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World J Surg. 2017 May;41(5):1208-1217. doi: 10.1007/s00268-016-3866-6.

Beyond a Moral Obligation: A Legal Framework for Emergency and Essential Surgical Care and Anesthesia.

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Department of Surgery, Thomas Jefferson University Hospital, 909 Walnut St, Philadelphia, PA, 19107, USA.
Department of Surgery, 1015 Walnut Street, Curtis Building, Suite 620, Philadelphia, PA, 19107, USA.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
Department of Surgery, UCLA, 200 Medical Plaza Driveway #550, Los Angeles, CA, 90095, USA.
Department of Surgery, Columbia University, 177 Fort Washington Ave., New York, NY, 10032, USA.
Surgeons OverSeas, 99 Avenue B, Suite 5E, New York, NY, 10009, USA.
Department of Surgery, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.
Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa.



Access to quality and timely emergency and essential surgical care and anesthesia (EESCA) is an integral component of the right to health as reinforced by the ratification of the World Health Assembly Resolution 68.15. However, this resolution is merely a guideline and has not been able to bolster the necessary political will to promote EESCA. Our objective was to evaluate international treaties, which carry legal obligations, for EESCA-related text, and develop a human rights-based framework to support EESCA advancement and advocacy.


We conducted a comprehensive review of all the UN Treaty Collection-Certified True Copies (CTCs) of multilateral treaties database from December 2015 to April 2016. The relevant text was manually searched to abstract and analyze to identify major themes supporting a human rights-based approach to EESCA.


Multiple treaties in the UN database addressed EESCA in the areas of human rights, refugees and stateless persons, health, penal matters, and disarmament. A total of 13 treaties containing 23 articles had language that endorsed aspects of EESCA. The three major themes, supported by the phraseology in the treaties, included: (1) equal access to EESCA (eight articles); (2) timely care of injured and those with emergency surgical conditions (eight articles); and (3) protection, rehabilitation, psychosocial support, and social security (seven articles).


A number of United Nations multilateral treaties support available and equitable EESCA. These findings can be used to galvanize support and encourage signatory Member States to promote and implement EESCA development initiatives.

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