Surgery is often perceived as a highly specialised form of medical care that is available primarily in advanced hospitals and wealthier countries. In reality, essential surgical care is a fundamental component of universal health coverage and an important determinant of global health equity. Surgical conditions affect people across all populations and include obstetric complications, traumatic injuries, infections, congenital conditions, cancers, and many other diseases. Despite its importance, access to safe, timely, and affordable surgical and anaesthesia care remains profoundly unequal. In low-resource settings, limitations in infrastructure, workforce, equipment, financing, and referral systems can prevent patients from receiving life-saving interventions.
Approximately 5 billion people worldwide lack access to safe, affordable surgical and anaesthesia care when needed, making access to surgery one of the major unfinished challenges in global health. This gap has significant consequences for individuals, families, communities, and health systems. For many patients, the absence of timely surgical care is not simply a medical inconvenience; it can result in permanent disability, avoidable complications, loss of income, or premature death. Conditions that could be effectively treated through relatively straightforward procedures may become life-threatening when treatment is delayed or unavailable. Consequently, improving access to essential surgery should be considered an important component of efforts to reduce preventable mortality and achieve health equity.
The barriers to surgical care are complex and extend beyond the availability of surgeons. Patients may live considerable distances from hospitals capable of providing surgery, particularly in rural and remote communities. Transportation difficulties, poor roads, geographical isolation, and inadequate referral networks can result in dangerous delays. Within health facilities, shortages of surgeons, anaesthetists, nurses, midwives, technicians, and other healthcare professionals can limit the number and complexity of procedures that can be safely performed. Inadequate operating theatres, unreliable electricity and water supplies, limited oxygen, insufficient blood supplies, shortages of medicines, and inadequate infection-prevention systems further constrain surgical capacity. Financial barriers can also prevent patients from seeking or completing treatment, particularly where healthcare costs are paid directly by individuals and families.
Global surgery has emerged as an important field seeking to address these inequalities by strengthening surgical systems and improving access to safe, affordable, and timely care. Importantly, global surgery should not be understood as simply exporting high-technology medicine from wealthy countries to low-resource settings. Short-term interventions or externally driven programmes may provide temporary benefits but do not necessarily create sustainable improvements. Instead, global surgery should focus on strengthening local capacity and health systems through education, training, infrastructure, workforce development, research, appropriate technology, financing, and effective governance. Local professionals and communities should be central to determining priorities and designing solutions.
Essential surgery is also closely connected to broader health-system strengthening. Surgical services depend on many components of a functioning health system, including primary healthcare, emergency transport, referral networks, laboratory services, blood transfusion systems, pharmacy services, infection prevention and control, anaesthesia, and postoperative care. Investment in these areas can therefore generate benefits that extend beyond surgery itself. For example, improving oxygen systems, electricity supplies, sterilisation capacity, or blood services can strengthen the ability of hospitals to manage a wide range of medical emergencies. Similarly, developing a skilled surgical workforce can increase capacity to respond to trauma, obstetric emergencies, cancer, and other conditions.
Maternal health provides a particularly important example of the relationship between surgery and global health equity. Complications such as obstructed labour, severe bleeding, and other obstetric emergencies may require timely surgical intervention. When caesarean sections or other essential procedures are unavailable, women and newborns can face serious complications or death. Strengthening surgical and anaesthesia capacity is therefore an essential component of improving maternal and newborn outcomes. Similarly, trauma care is increasingly important in many settings because road traffic injuries, occupational injuries, violence, and natural disasters can create a substantial demand for emergency surgery.
Innovation also has the potential to improve access to essential surgical care, particularly in remote and resource-limited settings. Telemedicine and digital health platforms can facilitate specialist consultations, education, referral, and postoperative follow-up. Portable and low-cost technologies may help healthcare facilities perform essential procedures where conventional infrastructure is limited. Simulation-based training can allow healthcare professionals to develop and maintain technical skills without placing patients at unnecessary risk. Artificial intelligence may also support areas such as diagnostic imaging, clinical decision-making, surgical planning, and resource allocation. However, technological innovation should not be viewed as a substitute for investment in fundamental health-system capacity. Technologies must be affordable, evidence-based, sustainable, and adapted to local contexts, infrastructure, and workforce capabilities.
The relationship between essential surgery and antimicrobial resistance also deserves attention. Safe surgery depends on effective infection prevention and control and, where appropriate, access to antimicrobial medicines. At the same time, inappropriate antimicrobial prescribing can contribute to the development of resistant infections, potentially making surgical procedures more difficult and dangerous. Strengthening infection prevention, antimicrobial stewardship, diagnostic capacity, sanitation, and appropriate prescribing can therefore support both surgical safety and wider public health.
Humanitarian crises and climate-related disasters further demonstrate the importance of resilient surgical systems. Armed conflict, displacement, earthquakes, floods, and other emergencies can generate large numbers of patients requiring trauma and emergency surgery while simultaneously damaging hospitals and disrupting medical supply chains. Health systems with strong essential surgical capacity are better positioned to respond to these emergencies. Building resilience therefore requires not only increasing the number of surgical procedures performed but also ensuring that facilities, referral systems, supply chains, healthcare workers, and emergency services can continue functioning during crises.
The future of global surgery depends on genuine partnership and collaboration. Surgeons, anaesthetists, nurses, policymakers, researchers, engineers, public health professionals, communities, patients, and international organisations all have important roles to play. Partnerships should be based on mutual respect, shared decision-making, and long-term commitment. Local healthcare professionals should lead the identification of priorities and the development of sustainable solutions because they understand the specific cultural, geographical, economic, and health-system contexts in which care is delivered. Research should similarly address locally relevant problems and generate evidence that can inform effective policy and practice.
In conclusion, access to essential surgery should not depend on where a person lives or their ability to pay. It is a matter of equity, dignity, and social justice. Achieving universal health coverage will remain incomplete if millions of people continue to lack access to life-saving surgical and anaesthesia services. Global health must therefore move beyond viewing surgery as a luxury or highly specialised service and recognise it as an essential public-health intervention. Investment in surgical workforce development, anaesthesia, infrastructure, blood systems, infection prevention, referral networks, innovation, and financial protection can save lives, reduce disability, and strengthen health-system resilience.
Global surgery is, in conclusion, based on a simple but powerful principle: everyone should have the opportunity to receive the safe, timely, and affordable surgical care they need, regardless of where they live or their socioeconomic circumstances. Recognising essential surgery as a global health priority is therefore not only an investment in surgical services; it is an investment in stronger health systems, healthier communities, and a more equitable future.
References
Sartelli M, Mossialos E, Coccolini F, Jammer I, Labricciosa FM, Barie P, Biffl WL, Memish ZA, Maeurer M, Kobinger GP, Ippolito G, Zumla A, Catena F; Global Consortium for Solidarity to Overcome Challenges, Restore Trustand Advance Science for a Sustainable Future. Global health at crossroads: uniting together to overcome challenges, restore trust and advance priorities for a sustainable future. World J Emerg Surg. 2025 Nov 10;20(1):84.
Diskin B, Hopkins MA. Surgery in Low-Income and Middle-Income Countries. Surg Clin North Am. 2025 Dec;105(6):1021-1024.
Author
Massimo Sartelli
Leave a Reply