Surgery as a Global Necessity: Evolution of the State of Global Surgical Access

Credits: Global Surgery Research Collaborations During the COVID-19 Pandemic, Journal of Global Health Economics and Policy

“Why is fate cruel to us? Why do rich people who can afford to cure their kids never get diseases like this?” Fatima Begum asked, filled with pain and sorrow, in response to her daughter, Roona’s condition. Roona Begum, the 18 month-old daughter of two lower class village residents in north-eastern India, was diagnosed with hydrocephalus, a condition caused by fluid build up in the brain, leading to walking difficulties, discomfort while eating, and high risk of brain damage. Her young father Abdul, worked diligently in the extreme heat radiated by the brick kiln to make less than 3 dollars per day, to make ends meet. Even still, treatment options were extremely expensive, yet Roona’s condition only worsened with time. Many children and even adults from underserved communities on a global scale experience difficulties in affording critical surgical care. Luckily, Roona’s condition took a global stage via social media platforms, gaining her and her family access to treatment funding from a Norwegian NGO with surgical treatment at a well-known hospital in Delhi that also covered transportation costs. While initial surgical treatments showed hopeful progress, Roona unfortunately passed away in 2017. 

However, the power of social media may not capture the stories of all individuals who pass away from not getting access to safe and sustainable surgical treatment. In fact, according to The Lancet’s widely known article, “ Global Surgery 2030 ”, 3.5 million adults pass away annually following surgery. This strongly necessitates reform in access and quality of surgical treatment worldwide, otherwise known as global surgery.

What Exactly is Global Surgery?

Global surgery can be defined as quality, safe, timely, and affordable surgical, obstetric, and anesthetic care worldwide. Many low-income countries lack surgical professionals in various specialties, such as cardiothoracic care, and often available surgical care is highly unaffordable for the communities seeking urgent care. To top it off, hygiene conditions and proper training in obstetric surgery and anesthesia are lacking, causing high numbers of preventable deaths. As a result, larger health organizations such as the WHO and journals such as The Lancet are working to create global training programs through mission trips and establish policy reforms that work to enhance the quality of surgical care. While policy makers are considered to be at the center of instigating this change, widespread expert opinion asks patients and low income families to step up to speak out for their conditions. Even more crucial are surgical providers in evaluating their provision of care, state of care in the countries they provide it in, and also policy impacts on their hospital settings and broader countryside surgical care, creating a crossroads between public health and medicine. In order to understand the evolution of this increasingly important field, we must dive into its origin story. 

Historical Beginnings

The conversation regarding global surgery began long before the formal recognition of the field. Surgery had long been considered a highly profitable field with treatment that was supplemental rather than necessary. This changed when WHO Director General Mahler first voiced the lack of access and action for proper surgical care to the World Congress of the International College of Surgeons in 1980. Managing disease outbreaks and relevant diseases such as HIV/AIDs and malaria were still prioritized over global surgery. Surgeons began to hear the recent calls to directly come forth to influence policy efforts. Renowned medical author and surgeon Dr. Atul Gawande, having long been a proponent for global surgery played a significant role in synthesizing WHO’s Surgical Safety Check-list initiative. This covered preventing surgical infections, ensuring safe teams and use of surgical technology.

The Lancet took an actionable lead by establishing a Commission on Global Surgery in January of 2014, which was a revolutionary report with quantitative statistics on the global status of surgical access setting precedent. Such numbers including “5 billion people not having access to safe and accessible surgery, with 18.6 million of these being preventable” surpassing the combined rate of HIV/AIDs, malaria, and tuberculosis infections, radically shifted this view.

Even notable infectious disease expert Paul Farmer, realized the importance of now heading to global surgery issues, with post-surgical deaths surpassing epidemiological disease rates. Initially referring to global surgery as “the neglected stepchild of global health,” he personally worked on reform global surgery, by uplifting surgical infrastructure. Organizations such as the G4 Alliance, InciSioN Global, Global Initiative of Children’s Surgery, and the NIHR Global Funding Programme were established between 2015 and 2016 to fund and work on the values global surgery works to uphold. 

 On a policy level, Sustainable Development Goals and a Manual were launched as initial efforts to establish global surgery in writing. Additionally, following The Lancet’s report, the World Health Assembly passed Resolutions 68.15 and 70(22) over the course of two years to legitimize the importance of reforming global surgery in the broader context of universal access to health through reports of putting solutions to work. Countries have also created localized National Surgical Obstetric, and Anesthesia Plans to ensure the involvement of surgical providers and stakeholders in national health policy and that surgical reforms are made along with broader health policy reforms since 2015. With the increase in demand for surgical-specializing healthcare providers during the pandemic as well as recent funding cuts by the US government to healthcare organizations it was once involved in, the stage for global surgical policy is being transformed, for better and for worse. 

More Recent Solutions and Reforms

With the COVID pandemic just a few years into the past, the impacts on the global healthcare landscape are unprecedented for current healthcare systems. With 28 million surgeries initially put on the back burner towards the beginning of the COVID pandemic to focus on the widespread disease of the deadly and constantly evolving coronavirus strains, deaths and health complications caused by the elimination of surgical care were not addressed. Though research based efforts in response to the COVID pandemic were initialized in 2020, the promise to consider global surgery as integral to universal health coverage was falling out of place. As a result, The Lancet voiced these concerns in a letter to the WHO in 2022, detailing the need to fortify future preparedness for the pandemic in the provision of surgical care. They specifically voiced the need to integrate the voices of surgical care providers into the Pandemic Preparedness Treaty, to recognize the field’s importance throughout the present and future. 

From a more public health standpoint, intersecting with medicine, efforts during the United Nation’s Geneva World Health Assembly (WHA) in 2022 combined both support for surgical medicine and preventative interventions to reduce the development of critical conditions requiring surgery. The G4 Alliance and the Global Alliance for Prevention of Spina Bifida-F collaborated to prevent birth defects such as spina bifida by mandating the incorporation of folic acid into staple foods. 

Organizations also complete larger scale projects involving trips, fortified training for student surgeons, and funding to ensure safe and timely surgical practice. One such example is Operation Smile, which worked in 2025 to ameliorate Africa’s 25% surgical disease burden. This nonprofit worked to establish local partnerships and also standardized training to expand the reach, population, and variety of specialized surgeons in Rwanda. In the future they are hoping to bring surgical care to the patients in hospitals and surgical job creation.

Recent Impact of Funding Cuts and What the Future Holds

Despite all these diligent efforts to bring surgical care to the front lines, recent funding cuts to various global health organizations and unfinished localized policy reforms suggest growing neglect for the field.

In 2022, while U.S Congress incorporated a statement on “Neglected Surgical Conditions” that indeed called to action in implementing surgical care plans, represented the pillars for sustainability, safety, and timelines, it was only a small paragraph under “Other Global Health Issues,” likely to be figuratively and literally unseen by government health officials. 

More recently, in 2025, the United States under the current political administration, along with the UK, via USAID and UKAID, significantly withdrew funding cuts in an attempt to reserve those funds for healthcare within their own nations. This shattered funding needed for global surgery efforts, both in the research and policy sectors. To top it all off, The Lancet’s Global Surgery 2030 goals, interventions, and policy recommendations are being delayed and have been projected to not be implemented by the scheduled radar by 2030.

However, complete hope is not lost; The Lancet yet again came to the rescue by publishing a solution-based review, proposing solutions that have been effective and will prove to be effective if implemented between 2025 and 2035. One recommendation is to expand focus on specialties such as head and neck surgery, with the expansion of obstetrics being evident, likely modeling Operation Smile’s expansion efforts. Additionally, tracking the effectiveness of emergency laparotomy, caesarean section, and open fracture management, known as Bellwether procedures, has shown that future data-based research on these three areas can ensure efficient funding. Investments in surgical equipment in hospital settings can offset treatment costs for surgical and non surgical treatments; the recent rise in telemedicine decreases staff burden and burn-out, ensuring quality surgical care for providers in in-patient settings. 

Finally, of course, patients as a voice for their surgical conditions is the most powerful intervention, and magnifying their voices in policy, intervention, organizational, and hospital settings will help us to see that global surgery is no longer the “ neglected step-child » but the thriving, growing child with a family and stakeholders and support systems ensuring surgery reaches all those who need it.

Call to Action

If you are more interested in learning about this topic or getting involved in global surgery advocacy, join UC Berkeley’s chapter of Global Surgery Student Alliance, an organization focused on fostering an interest in surgery as well as educating and advocating for safer, sustainable surgery!