The Urgent Need for Emergency and Critical Care in Africa

When someone becomes critically ill, we expect hospitals to provide life-saving care. However, in many African countries, this expectation does not match reality. Intensive care units (ICUs) are rare, and most critically ill patients receive treatment in general wards with limited access to essential emergency and critical care (EECC). Until now, there has been little data on the extent of this issue.

To address this knowledge gap, we conducted  the African Critical Illness Outcomes Study (ACIOS)—the first large-scale study to assess critical illness care across the continent. The study was a collaboration with the EECC network, a global network of clinicians, policy makers and researchers that has been built up over the past decade.

This research highlights a concerning reality: one in eight hospital inpatients in Africa is critically ill, over two thirds are in general wards (not specialist units), and one in five of them dies within a week.

The Scope of the Problem

Critical illness refers to a life-threatening condition where at least one vital organ—such as the heart, lungs, or brain—is failing. Critical illness can be due to any infection, injury, or disease. In well-resourced hospitals, some critically ill patients are cared for in ICUs, to receive continuous monitoring, oxygen, and medication to stabilize their condition. However, in many African hospitals, ICU care is not available.

Before ACIOS, most data on critical illness in Africa came from small, single-hospital studies. While these studies hinted at a serious problem, a continent-wide analysis had been missing.

Key Findings from the African Critical Illness Outcomes Study

ACIOS was conducted between September and December 2023, collecting data from 180 hospitals in 22 African countries and includes nearly 20,000 patients. The results paint a stark picture:

• 12.5% of hospital inpatients are critically ill..
• 68.6% of critically ill patients are treated in general hospital wards, not ICUs.
• More than half of critically ill patients do not receive the EECC they need.
• Patients with critical illness are nearly eight times more likely to die in hospital than non-critically ill patients.

The study exposed critical gaps in basic life-saving interventions:

• Only 48.4% of patients with respiratory failure receive oxygen therapy.
• Just 54% of patients with circulatory failure (such as shock) receive fluids or medications to stabilize blood pressure.
• Less than half of patients with dangerously low consciousness levels receive airway protection or are placed in the recovery position.

These findings reveal an urgent issue: many critically ill patients in Africa are not receiving the essential treatments that could save their lives.

Strengthening Essential Emergency and Critical Care: A Way Forward

Thousands of lives could be saved if hospitals provided essential emergency and critical care. EECC is a set of simple, low-cost interventions including:

• Ensuring oxygen availability for patients struggling to breathe.
• Providing fluids or medications to stabilize blood pressure in patients with circulatory failure.
• Training healthcare workers in basic life-support techniques to manage unconscious patients.

Unlike high-cost ICU care, EECC can be implemented in general wards with minimal resources. Increasing EECC provision  could dramatically reduce preventable deaths from conditions such as pneumonia, sepsis, and trauma.

Implications for Policy and Global Health

This study reveals a neglected  healthcare crisis affecting millions of people. Improving critical care in African hospitals does not primarily require building more ICUs—it’s about ensuring that every critically ill patient receives the basic life-saving care they need. Relatively simple, affordable improvements—such as increasing oxygen availability and training staff in emergency care—could prevent thousands of unnecessary deaths.

A Call to Action

Governments must make essential emergency and critical care part of universal health coverage. The WHO should integrate EECC into global health strategies, including as a foundation of the World Health Assembly resolution 76.2 on Emergency, Critical and Operative Care. Funders must prioritize EECC research and implementation, especially in low-income countries. Medical societies should include EECC in guidelines and training. Researchers, clinicians, and policymakers can collaborate through The EECC Network to share knowledge and drive change. We urge readers and decision-makers to advocate for immediate action—because providing life-saving care to critically ill patients is a medical and ethical necessity.