Introduction Emergency medicine is a medical speciality that focuses on the immediate diagnosis, resuscitation, and treatment of patients suffering from acute illnesses or injuries. Emergency surgery (ES) is a type of surgery that is performed in an emergency, such as when a patient has a life-threatening injury or condition that requires immediate surgical intervention1. ES is an essential component of health care systems all over the world, providing life-saving care during times of crisis and trauma1. However, a significant portion of the African population does not have access to emergency surgical care, which is a major concern. The problem is not just a lack of access. Even when emergency surgical services are available, there is frequently an excess of demand2. This could be attributed to the high prevalence of medical emergencies such as accidents, injuries, and infectious diseases. Most African countries that have reported ES delivery have reported a massive number of ES cases and surgeries performed annually compared with elective surgeries but with significant management gaps. According to the statistics, ES accounts for a significant portion of surgical procedures in major African countries. Ghana has 48% of ES cases, whereas Uganda has 75% of all procedures as surgical emergencies, Mozambique has 57% of operations as emergency procedures, and Ethiopia has 93.2% of emergency operations performed on an emergency basis.3–5 (Figure 1) These figures are astronomically high when compared with most high-income countries, such as the United States.Figure 1: Map Representation of African countries on Emergency Surgery Gaps3–5 (created with MapChart.Net).It is also worth noting that these statistics only provide a snapshot of surgical emergencies in these countries and do not necessarily reflect the overall health care in these regions. The combination of a lack of access and an excess of demand for ES services is a major source of concern because it indicates a higher risk of complications and death from treatable conditions, as well as long-term disability and a lower quality of life2. Gaps in ES delivery, causes, and consequences on the African Continent A variety of factors contribute to the large gaps in ES delivery in Africa. The lack of emergency care centers is a significant barrier to providing adequate care. Patients who have surgical complications and require ES are supposed to receive immediate medical attention from a nearby hospital, but most hospitals in Africa are unable to provide these patients with the best possible care. Most hospitals lack a prehospital care system, which includes a paramedic team, first aid, and an emergency helpline. Hospitals in most African countries, such as Tanzania, lack fully functional emergency departments6. They frequently rely on the reception units, which are simply the main entrance to the hospital as casualty rooms. Often, little or nothing is done to confirm a diagnosis or receive immediate medical care. Furthermore, the casualty rooms are understaffed and not properly equipped to handle critically ill or injured patients. Other African countries, such as Uganda, Kenya, and Ghana, have fewer than half of all hospitals capable of providing 24-hour emergency care, and <65% of hospitals have basic infrastructure components such as reliable water and electricity. The availability of basic infrastructure in clinics is even lower, with facilities ranging from 7% to 35%2. Oosting and colleagues discovered deficiencies in the availability of basic surgical equipment in 9 African countries (Kenya, Zambia, Ethiopia, Zimbabwe, Uganda, Malawi, Congo, Mozambique, and Nigeria), primarily in the public district and rural hospitals. (Figure 1) Furthermore, most hospitals and clinics lack basic surgical equipment such as operating tables, anesthesia machines, and monitoring devices, all of which are required for safe ES. Even if these medical devices exist, more than half of African countries lack the means to maintain them2. Furthermore, systemic issues such as poverty, political instability, and most Africans’ cultural indifferences exacerbate the problem. A large number of people in Africa struggle to pay for their surgeries due to a lack of cash. An Ethiopian study found that two-thirds of emergency abdominal surgery patients could not afford their procedures. Each year, ~81.2 million patients face financial constraints, according to the Lancet Commission on Global Surgery, with Africa accounting for the majority of these figures7. The percentage of people in African countries who do not have enough money to pay for surgery varies, with Burundi ranking first at 91%. Moreover, a Malawian study found that 90%–97% of patients who underwent hernia surgical procedures in district hospitals lacked funds. A subsequent study from Rwanda revealed that only 28% of patients were at lower risk of a lack of funds to provide for peritonitis surgery because they were covered by community-based health insurance6, indicating that 72% of these populations face serious financial difficulties due to inadequate insurance coverage. Concerning political instabilities, devastating conflicts in countries such as the Democratic Republic of the Congo have had devastating impacts on the health care system, particularly due to massive health care infrastructural destruction, resulting in huge surgical health care workers’ deficits. Their medical educational systems were also severely impacted, resulting in significant deficits such as the absence of emergency medicine and surgery establishments as of 20158. Cultural factors also have a significant impact on the acceptance and implementation of certain medical procedures. Traditional medicine and health care are used by 80% of people in rural Africa. They also have limited or no access to most government health care facilities, making them more likely to seek care from traditional healers before going to a hospital, especially when things get bad. Because of this major issue, there are numerous cases of delayed surgical case presentations, resulting in high demand for ES cases. Also, the populations in these indigenous regions have a high level of distrust in the health care system, which stems from a variety of factors such as poor health care attendance and high mortality rates after surgeries. Other barriers, such as long distances between hospitals, particularly in rural areas, and poor transportation services, such as bad roads, have been grossly underestimated. According to a study conducted in SSA9, transportation availability and quality was identified as a major barrier to accessing health care, particularly emergency surgical care. In some cases, patients had to travel extremely long distances on foot or by bicycle to reach the nearest health care facility, and the journey was either too long or too expensive for many. The shortage of surgeons and trained personnel is also a complex issue influenced by a number of factors, including a lack of funding for surgical training programs, limited opportunities for continuing education, and low surgeon salaries. The surgeon shortage has serious implications for the availability of ES care in most rural areas and throughout Africa. The majority of African hospitals, particularly those in district or rural areas, have few or no surgeons. In general, the availability of emergency health personnel in Africa is unexplored and unspoken. There are also significant research gaps on ES cases to critically assess the continent’s problem, despite the fact that they have the greatest needs. Given Africa’s massive infection control issues, inadequate infection control implementation is a major setback for ES in Africa. In comparison to Rwanda, which has made significant progress in providing these necessities, the availability of essential infection control measures such as soap, running water, latex gloves, and disinfectant in assessed areas is relatively low or nonexistent in Kenya, Ghana, Tanzania, and Uganda2. Poor infection control practices can lead to the development of serious infections and exacerbate ES cases. Poor emergency surgical delivery in Africa can have serious and far-reaching consequences, including increased morbidity and mortality, as well as negative economic and social consequences. Certain medical emergencies, which are so common in Africa, such as traumatic brain and spinal cord injuries, acute appendicitis, strangulated hernias, emergency cesarean section cases, and severe bone fractures, would have severe complications and a high mortality rate if not treated immediately. Improving emergency services in terms of quality, access, efficiency, and timely administration has the potential to reduce mortality by 45% and disability by 36% in LMICs10. Recommendations Emergency surgical care is critical in all health care settings and requires a great deal of attention and quality. This could be accomplished by increasing government funding for health care and expanding and improving surgical health infrastructure. It is also critical to ensure that basic necessities, such as stable sources of water and electricity, are available in hospitals and clinics. Creating a prehospital care system that includes paramedic teams, emergency hotlines, and first aid can also help to improve the availability and quality of care. Implementing an effective community-based health insurance program can also aid in making emergency care more accessible and affordable to Africans. Systemic issues such as poverty and cultural drawbacks should all be addressed. This could be accomplished through effective public health awareness and appropriate educational strategies. It is also critical to improve transportation systems so that people can get to emergency care facilities. This could include spending money on better roads and public transportation, as well as creating referral systems to ensure that patients receive the appropriate level of care. Increased emergency care facilities in rural areas can also help to ensure that people in these areas have access to care. Implementing a system for tracking and analyzing emergency care data can assist in identifying areas for improvement and informing future efforts to address Africa’s lack of emergency care. This can also serve as a solid foundation for ES research on the continent. Finally, collaborations between African nations and international organizations and nongovernmental organizations that can bring resources and expertise to bear on the issue will be extremely beneficial. These organizations can offer valuable assistance in the form of funding, training, and other resources to help improve the availability and quality of emergency care in Africa. Ethical approval None. Sources of funding None. Author contributions All authors have met ICMJE authorship criteria. Conflicts of interest disclosures None. Research registration unique identifying number (UIN) None. Guarantor Favour Tope Adebusoye.