Goal 16 - Peace and Justice

Reform to U.S. Refugee and Immigration Policies: Overlooked Solution to the Global Health Worker Shortage

There are potentially hundreds of thousands of professionals not working simply because of their refugee or immigrant status.

Discussions around refugees have defied our typically short attention spans when it comes to global challenges. The magnitude and awareness of this crisis among Americans has only been amplified by travel bans and stigma against refugees. Tensions are high, while answers to address the refugee crisis still seem far away.

Amidst the discussions of the world’s problems, however, there may be one obvious way to humanely and productively support refugees – and it’s staring right at us.

Globally, we face a shortage of 7.2 million health professionals. Yet, among the 65 million refugees in the world right now, there are potentially hundreds of thousands of professionals not working simply because of their refugee or immigrant status. A 2014 report by the Massachusetts Advisory Council for Refugees and Immigrants found that in just that one state, there were 3,000 doctors unable to work in their trained professions. Considering the millions who have fled conflicts – in addition to those who immigrate – we can estimate there are a staggering number of health professionals in a similar position worldwide.

At the same time, there are communities who face crisis-level shortages of doctors, nurses and midwives. Amid the camps of conflict zones and their neighboring countries, there is an immense need for health workers. For example, Syria has an estimated 4.8 million people who have fled the country; more than 95% are in just four countries bordering the nation state. In both settings, the burden of disease from preventable illness continues to climb because of the inadequate supply of skilled health professionals.

Some countries have tried to entice skilled healthcare professionals to work with tax cuts or similar benefits and this has seen some results. Apparently, one of the reasons so many immigrant healthcare workers are attracted to the US is because of healthcare professional disability insurance and similar discounted policies that would help them provide for their family. Though because of strict immigration laws, many healthcare professionals are not getting to where they need to be, or are prevented from working.

So what if our global leaders changed their mindset from refugees being “a problem,” and found ways that refugees can help meet urgent, existing needs? Refugee and immigrant health professionals could then work in refugee camps and/or in countries where there are critical shortages of such professionals.

The effects would be win-win-win. At-risk populations would receive much-needed care. The host country’s health system would be alleviated of overwhelming demand. The health professionals themselves could reclaim their hard-earned professions and maybe even help train future health professionals.

Programs like this have succeeded in small initiatives in Canada and the UK. Studies suggest the UK’s proactive approach to pitching this solution has contributed to the development of a political system of support. The benefits are clear: health professionals are able to apply their skills to support population needs and provide specific, culturally appropriate care to their native populations, move from a tentative refugee status to employment, integrate into their new homelands and help reduce the stigma confronting their refugee status.

To achieve this, however, there are very real policy and structural barriers that need to be surmounted. The political status of many refugees places them in an endless purgatory. Countries must be willing to create new programs and visa statuses for these individuals, and this status should be inclusive of families as a path to true resettlement, as per the J1 to Green Card route.

Also, some health professionals will need their skills updated or refreshed. Programs to help support and maintain clinical skills will need to be established, and many will need to engage in continuing education to ensure they are well-positioned to provide excellent care. These same programs can help assure quality and oversight of practicing health professionals.

One of the largest barriers, though, will be ensuring certification and verifying training. In fleeing the terrible situations they have endured, many health professionals may have lost their credentials. In these cases, civil society and refugee organizations could create a credentialing coalition or committee made of health education leaders from respective countries who can help vouch for individuals’ backgrounds, experience and training. Recipient countries and communities will also need to be flexible to accept non-traditional credentialing.

This will be a substantial undertaking, but one that could create an incredible ripple effect. By helping these health professionals stay current, practicing and committed to medicine, they will be able to help rebuild their home countries’ health systems in the future. Sustaining this group of professionals will avert a generational void – like what we have witnessed in sub-Saharan Africa for years – that would be complicated to rebuild. Devoid of health workers, these countries cannot help train their own future leaders and caregivers and are now reliant on external support to provide even basic services.

As a physician, I learned about Occam’s razor which would be used to unify a number of myriad symptoms into a single diagnosis instead of myriad separate ones. In employing qualified health professionals to work in places of need, we may have an Occam’s solution – and one that not only meets a critical global need, but restores to refugee and immigrant health workers the productivity and dignity they so very much deserve.

Vanessa Kerry, MD, MSc, is the founder and CEO of Seed Global Health, a nonprofit working in 22 sites in five countries and growing to help sustainably change health outcomes through leadership development.

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