Background and Aims: Information regarding the clinical features and outcomes of severely ill COVID‐19 patients in low‐resource settings is limited. The objective of this study was to evaluate the clinical characteristics, comorbidities, and prognostic factors associated with mortality and COVID‐19 severity among COVID‐19 patients admitted to the national COVID‐19 treatment center in The Gambia.Methods: We conducted a retrospective cross‐sectional study on 930 confirmed COVID‐19 patients admitted to The Gambia’s national COVID‐19 treatment center from March 17, 2020, to March 13, 2023. We assessed the association between patients’ characteristics using the t‐test and the chi‐square test. Prognostic factors of mortality and COVID‐19 severity were investigated using a multivariable logistic regression model. Statistical analyses were performed using the STATA/SE 12.1 statistics/data analysis.Results: Patients with COVID‐19 who had a saturation of peripheral oxygen (SPO2) level below 90 (severe COVID‐19) faced a fivefold higher risk of death (adjusted odds ratio [aOR] = 5.15; 95% confidence interval [CI] = 1.08, 24.58; p = 0.040). Additionally, individuals aged 60 years and older had an approximately threefold higher risk of experiencing severe COVID‐19 (aOR = 3.43; 95% CI = 2.30, 5.13; p < 0.001), while those with comorbidities showed a 60% higher risk of severe disease (aOR = 1.60; 95% CI = 1.07, 2.38; p = 0.021).Conclusion: These findings underscore the importance of early detection and management strategies targeting older patients and those with underlying health conditions to mitigate the impact of COVID‐19 and improve patient outcomes. Future efforts should prioritize tailored interventions and supportive care for these high‐risk populations.