With a projected increase in the world population from 7.2 billion currently to 9.6 billion by 2050, the population of the 49 least developed countries is expected to double from 900 million in 2013 to 1.8 billion . As such, the number of patients who may need critical care will increase substantially, with a majority of these in resource-restricted settings. Coupled with an ageing global population, the complexity of the challenge will be enormous. Infectious diseases and trauma will continue to be main reasons for intensive care unit (ICU) admission, but natural as well as man-made disasters will occasionally place additional strain on critical care services, with the largest strain again in resource-restricted settings. Healthcare expenditures vary considerably from approximately US $9400 annually per capita in the USA to less than US $20 per capita in many African countries , and with limited financial resources, the strategic priority is given to public health programs and not to more expensive services such as critical care. Around the globe, what constitutes an ICU will continue to vary in terms of structure, processes and staffing, all of which often remain inadequate in resource-restricted settings . However, the basic premise will remain the same: the outcome of critically ill patients will substantially be improved by the provision of essential critical care , and many aspects can and should be provided even if resources are low . Moving towards better critical care globally will require a multifaceted approach to address not only patient and organizational challenges, but also those related to staffing, cultural and technological aspects, as well as quality and safety. Addressing these complex challenges will certainly require involvement not only at the local ICU level but also at the level of hospitals, national societies and governments. In Table 1, we present examples of where and how critical care could and should improve, with a focus on resource-restricted settings. Some of these cases are highlighted in the following text.