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Moroccan doctors check Syrian woman after her caesarean section, in a field hospital in Al Zaatari refugee camp in the Jordanian city of Mafraq, near the border with Syria, March 7, 2016. Since the beginning of the Syrian crisis, 50-80 Syrian children were born in the Zaatari refugee camp each week, according to the official website of UNHCR. REUTERS/ Muhammad Hamed  SEARCH "HAMED BORN" FOR THIS STORY. SEARCH "THE WIDER IMAGE" FOR ALL STORIES - RTX293RK
Future Development

Amid growing need, refugee health workers could fill key gaps

Kent Garber

Over the past six years, at least half of Syria’s 30,000 physicians—perhaps more, no one knows for sure—have fled the country. Like other Syrian refugees, they have gone wherever they can: Lebanon, Jordan, Turkey, Europe, and, in much smaller numbers, Canada and the United States.

Author

Kent Garber

Consultant, Health, Nutrition, and Population, World Bank

Meanwhile, in many receiving countries, the supply of health workers is shrinking. Europe is aging. Doctors are retiring. Fewer young physicians are being trained. And long before the Syria crisis erupted, some countries in Europe had already begun recruiting foreign health workers to fill the gap. Amid this backdrop, as the flow of refugees from Syria has continued, the demand for health services has increased and supply of workers to meet these demands has shrunk.

The staggering health toll of the Syrian civil war, which marked its six-year anniversary last week, is most obvious inside Syria, where the average life expectancy has plummeted by nearly 20 years, but it is also the fact for many refugees. Mental health issues are rising; previously eradicated communicable diseases are remerging; and untreated non-communicable diseases are resulting in complications.

That is why several multinational actors—including the Organization for Economic Cooperation and Development, the Center for Mediterranean Integration, and the World Bank—are starting to explore country experiences with one line of response: creating opportunities for refugee doctors, nurses, and other health workers to serve the communities where they live.

Getting a job as a health care worker is not easy. Every country has important rules for how medical professionals are educated, trained, and licensed. The system—from formal education to examinations to practical training and professional certification—can be byzantine enough for someone who grew up in it, let alone a refugee encountering it for the first time. Language and cultural barriers loom large. Financial and political interests often intervene.

Nor should certain barriers be dismissed. Doctors and nurses, after all, are held to high standards, and for good reason. They are entrusted with making decisions at critical moments in people’s lives. And politically, it is not always easy giving jobs to refugees when host populations lack livelihoods.

But that has not prevented some countries from making refugee health workers part of the solution nor discouraged others from taking reasonable steps to harness their skills and knowledge. Sweden, for example, has created a fast-track program to streamline the process of credentialing refugee physicians. Scotland, just last month, announced that it has begun to retrain Syrian doctors to fill vacancies in the United Kingdom National Health Service. Other nations, such as Turkey, have taken notable steps to allow Syrian doctors to care for refugees in refugee health centers.

These are important first steps. But these ideas need to be shared, discussed, and supported where feasible and possible, through collective efforts by Middle East and North Africa and OECD countries, including government, multinational agencies, academia, and other stakeholders.

It is not the first time the world has faced these questions. During World War II, the U.K., after significant opposition from its leading medical associations, ultimately agreed to recognize refugees’ foreign doctor degrees and granted them an increasing number of medical posts as the war progressed. In the 1950s, Palestinian refugees were allowed to begin practicing medicine in Egypt. In the 1980s, the Canadian province of Manitoba created an expedited training program for refugee physicians to help fill vacancies in underserved regions.

These are just a few examples. But in all of these cases, policymakers faced a critical question: whether to view refugee health workers as a source of human capital and a potential benefit to their communities or to view them as a burden or dismiss them entirely.

Some country experiences show that the former can be a win-win. By resuming their education, training, and livelihoods, refugee health workers are able to maintain their skills, restore their dignity, and serve the community. Many have gone through the same traumas as fellow refugees, speak the same language, and are uniquely positioned to care for them. For host countries, refugees can provide a pool of highly trained health workers—not just doctors and nurses but also pharmacists, social workers, physical therapists, and others—to fill gaps and meet the increased health demands caused by conflict.

Yet focusing on the challenges, rather than solutions, may be the historical default. In 1952, in the aftermath of the World War II, the World Health Organization found itself grappling with a large number of refugee physicians. It sent a cable to Louis Bauer, then secretary-general of the World Medical Association, asking what could be done. “Our latest information is that it is a matter of law,” Bauer wrote back, “and there is not very much that medical societies can do.”

Bauer was half right. Laws do matter. But laws can also adapt to reality; in 2015, Germany’s parliament passed a law allowing refugee doctors to work with licensed doctors in German refugee centers that were caring for more than a million displaced people.

True, mass displacement is placing new strains on health systems around the world. But perhaps those who have been affected most—the refugees themselves—can be part of the response. 

This blog was first launched in September 2013 by the World Bank in an effort to hold governments more accountable to poor people and offer solutions to the most prominent development challenges. Continuing this goal, Future Development was re-launched in January 2015 at brookings.edu.

For archived content, visit worldbank.org »

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