The Missing Room

by Dr. Ala Nazir, DEJ lead

Global Surgery at the Commission on the Status of Women - Part 1

March in New York carries a particular energy. Outside the United Nations, 193 flags line First Avenue, still managing to feel symbolic even after you have walked past them several times.

Inside, the corridors fill early. Delegates, mission representatives, civil society advocates, youth delegates who have practised their two-minute interventions until the words arrive without hesitation. For some, this is just another workday. For others, being here reflects years spent navigating institutions just to get here.

One speaker reminded the room that simply being there was a privilege. Not because of access, but because many people with valuable experience never make it in at all. Visa barriers, funding limitations, institutional constraints. If you are here, make it count.

After days of hallway conversations and sessions where new health priorities were discussed one after another, surgery rarely appeared in those discussions.

That absence raised a quieter question: where does surgical care fit within conversations about gender equity?

The Agenda That Was Missing

That question becomes harder to ignore once the sessions begin. The Commission on the Status of Women is built around gender equity. The rooms are full. The language is urgent. And yet surgery is largely absent from the agenda, from financing discussions, and from the negotiated conclusions member states spend the week shaping.

The absence is striking when you consider what surgical care actually addresses. Obstetric emergencies. Ectopic pregnancies. Injuries after gender-based violence. Obstetric fistula across low- and middle-income countries. Each depends on functioning surgical systems: trained providers, safe anaesthesia, reliable referral pathways. These are not peripheral concerns. They sit at the centre of women's health.

Yet in policy conversations they rarely appear as surgical care. They arrive instead as maternal health, reproductive health, or gender-based violence. All important. All urgent. But the surgical systems required to treat these conditions quietly disappear inside those broader programmes.

Women's surgical care has long remained in that gap.

During a session on How Inter-agency Pooled Funds Strengthen Financial Accountability and Partnerships for Gender Equality, I requested the floor to offer an intervention: ‘pooled funding mechanisms have demonstrated real accountability in infectious disease programmes, yet surgical care remains a persistent blind spot in those same reports.’

One of the panelists acknowledged that similar concerns surface across many sectors in global health, each feeling underrepresented in financing discussions. The intervention led to follow-up conversations after the session. What emerged across those exchanges was not resistance but unfamiliarity. Global surgery had simply not entered the conversation as a distinct priority within how global health financing is usually understood. That unfamiliarity helps explain why surgical care so often disappears into broader health categories without being named directly.

There were conversations at UNCSW that did move: gender-based violence, digital harassment, economic exclusion. The language around them was specific, and in some rooms gender-fluid and queer identities were named with deliberate care. But naming something is not the same as acting on it. At times inclusion is most visible in the language of these spaces, while the structural changes it implies are slower to follow.

Surgery rarely enters that conversation. It does not arrive with the same cultural legibility. It becomes the clause after the comma, the page nobody quite finishes turning.

The Limits of Participation 

Youth delegates arrive with genuine intent, clear frameworks, and something real to contribute. Among them are a few of us working on surgical access within universal health coverage and the SDG 2030 targets. Once the sessions begin, the structure of participation becomes clearer.

Plenary sessions are open, but the substantive work happens elsewhere. Mission meetings, where member states negotiate language and push agendas forward, remain closed to civil society delegates. The seat available is at the advocacy table, not yet where decisions are made.

What fills the hours instead is networking. Side event receptions, hallway conversations, LinkedIn exchanges with senior advocates who have attended the same conference for years and understand exactly how the room operates.

None of this is meaningless. Relationships matter in diplomacy. But as the week goes on, a more uncomfortable question starts to surface.

Are we actually participating in the process, or simply present within it?

The delegate is present, visible, photographed. Last year's intervention appears again this year, slightly revised, in a slightly different room.

Building The Room 

For global surgery, there is no room. Not because the space is crowded or there is a waitlist, but because the room was never built, even here, in a building designed for global conversations.

Until surgical systems are explicitly financed, protected, and monitored, rather than footnoted into someone else's programme, equity in global surgery remains largely rhetorical.

Building that room will take more than conversations here. It begins in national systems, institutions, and grassroots efforts that shape which issues reach global agendas.

The real question is not who spoke in March, but who controls the budget in May..

To be continued...