When reflecting on the last 12 months, I am always impressed, humbled and deeply thankful for the extraordinary efforts of emergency physicians and emergency care teams in rising to the challenges of providing emergency care during the COVID-19 pandemic.

Caring for those suffering COVID-19, while themselves being under threat of infection or the not insubstantial chance of suffering severe morbidity or death is heroic. Sadly, this should not be the case.

As a doctor commented in the BMJ earlier this year “as long as the implication is generally accepted that healthcare workers have an unequivocal moral obligation to treat patients, irrespective of any risk to themselves, then governments are conveniently released from the obligation to provide a safe workplace” (Berger 2021). Emergency health care provision should not now require heroes, given what we know about how to prevent the spread of COVID-19, assess and treat patients who are affected, and implement safe environments where care can be provided. This includes the last line of defence, available and appropriate personal protective equipment for health care workers. However, despite what is known, the healthcare workforce is still not universally protected, and this comes about due to failures at the highest levels of governments. Now that there are effective vaccines, the challenge of rapid equitable distribution must be met. More than 75% of all vaccines have been administered in just 10 countries (WHO May 2021). This disparity only prolongs the pandemic in all parts of the world.

The toll on the healthcare workforce has been severe. In March, Amnesty International said that 17,000 deaths from COVID-19, which amounted to a health worker dying every 30 minutes, was a “tragedy and an injustice”, and also pointed out that this number is “certainly a significant underestimate because there is a degree of under-reporting in a lot of countries”. Recently WHO estimated that “at least 115,000 health and care workers have paid the ultimate price in the service of others.”

Emergency physicians and the provision of emergency care also continue to be under threat from orchestrated violence against states. This is despite the UN Security Council Resolution 2286 (2016) strongly condemning attacks against medical facilities and personnel in conflict situations. IFEM has joined many emergency medicine societies around the world to publicly stress the importance of ensuring the safety and independence of healthcare personnel, in accordance with the Geneva Conventions and their additional protocols. IFEM also deplores the abduction and arbitrary detention of healthcare personnel in flagrant contravention of international humanitarian and human rights law.

Over the recent past, IFEM’s work and advocacy for a world where all people, in all countries, have access to high quality emergency medical care, which has been done through advancing education and standards, collaboration and networking, and promoting the creation and growth of the specialty of emergency medicine in every country, has been underpinned by a renewed focus on equity and inclusion. This includes ensuring our Committees have diverse membership and inputs. It was therefore wonderful to receive a huge and broad response to the recent invitation for expressions of interest for IFEM committees and we welcome all new members. Development of a diversity and inclusion policy is underway, and there is ongoing work reviewing and updating all IFEM documents to ensure they are in alignment.

As a not-for-profit predominantly volunteer run entity which had relied almost exclusively upon member subscriptions and income from in person ICEMs, IFEM is working to strategically identify and develop potential new income streams in this age of virtual meetings and restricted travel. As a positive, the challenge has forced the organization to focus in depth on generating sustainable diversified income to underpin increased activity for the future.

Despite the challenges faced, IFEM has had a highly productive 12 months, due to the unstinting work of our leadership team, committees, special interest groups and taskforces and our wonderful staff and volunteers. A number of influential documents establishing standards of care, new resources for emergency care providers and researchers, and collated up to date resources on COVID-19 have been published. Our website, newsletters and resources are now provided in English, Spanish, and increasingly Portuguese, French and Chinese, and we are soon to undertake a complete website overhaul and implement better communications software. As part of the website revision, we are holding focus groups to ensure we are meeting your needs. Please find information below on how to get involved and join a focus group.

I would like to congratulate Professor Lee Wallis, IFEM Board member and a past IFEM President, who has recently commenced a new role at the World Health Organization. Sadly, this has meant Lee has also recently resigned from the IFEM Board, however he will remain involved with IFEM in a different capacity. I would like to extend the thanks of the Board on behalf of all members to Lee for his significant contributions over many years to the development of the specialty of emergency medicine in Africa and to the advancement of emergency care globally through IFEM. We look forward to working with him in his new role at WHO.

As a result of the casual vacancy on the Board, I am pleased to welcome Dr Mulinda Nyirenda, a leader in emergency medicine in Malawi and southern Africa regional representative on the Board of African Federation for Emergency Medicine, who has been appointed to the IFEM Board.

Finally, I ask all of you to become actively involved with advocacy efforts at all levels to deliver vaccine equity, reduce emergency and healthcare inequities, and to advocate for better physician and healthcare worker workplace conditions and safety. Taking time to remember our colleagues and team members who have suffered and died during the pandemic, and during conflict and violence targeting healthcare facilities, is important.

Also, take the time to look after your own health and well-being as increased risks for emergency workers for psychological distress including anxiety, burnout, depression and post-traumatic stress disorder during the pandemic are well documented. I truly hope the coming year is better than the last.