Reflections from UNGA81

Attending the 81st United Nations General Assembly in New York was an important and genuinely enriching experience for us. More than anything, UNGA81 reinforced how broad, inclusive and interconnected the global health space around the General Assembly has become.

What struck us most was that global surgery no longer needs to sit only within specialist surgical forums. Throughout the week, discussions on Universal Health Coverage, pandemic preparedness, development, innovation, brain health, stroke, emergency and critical care, digital health, health-system resilience and equity all had clear relevance to surgical, obstetric, trauma and anaesthesia care.

For us, this was one of the strongest messages of the week: global surgery belongs within the wider global health conversation.

Our G4 Alliance presence reflected that breadth. We were able to engage across formal United Nations meetings, global health forums, side events, bilateral discussions and networking opportunities, while also strengthening relationships within our own Alliance and with our member organizations.

One particularly meaningful part of the week was bringing members of the G4 Alliance Board of Directors together in New York. We remain very grateful to Smile Train for generously hosting our Board meeting at its headquarters, and especially to Sarah Hamilton and the Smile Train team for their warm hospitality and support. Beyond the formal meeting itself, it was valuable to bring together Board members, Permanent Council colleagues, member organizations and partners who were already in New York and create space for discussion, connection and collaboration.

Another major part of the week was our engagement with the Global Brain Economy Summit and the UN Brain Days.

At the Global Brain Economy Summit, Dr Gail Rosseau represented the G4 Alliance and the Global Coalition for Traumatic Brain Injury, helping bring injury, surgery and health systems into a wider conversation about brain health, human capability, productivity and development.

At the UN Brain Days, convened by the European Brain Council, towards a UN Brain Health Resolution, the Global Coalition for Traumatic Brain Injury was actively represented and advocated for brain injury to be recognized within the broader global brain-health agenda. We emphasized that traumatic and other acquired brain injuries should not remain peripheral to discussions on brain health, and that surgical and neurosurgical care, trauma systems, rehabilitation and long-term recovery must be part of that wider framework.

The Brain Days also gave us the opportunity to engage with leaders from neuroscience, research, advocacy, policy, international organizations and patient communities, while building new relationships around traumatic brain injury, global neurosurgery, road safety and health systems. For us, the wider value was clear: the global brain-health agenda is stronger when it includes injury and the surgical dimensions of care, alongside prevention, rehabilitation and long-term outcomes.

One of the most memorable moments of UNGA81 was the Operation Smile documentary screening, The Making of a Surgeon: Fighting Africa's Hidden Crisis.

The documentary itself highlighted the importance of strengthening locally led surgical training and reconstructive surgical capacity. But what made the evening particularly special was meeting Dr Bill Magee and Kathy Magee, the founders of Operation Smile, and hearing directly how their work began and how it grew into a global movement.

Their story stayed with us. It was a reminder that transformative global initiatives often begin with seeing a need clearly, acting on it, and then sustaining that commitment through partnerships, perseverance and time.

Our engagement also extended to stroke-focused events, the Surgical Data Science Collective event, discussions on integrated emergency, critical and operative care, and two formal UN High-Level Meetings.

The discussions around stroke were particularly relevant to the wider acute-care continuum - connecting prevention, emergency response, specialist care, rehabilitation and health-system readiness.

The Surgical Data Science Collective event was equally thought-provoking, particularly in relation to how artificial intelligence and data science are entering surgery and health systems. For us, the key issue is not simply whether innovation is technically advanced, but whether it is safe, measurable, equitable and usable in the settings where the need is greatest.

Our attendance at the High-Level Meeting on the 40th anniversary of the Declaration on the Right to Development, where the G4 Alliance was represented by Dr Gail Rosseau, Chair of the G4 Alliance Board of Directors, and Dr Neil Wetzig, President of the G4 Alliance Permanent Council, also resonated strongly with us. Access to safe surgical, obstetric, trauma and anaesthesia care remains deeply unequal within and between countries. In that context, access to essential health services cannot be separated from people's ability to participate fully in social and economic development.

At the High-Level Meeting on Pandemic Prevention, Preparedness and Response, where the G4 Alliance was again represented by Dr Gail Rosseau and Dr Neil Wetzig, the relevance of surgical and anaesthesia systems was equally clear. Oxygen systems, critical care, infection prevention and control, emergency response, operating theatres, supply chains and trained clinical teams are not peripheral to preparedness — they are part of the resilient health systems countries depend upon in both routine care and crises.

The Alliance also had a visible presence around the WHO Acute Care Action Network during UNGA week. G4 Alliance Permanent Council President Neil Wetzig, Board Director and International Federation for Emergency Medicine President Dr Janis Tupesis, and G4 Board Director John Sampson participated in the discussions, with G4 representatives speaking both from the panel and from the floor. This was closely aligned with one of G4's core priorities: advancing integrated emergency, critical and operative care rather than treating emergency medicine, critical care, anaesthesia, surgery and trauma services as isolated systems.

But perhaps the greatest value of UNGA was not only in the formal sessions.

Some of the most useful conversations happened between meetings - in corridors, over lunches, during receptions and through bilateral discussions. We met Member State representatives, international organizations, professional societies, researchers, civil-society organizations, G4 member organizations and potential new partners. Many of those conversations have already led to follow-up discussions and opportunities for collaboration.

That, for us, is one of the unique strengths of UNGA.

The General Assembly remains the world's principal intergovernmental forum, but the ecosystem surrounding High-Level Week has become much broader. Governments, UN agencies, civil society, academia, professional organizations, foundations, patient advocates, innovators and global-health communities all share the same space.

Health was highly visible throughout the week, and what I found particularly encouraging was the willingness to connect health with development, resilience, equity, technology, financing and human rights.

For global surgery, that openness creates an important opportunity.

We were not in New York simply to advocate for more surgery. We were there to demonstrate that surgical, obstetric, trauma and anaesthesia care are essential components of functioning health systems and sustainable development.

We left UNGA81 with new relationships, strengthened partnerships, and a much stronger sense that the global surgical community belongs within these wider global health discussions.

The next step is clear: to turn presence into partnership, partnership into policy, and policy into stronger health systems for the patients and communities we collectively serve.