Five billion people have no access to basic surgery

Millions of people are dying from easily treatable conditions like appendicitis, fractures or obstructed labour because they either have no access or cannot afford proper surgical care, a significant research published in the prestigious journal Lancet has revealed.

Part of a major project that was launched in London on Monday, the findings show that two-thirds of people worldwide do not have access to safe and affordable surgery and an anesthesia when they need it.

"Too many people are dying from common, treatable surgical conditions. The problem is especially acute in the low-and-middle-income countries of eastern, western and central sub-Saharan Africa, and South and Southeast Asia," said Lars Hagander, one of the lead authors from the Lund University, Sweden.

The project is written by a group of 25 leading experts from across the fields of surgery and an anesthesia with contributions from more than 110 countries.Access is worst in low-income and lower-middle income countries where as many as nine out of 10 people cannot access basic surgical care.

Just under a third of all deaths in 2010 (16.9 million deaths) were from conditions treatable with surgery - well surpassing the number of deaths from HIV/AIDS, TB and malaria combined, the report said.Yet, despite this enormous burden of death and illness -which is largely borne by the world's poorest people - surgery has, until now, been overlooked as a critical need for the health of the world's population.

"Millions of people are already dying unnecessarily and the need for equitable and affordable access to surgical services is projected to increase in the coming decades, as many of the worst affected countries face rising rates of cancer, cardiovascular disease, and road accidents," he emphasised. Of the 313 million operations done worldwide each year, just one in 20 occur in the poorest countries, where over a third of the world's population lives.

New estimates produced for the project found that there is a global shortfall of at least 143 million surgical procedures every year, with some regions needing nearly twice as many additional operations as others."Although the scale-up costs are large, the costs of inaction are higher and will accumulate progressively with delay," noted project lead author John Meara from the Harvard Medical School.

Despite the overwhelming magnitude of the problem, the report estimates that the countries where access to surgery is weakest could be scaled up to acceptable, and achievable, levels of access to surgery by 2030 with an investment of $420 billion.

( The project was launched with a day-long symposium at the Royal Society of Medicine in London).