Health Inequality

A third of all deaths in 2010 (16.9 million) were from conditions which were treatable with surgery. That was more than the number of deaths from HIV/AIDS, tuberculosis and malaria combined.

Two-thirds of the world's population have no access to safe and affordable surgery, according to a new study in The Lancet - more than double the number in previous estimates. It means millions of people are dying from treatable conditions such as appendicitis and obstructed labour. Most live in low and middle-income countries.

93% of people in sub-Saharan Africa cannot obtain basic surgical care. Previous estimates have only looked at whether surgery was available. This research considered whether people can travel to facilities within two hours, whether the procedure will be safe, and whether patients can actually afford the treatment.

One of the study's authors, Andy Leather, director of the King's Centre for Global Health, said the situation was outrageous. "People are dying and living with disabilities that could be avoided if they had good surgical treatment," he said.

"Also, more and more people are being pushed into poverty trying to access surgical care."

The study suggests a quarter of people who have an operation cannot in fact afford it.

Numbers of trained surgical specialists per 100,000 people

UK: 35

US: 36

Brazil 35

Japan 17

South Africa: 7

Bangladesh 1.7

Sierra Leone (before Ebola): 0.1

"Unfortunately a lot of people have given up on the hospitals because they can't find surgeons there," said Dr Duffy, consultant obstetrician and gynaecologist who has recently returned from a surgical training camp in central Uganda. "People are living in the community with debilitating conditions and they just can't find the skilled people to help them."

313 million operations are carried out worldwide each year. Just one in 20 operations occur in the poorest countries, where over a third of the world's population lives. There is a global shortfall of at least 143 million surgical procedures every year.