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Setbacks in Global Paediatric Surgery: Obstacles and Hindrances

Written By: Yousif George Baho

4th year Medical Student | Hull York Medical School


The pathological conditions which can unfortunately afflict the paediatric demographic is considerable and surgery can be one such interventions in the treatment of these conditions. However, there remains a disparity in the provision of surgical care with reports stating that <8% of the child population in low- and middle- income countries (LMICs) have access to surgical care (1). There exist several barriers to the provision of such surgical treatments which will be briefly explored.

Firstly, there is a paucity of trained paediatric surgeons in many LMICs (2). Africa in particular has a severe shortage of paediatric surgeons (3). For comparison, Nigeria has 0.55 paediatric surgeons per one million children. This undeniably pales in comparison when one considers that there exist 29.3 paediatric surgeons per one million children in England (4). This is of course a stark example but the core issue of a lack of paediatric surgeons in LMICs is exemplified by these statistics. Additionally, factors such as war which plague many countries in the Middle East, influence the delivery of surgical care for the paediatric population (2). War has damaged the hospital infrastructures and disrupted the delivery of supplies and medicine, including anaesthetics medication (2).

The impact of war goes beyond the initial effect of damaging infrastructure. War has displaced people either internally or into other countries as refugees (2). One can argue that this sudden influx of people may place an additional strain onto the paediatric surgery resources of the country into which people are being displaced into. Indeed, if a country is already struggling to provide paediatric surgical care for its current population, any additional influx of people has the potential to exacerbate this issue.

A key barrier to the provision to paediatric surgical care in LMICs is the lack of necessary equipment, even in tertiary hospitals. When such equipment is present, lack of maintenance renders the equipment unserviceable (5).

Additionally, factors not directly related to healthcare impair the delivery of care. For example, transport systems in many LMICs are poor and roads are challenging to navigate in the rural areas (5) and this can limit accessibility to care. Similarly, the geographical layout of the country can make accessing care challenging. For example, Indonesia is an archipelago which is composed of more than 15,000 islands, with the majority of the country’s 150 paediatric surgeon being located in urban areas (2).

In conclusion, there exists many different barriers to the provision of effective paediatric surgery in LMICs, some of which are out of our control (the geographical layout of the country being one such example). The provision of effective surgical treatments for the paediatric population in LMICs is undeniably a crucial disparity to overcome as every child should be entitled to surgical care when needed. Resolving these issues is potentially not impossible but may require fundamental modifications to the healthcare and societal infrastructures in LMICs.

Mosul’s Al-Salam hospital was recently ravaged by fighting. A poignant reminder of the devastating effects of war (6).



  1. Philipo GS, Nagraj S, Bokhary ZM, Lakhoo K. Lessons from developing, implementing and sustaining a participatory partnership for children’s surgical care in Tanzania. BMJ Glob Health. 2020;5(3): e002118.

  2. Garber K, Cabrera CCR, Dinh QL, Gerstle JT, Holterman A, Millano L. The Heterogeneity of Global Paediatric Surgery: Defining Needs and Opportunities Around the World. World J Surg. 2019;43(6): 1404-1415

  3. Butler MW, Ozgediz D, Poenaru D, Ameh E, Andrawes S, Azzie G, et al. The Global Paediatric Surgery Network: A Model of Subspecialty Collaboration Within Global Surgery. World J Surg. 2015;39(2): 335-342.

  4. Lalchandani P, Dunn JCY. Global comparison of pediatric surgery workforce and training. J Pediatr Surg. 2015;50(7): 1180-1183.

  5. Ameh EA, Butler MW. Infrastructure Expansion for Children's Surgery: Models That are Working. World J Surg. 2019;43(6): 1426-1434.

  6. Aboulenein A, Levinson R, A Reuters Special Report, The Medical crisis that’s aggravating Iraq’s unrest [Internet]. Iraq and London: Reuters; [Filed 2nd March 2020, cited 16 January 2021]. Available from:

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