, there were about 100 elementary schools in the Area that were officially registered, comprising 60 private and 40 public schools. Results: Of the Teachers in the schools surveyed, 8 (30.8%) were trained to assess the physical status of children. Only 6 (23%) schools observe and assess health status of school children regularly. Overall, twenty-one schools (80.7%) has no sick bay/health center. 80.8% has no a policy on first aid and emergency treatment. First Aid boxes were present only 2 schools (7.7%). Only 6 schools (23%) used their dispositions to exclude and re-admit students suffering from communicable diseases from school. 7 Schools 26.9% require students to be immunized against communicable diseases. Conclusion: both public and private elementary schools in Mogadishu southwest districts, the quality of the school health services was generally poor. Thus, we would like to encourage that the management of the elementary schools be given immediate attention. First aid should be taught to at least one member of staff in every elementary school. The Ministry of Education ought to make this a requirement for registration and a policy.