Global Surgery as an emerging discipline: Why it thrives despite barriers-And what must happen next

Global Surgery aspires to eliminate inequities in surgical care worldwide, yet it remains a field defined by paradox. This essay critically examines its conceptual, structural, and ethical flaws and why, despite the challenges, Global Surgery continues to flourish. Ten key challenges are explored, including the absence of clear definitions, a persistent awareness-action gap, unrecognized leadership from the Global South, voluntarism without remuneration, and entrenched Global North dominance in agenda-setting and authorship. These weaknesses undermine credibility, fragment initiatives, and risk perpetuating colonial legacies. Yet the field thrives-driven by idealism, moral duty, emotional rewards, interdisciplinary engagement, and growing institutional recognition. It provides fertile ground for frugal innovation, fosters vibrant peer networks, and carries a powerful moral and historical imperative. For Global Surgery to mature into a true discipline, contradictions must be reconciled through sharper definitions, equitable leadership, South-South collaboration, sustainable financing, ethical authorship, and accountability. Partnerships must move beyond symbolism toward long-term capacity building with local ownership at their core. To translate these priorities into action, this essay critically appraises the strengths and weaknesses of the emerging discipline and provides opportunities to strengthen the new discipline. To do so, it introduces PRISM framework that structures recommendations by: Proposal, Relevance to Global Surgery, Implementation roadmap, Societal benefit, and Measurable indicators. Ultimately, Global Surgery must evolve from a movement into a cohesive, inclusive, and accountable discipline-one that delivers on its promise of safe, timely, and equitable surgical care for all. Until then, it will embody both hope and hard truths, reflecting the tension between aspiration and reality while offering a unique opportunity to reshape the future of global health.