As coronavirus spreads, refugee doctors want to join the fight
NEW YORK – When Lubab al-Quraishi heard that officials in New Jersey would allow internationally trained medical workers to help the city fight COVID-19, she quickly filled out an online application. Six years after arriving in the United States as a refugee from Iraq, she hoped finally to practice medicine again.
Lubab, 47, had been a pathologist in her homeland before her brother’s work for the United States military forced her to flee. A bullet struck her windshield as she drove to work one day and she realized she had no choice but to leave the country.
With no money or time to study for the medical exams, she worked as a cashier at a fast food restaurant in Texas. Finally, she learned about an opening to work as a pathology assistant in New Jersey and moved there along with her husband and two daughters.
Now Lubab has a chance both to help her new country and to work as a physician. At the start of the outbreak, she volunteered to administer tests for the virus. And last month, she received her temporary license to practice medicine in New Jersey for six months, and possibly longer if the emergency continues.
"Now you realize there are internationally trained physicians here … and recognize we can help.”
“Now you realize there are internationally trained physicians here … and recognize we can help,” she recalled thinking when the governor announced the emergency measures.
With the pandemic continuing to spread and claim lives around the world, New York is one of six American states making it easier for refugees, immigrants and migrants who trained overseas to practice medicine – at least during the crisis – by expediting or easing residency and licensing requirements.
“We are now pushing to ensure that progress is permanent," said Esther Benjamin, CEO and executive director of World Education Services, a non-profit organization in New York that helps international students and immigrants put their training and skills to use in the US and Canada.
Faced with potential shortages of medical workers, several countries around the world have taken similar steps.
Among them are Peru, Chile and Argentina which recently began allowing foreign-trained refugee doctors, nurses and others with medical training to work during the COVID-19 response.
In Mexico, UNHCR is working with the government to help accelerate the licensing of foreign-trained nurses, doctors and other medical workers to join the country’s emergency pool of workers. UNHCR, the UN Refugee Agency, has identified about 100 refugee health professionals and is currently working with the Ministry of Education to accelerate their title revalidation.
In Colombia, the government allows Venezuelans who have validated medical credentials to work as doctors and nurses. The Ministry of Health is currently working with the Association of Health Professionals to recruit more health workers into the national health system.
Albert Cova, 34, a physician who fled political, social and economic crisis in Venezuela four years ago, is now working in the Colombian border city of Cúcuta in the coronavirus isolation area of a local hospital built with in part with help from UNHCR.
One of the hardest parts of his job, he said, is connecting with children he treats from behind the protective gear he must wear to protect himself from contagion.
“I try to make the kids feel calm,” he said, adding that he must calm himself as well. “It makes me panic to think I could be infected and spread [the virus] to my family. However, when you decide to be a doctor, you have to face such things.”
Refugees and immigrants trained in medicine represent a large untapped pool of talent in many countries with time-consuming or expensive re-certification procedures and regulations. Many arriving in a new country must find work right away to survive and cannot afford to repeat education and training. Some try but cannot land residencies – which are required by all states in the US – or clinical experience.
The result is that hundreds of thousands of skilled medical professionals around the world are working in jobs that have nothing to do with their training – often low level jobs that require barely more than a high school degree. In the United States alone, as many as 263,000 immigrants and refugees with health-related degrees are unemployed or under-employed, according to the Migration Policy Institute think-tank.
“There’s a dignity question involved when ... you’re not able to use the expertise you trained for.”
“There’s a dignity question involved when you are forced to work in spaces you weren’t set up for, in jobs you are overqualified for, and when you’re not able to use the expertise you trained for,” said Nili Sarit Yossinger, National Director for the Refugee Congress, an advocacy organization in Washington, D.C. “It’s hard to feel you’re part of the community, it’s hard to feel like you’ve really made it.”
Hussam Nash, a physician trained in Iraq, settled in the United States in 2007 after fleeing persecution and violence. He hoped to practice medicine when he arrived but ended up earning the minimum wage at a video game arcade in San Diego, California.
Hussam eventually passed the United States Medical Licensing Exam but then struggled to be accepted into a residency program. Many hospitals only wanted recent medical school graduates, and Hussam could not tap into a network of peers or mentors to recommend him for positions in those hospitals willing to consider his application.
“When COVID-19 happened, honestly I felt sad every day that I could not practice medicine."
When he did get interviews, he felt they were simply out of courtesy. Finally, in 2018 Hussam earned a masters degree in public health. He is now working for the government's Special Supplemental Nutrition Program for Women, Infants & Children as an administrative nutrition manager in Philadelphia – a role which does not draw on his long years of medical training. Since the pandemic began, he has felt an urge to contribute more.
“When COVID-19 happened, honestly I felt sad every day that I could not practice medicine,” he said. “We have a good life, but as a passion, as a dream, it’s not what we looked for.”
Many countries were already struggling with shortages of health care workers before the COVID-19 pandemic. The United States is projected to be short as many as 122,000 physicians by 2032, according to the Association of American Medical Colleges – and it is not alone.
Peru has grappled with a shortage of medical professionals for several years, according to the Peruvian Medical Federation. It is time-consuming and expensive to validate a foreign medical license.
Carmen Parra, 35, a doctor who once practiced in San Juan de los Morros in central Venezuela, arrived in Peru after fleeing violence in her home country two years ago. She worked as a waitress and in retail sales before landing a job that was the closest she could come to practicing her profession – as receptionist for a medical clinic.
“I had no money to afford anything other than the essentials for my family,” Carmen said.
Her life changed when an organization working to help Venezuelan doctors validate their license helped her get into a pilot program supported by UNHCR. Within months, she received her credentials and went back to the medical clinic – this time to work as a doctor.
When the clinic closed because of the pandemic, she applied to help the country’s Covid-19 response. She now works four days a week in an ambulance traveling to reach people with suspected infections and transporting the critically ill to hospitals.
Countries around the world have put in licensing procedures to keep people safe. There are ways to ensure quality while still allowing refugees to contribute. UNHCR has supported several innovative approaches to allow medical practitioners work in their chosen fields by putting them on a pathway to eventual licensing or certification.
The Council of Europe and UNHCR last month recommended states use the European Qualifications Passport for Refugees, which helps to document and validate overseas qualifications, to give more refugee healthcare workers a way to participate in the COVID-19 response. And Europe has seen several countries experiment with ways to bring refugee and migrant healthcare workers to contribute their skills.
Ireland, France and the United Kingdom are considering measures that would make it easier to enlist refugee and migrant doctors to help respond to the coronavirus.
"We are really focused on how do we get the internationally trained on a pathway ... this has opened doors.”
In France, the government has allowed foreign-trained doctors to work, but only under supervision or in overseas French territories. In the Saxony region of Germany, officials are considering measures that would allow them to serve in supporting roles only.
In many countries, overcoming the perception that degrees from overseas are not good enough is a challenge. But advocates for refugees and immigrants say you can maintain high standards while still cutting down on unnecessary and expensive bureaucracy.
The pandemic has led some governments to remove unnecessary obstacles. And they hope now that refugees and immigrants who trained overseas are risking their lives, the countries they are supporting will support them – even after the emergency ends.
“Through COVID, we are really focused on how do we get the internationally trained on a pathway that is not sacrificing quality but reducing redundancy,” said Jina Krause- Vilmar, president and CEO of Upwardly Global, an American nonprofit organization that provides job coaching, networking and skill-building programs for refugees and migrants. “This has opened doors.”
With additional reporting by Regina De La Portilla from Peru, Fernando Hernandez Parada in Colombia and USA for UNHCR.