Transportation Barriers and Surgical Access in the Brazilian Amazon: A Review of Health System Gaps and Community Impact

Background: Across the Brazilian Amazon, surgical care remains critically inaccessible due to geographic isolation, dispersed populations, and fragmented transport systems. Riverine and Indigenous communities such as the Ticuna and Yanomami are particularly affected. While mobile fluvial units provide primary care, surgical capacity is lacking, and rural hospitals are often ill-equipped to handle emergencies. These gaps result in preventable suffering and worsened clinical outcomes. Objective: To synthesize existing evidence on how transportation barriers impact timely surgical access and outcomes among remote Amazonian communities. Methods: Four studies published between 2017 and 2023 were reviewed, focusing on transportation logistics, such as travel distance, river reliance, and lack of integrated infrastructure, and their consequences for surgical access and patient care in the Brazilian Amazon. Results: The review found that in areas like the Alto Solimões and Rio Purus basins, patients may need to travel hours or days to reach surgical facilities. During flood seasons, these delays increase, further limiting emergency response. Most rural hospitals lack full surgical capability: only 35% had functional operating rooms, and fewer than 20% could handle obstetric emergencies. Fluvial health units reach thousands but are not designed for surgical care. Conclusions: Overcoming these barriers requires investment in transport and surgical infrastructure, expansion of rural surgical training, and culturally informed care models. Cross-sector collaboration is essential. Future research should explore cost-effective deployment of surgical units in the region to close the equity gap.