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Critical illnesses are a major cause of morbidity and mortality in The Gambia, yet national data on critical care capacity is lacking.We surveyed eight of the eleven government-owned health facilities providing secondary and tertiary care in The Gambia's public health sector. At each hospital, a designated respondent completed a questionnaire reporting information on the presence of an intensive care unit, the number of critical care beds where available, monitoring equipment, and the ability to provide basic critical care services at their respective hospitals.The response rate was 88% (7/8 hospitals). Only one hospital had a dedicated intensive care unit with eight ICU beds, resulting in an estimated 0.4 ICU beds/100,000 population in the country. All hospitals reported treating more than 50 critically ill patients a month, with trauma, obstetric emergencies, hypertensive emergencies and stroke accounting for the leading causes of admission respectively. The country lacks any trained specialists and resources to diagnose and treat critically ill patients.The Gambia has a very low ICU bed capacity and lacks the human resources and equipment necessary to diagnose and treat the large number of critically ill patients admitted to public hospitals in the country.What is already known on this topicMost low-income countries lack any published data on critical care capacity.What this study addsThe Gambia currently has only 1 ICU with 8 beds in the public health system with an estimated 0.4 ICU beds/100,000 population.Critical illnesses account for a large number of adult emergency admissions in Gambian public hospitals with an estimated 3,000 cases annually.Using the World Health Organization target of 1 physician per 1000 population, the physician deficit in The Gambia stands at 1,866 physicians.