‘Surgery in Low Resource Settings Symposium’ – Amsterdam, November 2014

November brought us one of the most exciting events of 2014 in the field of essential surgery in low resource countries.  The ‘Surgery in Low Resource Settings Symposium’, held in Amsterdam, was a three-day international conference hosted jointly by the Netherlands Society for International Surgery and the German Society for Tropical Medicine.  Experts were invited from all over the world to discuss the status of surgery in low-resource settings, and what we can do to improve essential surgical care worldwide.  

Key speakers at the symposium

Key speakers at the symposium

There were over 300 attendees from 23 countries worldwide.  To give a flavour, these included figures such as Dr Michael Cotton (UK), Dr Bob Lane (UK), Dr Jaymie Henry (US), Dr Edna Ismael (Somaliland), Dr Roeland Voorhoeve (Netherlands), Dr Peter Reemst (Netherlands), Dr Hugo Heij (Netherlands), Dr Emanuel Nuwass (Tanzania), Dr Henning Mothes (Germany), Dr Meena Cherian (WHO), Dr Pankaj Jani (COSESCA Kenya), Dr Maurizio Cardi (Italy), Dr Jacob Dreyer (South Africa, UK), Dr Joseph Musowoya (Zambia), Dr Lungu (Malawi), to name just a few.

Presentations ranged from general talks on how we can place essential surgery on the global agenda, to specific topics about the challenges and solutions met on-ground by experienced surgeons, gynaecologists, anaesthetists, and policy-makers who have been working in low-resource settings their whole lives.

Our role to advocate essential surgery at policy-making level was widely discussed, with support and use of the 15x15 campaign as a tool for focussing on the most important basic surgical interventions, as well as the new G4 Alliance which will act as a unified voice to build political priority for surgical care as part of the global development agenda.

Essential Surgery put forward by ICES’s Dr Michael Cotton

Essential Surgery put forward by ICES’s Dr Michael Cotton

Some of the ICES team at Amsterdam; Jane Maraka, Haadi Shalabi, Michael Cotton, Jaymie Henry

Some of the ICES team at Amsterdam; Jane Maraka, Haadi Shalabi, Michael Cotton, Jaymie Henry

Four of the most important aspects of essential surgery which we must work towards include defining what constitutes essential surgery and a basic package of interventions, demonstrating its cost-effectiveness, proving its feasibility, and to advocate it.

One of the key goals of this meeting was to produce a Declaration to direct essential surgery in the global development agenda.  The second evening of presentations concluded with an outstanding symposium in which the key ten figures summarised their message and way forward, followed by a united discussion. This formed the foundation of the ‘Amsterdam Declaration’ which was shortly afterwards fine-tailored between the main panel, and will be publically advocated in just a few days.

Some key writers of the Amsterdam Declaration

Some key writers of the Amsterdam Declaration

The messages of this meeting were not just limited to the four walls of the hall.  Indeed, it was broadcasted on Dutch National Television to over 3.5 million viewers, and national radio, and footage of all the presentations are now available online.

We would like to thank the organisers of this event for hosting such a stunning meeting, and may we all act on our moral and human obligations to work united in improving essential surgery for the two billion that do not have it.

ICES Writer: Haadi Tarek Shalabi is a young trainee surgeon in Nottingham, United Kingdom.  Egyptian by heritage, his passion is in improving surgical care in low-resource settings.  Contact him at haadi@shalabi.co.uk

2015: The Year for Surgery

Surgery has a crucial role to play in achieving universal health coverage and fulfilling the Millennium Development Goals. Sustainable provision of surgical care and anaesthesia is a critical part of integrated primary health care.

These needs are becoming more widely recognized by the international public health community and  by global policymakers. For the first time ever, a WHA global heath resolution has been formally proposed for 2015.

In most high-income countries, surgery and anaesthesia are integrated as part of the basic continuum of care.  However, throughout much of the developing world, surgical care remains a neglected but critically needed component of universal health coverage. When access to safe essential surgeries is deficient, easily treatable surgical conditions can lead to devastating lifelong disability, social exclusion, economic hardship, and even death. This is the reality for over a third of the global population, which lacks access to basic, cost-effective and life-saving surgical procedures to treat simple conditions such as obstructed labor, maternal hemorrhage, congenital birth defects such as clubfoot and cleft lip, traumatic injuries and accidents, soft tissue infections, and hernias.

In preparation for the 2015 introduction of a WHA global surgery resolution, we encourage all stakeholders to join in advocacy efforts by reaching out to national government representatives, professional associations, and leaders within the field to advocate for surgery and anaesthesia as critical components of universal health coverage.

For more information on the need and role of essential surgery please visit The Right to Heal and check back here on the ICES website for updates.

ICES Partners with Bay Area Global Health Film Festival

ICES is a proud partner in the Bay Area Global Health Film Festival- August 19th, 2014 in San Francisco, California.

The 2014 festival will focus on advocating for “Road Traffic Safety Locally…and Globally” a critical issue not only in San Francisco but around the world as the deaths and injuries related to road traffic accidents are slated to surpass the total of those related to HIV/AIDS, Tuberculosis and Malaria.

In simple terms more people will be permanently disabled or die because of an injury than the top 3 infectious diseases COMBINED. The good news is we know how to treat these injuries, we know exactly what we need to do to curb the statistics but we need your help!

We need to amplify our combined voices to encourage the leadership, policy makers and funders to support sustainable capacity building interventions.

The Bay Area Global Health Film Festival is an advocacy event to serve as a catalyst to spark a local grassroots movement with a global impact.

The festival is sponsored by IGOT (Institute for Global Orthopaedics and Traumatology) and the UCSF Orthopaedic Trauma Institute.

British Parliament Revisits Importance of Surgical Care in Global Health

The British parliament revisited the role of surgical care in global health with the introduction of a short debate question presented by Lord Ribeiro on 2 July 2014.  ICES’ presence through screening the Right to Heal in the Houses of Parliament featured in the both the discussion and the call to action that followed.

Asked by Lord Ribeiro: “The purpose of this debate is to raise awareness of the value of surgery as a means of delivering effective public health.”

“To ask Her Majesty’s Government whether they will support the strengthening of emergency and essential surgical care and anaesthesia by the World Health Organisation to reduce the global burden of disease.”

What followed was a robust discussion about the need for Britain and other governments to support global health efforts by addressing the need for increased access to essential surgeries. Baroness Jolly summarized the debate with her statements and highlighted the importance of participation in the WHO Executive Board Meeting in January 2015.

Baroness Jolly (LD): “The noble Lord, Lord Crisp, and my noble friend Lord Ribeiro, through their work, have highlighted the importance of surgery across the whole world, and indeed it is a key part of disease prevention and treatment, and a public health good. We welcome the All-Party Parliamentary Group on Global Health’s recent activity to highlight this issue, including the film “The Right to Heal”.

We very much support the strengthening of emergency and essential surgical care and anaesthesia in developing countries as a component of universal health coverage, and see it as an issue of great importance. To answer a question of the noble Lord, Lord Hunt, on whether surgery can relieve many of those conditions, yes, indeed—we heard many examples in this debate, including treatment of cataracts, cleft palate and fistula.

The UK supports further consideration by the WHO executive board in January—I say that in response to my noble friend Lord Ribeiro’s first question. Action must be taken to help prevent avoidable death and disability as a result of surgery. Indeed, surgically treatable diseases are among the top 15 causes of disability worldwide. Speakers today have highlighted different examples of the appalling statistics and human suffering resulting from poor training and procedures. This position can be changed by working together. The WHO process is an important part of this work and will help commit the international community to making greater progress in raising awareness, improving data and monitoring, and increasing global collaboration on this issue.”

The full transcript of the debate can be found here.

International Day to End Obstetric Fistula

Priscilla is a student in Kenya. She suffered a fistula following four days of unattended obstructed labour, nine months after she was forcibly sexually violated at age 15. 

 Because of her fistula, a condition that caused her to leak urine and feces, she was marginalized, cast aside by family and friends. Priscilla’s fistula, and the 50-100,000 new cases experienced by women every year, are totally preventable with access to essential surgery and trained medical personnel.  Because Priscilla didn’t have timely access to Emergency Obstetric Care at her District Hospital her baby died and she suffered a debilitating injury that forced her to leave school and lose the support of her family and community. One in five women giving birth face these same risks.

Fistulas can be prevented with access to essential surgery during labor and delivery and can be repaired with basic surgery for as little as USD$400.  Non-physician clinicians at District Hospitals, who are found to be performing about 70-80% of basic surgical procedures in countries like Malawi and Tanzania can be trained to prevent and correct fistula and perform other lifesaving procedures such as emergency Cesarean section.

 Priscilla, recently underwent fistula repair surgery to correct the damage done by her labour.  You can hear more about her story here.

Please join ICES and the Right To Heal in making sure all women have access to safe and essential surgery.

ICES at the World Health Assembly 2014 Global Surgery and Anaesthesia Reception

On May 21st, ICES co-hosted a private reception along with other civil society partners in Geneva in support of the World Health Assembly side event “Improving Safe Emergency and Essential Surgical Care and Anaesthesia.”

Hosting partners and sponsors included: International College of Surgeons (ICS), World Federation of Societies of Anaesthesiologists (WFSA), International Federation of Surgical Colleges (IFSC), Gradian Health, Operation Smile, The Right to Heal, Johns Hopkins University, Alliance for Surgery and Anaesthesia Presence (ASAP), Humanity First, International Federation of Medical Students’ Associations (IFMSA), Association of Surgeons in Training (ASiT), and The Lancet Commission on Global Surgery

“Surgical conditions kill more in our countries than infectious diseases”


This was among the common and pivotal messages shared by the leadership of Zambia, Rwanda, Nigeria, Ghana, Bangladesh, and representatives from other LMICs earlier in the day at the official WHA side event attended by more than 200 individuals from over 45 member states; statements supported by the governments of USA, Australia, Egypt, and Mongolia, among others. This message was reiterated by the voices of those suffering from untreated surgical conditions through a screening of The Right to Heal later in the evening reception.

There was also a commitment to taking action and agreement on strategies to move the agenda to increase surgical access forward. Strategies included:

  1. Raising awareness- to encourage surgical services
  2. Improving data- for policy decision-making- surgical services and health workforce
  3. Building political commitment- investment in surgical services
  4. Strengthening the surgical workforce- infrastructure
  5. Fostering global collaboration and partnerships through WHO GIEESC

Not only is now the time for surgery to be included in the health policy agenda“We’re 30 years too late,” The Honorable Rwandan Minister of Health Dr. Agnes Binagwaho strongly stated at the WHO side event.

There was also acknowledgement by the speakers and attendees that a lack of surgical access to emergency and essential surgeries has been an issue impacting advances in global health for more than thirty years. Without increased global access to safe anaesthesia and essential and emergency surgeries, advances in universal health coverage will be incomplete.

There was agreement between the stakeholders who gathered at the Global Surgery and Anaesthesia reception that it was time to take collective action to ensure access to safe anaesthesia and emergency and essential surgery regardless of economics or geography. It was also emphasized that although momentum is growing, we should not be complacent. The Executive Board meeting next week will ultimately decide if the proposal will move up to be considered as a resolution at the WHA 68 next year. Continued advocacy is important from all stakeholders.

ICES Presents at the House of Parliament in London

ICES and The Right to Heal supported the case for making essential surgery a global health priority to an audience of the House of Parliament in London on April 3rd, 2014.


The All Party Parliamentary Groups (APPG) on Global Health and on Population and Development and Reproductive Health joined forces to host a panel on essential surgery and a screening of The Right To Heal. The Right to Heal is the documentary by ICES co-founder Jaymie Ang Henry that puts the spotlight on the people who are sentenced to death and disability due to a lack of access to safe and timely basic surgical care – and those who are working to change this.

The session was opened by Lord Bernard Ribeiro, vice chair of the APPG on Global Health, as he welcomed the audience to the Houses of Parliament he stated, “We’re here today to talk about surgery, not as a luxury, but as something that changes lives.”

The panel included:

• Dr Jaymie Ang Henry, Director and Executive Producer of ‘The Right to Heal’ and Executive Director, ICES • Mr Michael Cotton, Chairman of the Board, ICES • Dr Iain Wilson, Past President, Association of Anaesthetists of Great Britain and Ireland and Board Member, Lifebox Foundation.

The room was full of leaders in the field – the Royal Society of Medicine (RSM), the Association of Anaesthetists of Great Britain and Ireland (AAGBI), The George Institute, Tropical Health and Education Trust (THET), Lifebox, and The Lancet Commission on Global Surgery, among other distinguished guests.

The panelist introduced the philosophy behind the making of The Right to Heal, which included a discussion about why there is global inequity in access to essential surgery and explored some of the reasons for this phenomenon.

The statements that followed made a compelling case as to why the Global community must make essential surgery part of the public health dialogue and a public health and funding priority. Among them:

“People are dying unnecessarily, and with great suffering,” said Michael Cotton, surgeon, co-founder and chair of the International Collaboration for Essential Surgery (ICES). “It’s not necessarily complicated or expensive to deliver essential surgery, it’s a cost-effective, one-off intervention with life-long results. These are the things that really need to be done.”

The panel facilitated questions and a discussion that resulted in the following points of consensus:

• Education and training is vital for providers in LMICs who are already performing surgeries; regardless of whether they are clinical officers, doctors in training or other community workers. • There is a need to drive the Essential Surgery agenda forward and make it take its right of place in the Public Health forum amongst the sustainable development goals (SDG’s). • There is a need for integrated ethical training for medical electives in overseas environments, where there is opportunity to develop clinical/surgical skills. • Raising awareness about essential surgery as a form of primary care in communities afflicted by shortages is critical to increasing access to care. • Governments have a responsibility to be receptive to change and to acknowledge essential surgery as being necessary to meeting the Public Health agenda for non-communicable diseases.

The message of the film needs to be carried forward and out into the wider public domain – Dr. Henry discussed initiatives that have already successfully done so, as well other future plans.

Lord Riberio concluded the discussion, by stating that “there is a need to take this message forward and that there needs to be a plan to enable this to happen”. With the MDGs expiring in 2015 it’s a vital time to get surgery on the international agenda and Lord Riberio called for support from the Lancet Commission and the British Medical Association (BMA).

The message is clear; a lack of access to safe surgery is a global health crisis, but like tackling polio or HIV, increasing surgical capacity not an impossible undertaking. ICES is working to contribute the solution through increasing awareness, education of policy makers, research and innovations in surgical training models.

ICES Report -The Association of Surgeons in Training- Belfast, UK

Presentation at ASIT (Association of Surgeons in Training) Belfast, UK 29th March 2014.

Thanks to the invitation of the outgoing president, Mr Andi Beamish, The Right to Heal was screened at the Association of Surgeons in Training (ASiT) conference, the only UK-wide surgical trainee conference for all specialties. Professor Michael Cotton, Chairman of ICES gave an abbreviated outline of the purpose and goal of ICES. This was followed by a presentation by Dr. Jaymie Henry, Executive Director of ICES, of the global advocacy efforts around Essential Surgery via the 15x15 campaign.

Over 600 delegates had gathered in Belfast’s spacious auditorium, where only a few months earlier, US President Barack Obama had adressed the G8 summit. Your ICES presenters felt not just a little awed at the prospect of speaking to such a large audience, which included all four presidents of the British and Irish Royal Colleges of Surgery, rarely present all together at any one event.

This was thus a huge privilege, as well as a great responsibility.

During the showing of the Right to Heal film the audience was hushed in rapt attention: indeed, when the viewing had finished, you could have heard a pin drop. Furthermore, during both talks, the same fixed concentration was virtually palpable throughout the auditorium.

Numbers of surgical trainees afterwards presented their compliments, and registered their keenness to get involved.

There was no doubt that the UK Surgeons of the future were as enthusiastic for the aims of ICES, as they were afterwards at jiving to the excellent sounds of the medical band, the Arythmics, in the grand replica dining hall of the Titanic, recreated in Belfast’s dockland.