Terminal Illness & End-of-Life Planning in Djibouti: 5-Step Official Checklist

1. 1

   Coordinating palliative care, hospital pathways, and Universal Health Insurance

   • Referral hospitals and specialist follow-up: In Djibouti, care for serious or progressive illnesses is coordinated through public and para-public hospitals supervised by the Ministère de la Santé de la République de Djibouti (notably Peltier General Hospital and Balbala Hospital) as well as medical and hospital centres operated by the social security system [1] [2]. The attending medical team establishes the care protocol, pain management regimen, and outpatient or home-based follow-up [1].
   • Universal Health Insurance (AMU) coverage: Administered by the Caisse Nationale de Sécurité Sociale, Universal Health Insurance (Assurance Maladie Universelle - AMU) covers specialist consultations, medical procedures, laboratory analyses, hospitalisations, and prescribed medications at contracted healthcare facilities [2]. For severe conditions requiring extended treatment or medical evacuation abroad, a prior authorisation request supported by a detailed medical report is submitted to the fund's medical control board [2] [3].
   • Continuity of care at home: Where the patient's clinical condition allows home care, the supervising physician coordinates analgesic prescriptions and supportive nursing visits to ensure patient comfort [1] [2].
2. 2

   Recording advance medical wishes and designating a trusted representative

   • Written statement of care preferences: While your relative retains full decision-making capacity, it is advisable to prepare a dated and signed written statement setting out their wishes regarding medical support, pain relief, limits on invasive interventions, and preferred place of care [1] [4]. This statement is provided to the attending physician for inclusion in the hospital medical file [1].
   • Designating a primary family spokesperson: Under Djiboutian law and hospital practice, the patient's informed consent is obtained before any medical procedure, and the healthcare team consults close family members once the patient can no longer communicate [1] [5]. Designating a trusted person within the family in writing establishes a clear family spokesperson for physicians and prevents disagreements during urgent clinical decisions [1] [4].
   • Access to certificates and medical records: The patient may expressly authorise this representative to collect medical reports, hospital summaries, and certificates required for procedures with social security and public authorities listed on the Portail Officiel e-Gouv de la République de Djibouti [2] [4].
3. 3

   Bank powers of attorney, notarial mandates, and legal protection

   • Bank account powers of attorney: While the ill person retains full legal capacity, they may sign a bank power of attorney with their financial institutions in Djibouti in favour of a trusted representative [4]. This step enables the representative to pay medical expenses, settle household bills, and collect salaries or pensions without administrative interruption [3] [4].
   • Authentic power of attorney before a notary: For broader property and financial administration (managing real estate, collecting rent, or dealing with tax authorities and the land registry), your relative should execute a special or general power of attorney by authentic deed before a notary practising in Djibouti, who can attend at the patient's home or hospital if their physical condition requires it [4] [5].
   • Statutory adult protection regimes: If the illness later causes a lasting impairment of mental or physical faculties certified by medical assessment, Law No. 152/AN/02/4ème L enacting the Family Code provides judicial protection measures (interdiction or guardianship ordered by the competent court to administer the protected person's property) [5].
4. 4

   Disability benefits, income continuation, and family caregiver support

   • CNSS disability pension: Where an insured worker suffers a permanent reduction of at least two-thirds of their physical or mental capacity due to illness, rendering them unable to engage in gainful employment, a disability pension claim may be submitted to the Caisse Nationale de Sécurité Sociale [3]. The claim file includes the official application form, a detailed medical report submitted to the social security medical adviser, proof of registration, and civil status records [3].
   • Sick leave and statutory employment guarantees: While an employment contract is suspended due to illness duly certified by an approved physician, salaried employees and public servants benefit from statutory salary continuation and protection against dismissal under Djiboutian labour and social legislation [2] [3].
   • Support from employed family caregivers: Family members who are employed may request authorised family leave or working-hour adjustments from their employer to accompany the ill relative during hospital stays and specialist medical appointments [3] [4].
5. 5

   Will preparation, life insurance beneficiaries, and estate organisation

   • Drafting a will under the Family Code: The Family Code of the Republic of Djibouti strictly regulates wills (wassiya): any person of sound mind may dispose of their property by written will or authentic deed before a notary or judge (Cadi of the Personal Status Court), up to a maximum limit of one-third of their net estate [5]. Bequests exceeding one-third of the estate or made in favour of a statutory heir require the express consent of the other adult heirs after the succession opens [5].
   • Preparing civil status and property records: To prevent future delays when applying for the judicial certificate of heirship before the Personal Status Court (Tribunal de Statut Personnel), it is essential to verify and compile now the National Identity Card (CNI), birth and marriage certificates, family record book, and registered land title deeds [4] [5].
   • Insurance policies, bank accounts, and cross-border assets: It is also important to review beneficiary clauses on insurance or provident policies and prepare an accurate inventory of bank accounts and financial commitments [3] [4]. Where real estate or an heir is located abroad, a Djiboutian notary can coordinate international recognition of powers of attorney and estate documents [4] [5].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Hospital Organisation and National Healthcare Policy — Ministère de la Santé de la République de Djibouti
2. [2]
   Universal Health Insurance (AMU) and Medical Care Coverage — Caisse Nationale de Sécurité Sociale (CNSS Djibouti)
3. [3]
   Social Security Benefits and Disability Pension Guides — Caisse Nationale de Sécurité Sociale (CNSS Djibouti)
4. [4]
   Online Public Administrative Services for Citizens (Health, Civil Status, and Justice) — Portail Officiel e-Gouv de la République de Djibouti
5. [5]
   Law No. 152/AN/02/4ème L Enacting the Family Code of the Republic of Djibouti — République de Djibouti / WIPO Lex