Doctors With New Borders
Syrian doctors are seizing the chance of a new life in Germany, where practitioners are in short supply
ABU MOHAMMED, A BESPECTACLED DOCTOR, sits at a desk in a nondescript, rectangular room littered with hand-scribbled notes on lined paper. The 30 year old is clad in a button-down shirt, jeans and sneakers. A white coat is nowhere to be seen. Across from him is an ‘ailing patient’.
The doctor begins evaluating the basics: How is the young man feeling? Can he describe his pain? “I have fever and a headache,” he complains.
“For how long have you had these symptoms?” Mohammed presses, in neat but accented German. “Several days,” the patient replies.
“May I do a quick exam so we can find out what’s going on?” Mohammed asks. The patient obliges. Then, the two men swap roles. Over three hours on an overcast November morning in central Germany, Mohammed, an orthopaedic surgeon, rattles off diagnostic questions to a handful of ‘patients’ – immigrants enrolled in medical-language class. Today their vocabulary includes Verhütungsmittel (contraceptives), Röntgenstrahl ( X- ray), and “Ist es eher ein stechendes oder brennendes Gefühl?” (“Is it more of a stinging or burning sensation?”).
Mohammed also works through a textbook and worksheets that he keeps tucked inside a child’s Winniethe-Pooh folder. The image reminds him of his nine-month-old son, who is more than 3200 kilometres away.
“My son is growing up without me, and you don’t get another firstborn,” he says. “It’s burning me.”
Mohammed is Syrian, and like many of the war-torn country’s doctors, he has fled his homeland to seek work and safety abroad. ( To protect his family, he asked that his real name not be used and that neither his exact location in Germany nor hometown in Syria be identified.)
BEFORE THE CONFLICT, Syria had roughly 31,000 doctors, according to the country’s Ministry of Health. Today, Physicians for Human Rights ( PHR) estimates about half have left the country, and hundreds more medical personnel have been detained or killed.
While the vast majority of Syria’s 4.9 million refugees remain in the Middle East, many countries there make it difficult for displaced doctors to practice. And getting permission to work in the US, Britain and other Western countries can take years.
Germany, though, is welcoming Syrian doctors by granting shortterm visas so they can avoid the crowded refugee process. (In 2015, some 430,000 Syrian asylum seekers
entered Germany.) More than 2000 Syrian physicians are now working in Germany. “When Syrian doctors flee, it’s right to give them refuge and to integrate their professional skills,” says Maria Michalk, who chairs the German government’s committee on health.
Beyond the humanitarian gesture, however, Germany needs doctors. One in six doctors is almost 60 years old. And every year, thousands leave to work abroad. By 2030, it’s estimated German hospitals will lack 110,000 doctors needed to serve a rapidly ageing population: more than 20 per cent of Germans are 65 or older. Germany has been hiring foreign physicians for several years, many from eastern EU countries. While Romania contributes the most physicians – some 4000 are practicing in Germany – Syrians escaping bloodshed are not far behind.
SYRIA’S HEALTHCARE SYSTEM was once the pride of the Middle East. Over the second half of the 20th century, the government invested heavily in public health: life expectancy increased from 59 years in 1970 to 73 years for men and 77 for women in 2009. “By and large, the system worked well,” says Professor Fouad M. Fouad, a Lebanon-based surgeon from Aleppo, Syria. “An ordinary citizen could get cancer treatment, cardiovascular treatment, and even small towns had primary-care clinics.”
Mohammed, whose extended family includes several doctors, knew from childhood that he wanted to work in medicine. “I’ve always liked helping people,” he says. In 2011, however, as he was finishing his orthopaedic training, war put a cruel end to his dreams – and Syria’s medical achievements.
At first, Mohammed wasn’t concerned by Syria’s burgeoning street protests; he had watched Tunisia’s and Egypt’s dictators fall and assumed President Bashar al-Assad would follow. But things took an ugly turn when police began firing on demonstrators. Soon, medical facilities became targets in an all-out civil war.
Mohammed remembers soldiers arriving one day at the hospital where he worked. “They said, ‘ You’re treating rebels,’” he says. “They ordered us out and put mortars on the roof.”
HOSPITALS AND DOCTORS ARE PROTECTED UNDER THE GENEVA CONVENTIONS, BUT IN PARTS OF SYRIA THIS IS DISREGARDED
Hospitals and doctors are protected under the Geneva Conventions, but in parts of Syria this is disregarded; government forces in particular use attacks on the healthcare system as weapons of war. When a doctor is killed, explains Widney Brown, PHR’s director of programmes, you also lose the people she or he may have saved. According to PHR figures, since the conflict began, more than two-thirds of hospitals in Aleppo, for example, have ceased functioning, and 95 per cent of doctors are gone.
FOR A FEW YEARS, Mohammed was one of the lucky ones. He volunteered at hospitals and field clinics for rebel fighters, treating abdominal injuries, shattered bones and other wounds with limited resources. It was risky: with transportation disrupted, he had to travel on foot, often carrying heavy bags with intravenous fluids and surgical equipment. Meanwhile, government officials were grilling captured fighters to find out which doctors had assisted them.
One day in early 2014, Mohammed was detained at a government checkpoint and taken to a police station cell, where he was interrogated for more than two weeks. Officers attached electrical nodes to his hands, threatening to shock him if he didn’t confess to aiding rebels. He managed to convince them he was innocent and was released with a warning.
Certain that government eyes would be on him, Mohammed decided to flee. He hired a driver who knew the checkpoints where soldiers could be bribed and sped towards one of Syria’s neighbouring countries. (To protect the safety of others on this route, he asked that the country not be identified.) He made it across the border.
Mohammed then sent for his wife, also a doctor. But neither could get a work visa. The couple, by then expecting their first child, resolved that Mohammed would try to secure work in Turkey, which they’d heard tolerated Syrian doctors working there. His wife would return to her family in Syria to give birth.
In Istanbul, Mohammed learnt that the Turkish government would not license refugee doctors (it now does allow Syrian refugees to work). He considered the US, but discovered that though he spoke English proficiently,
MOHAMMED HAD NEVER PLANNED A LIFE OUTSIDE THE MIDDLE EAST. YET HE SET OFF FOR THE GERMAN EMBASSY IN ANKARA
he’d need a formal job offer to apply for a visa. As for Britain, he got lost in the maze of requirements for obtaining a visa, including exams to pass, and certifications to acquire.
Living in a hostel and separated from his family, Mohammed was growing despondent. Then a surgeon friend originally from his hometown called from Germany to say he had a visa, an internship and a job offer. “You should definitely come,” he told Mohammed. He decided to try his luck with a German visa.
Mohammed says that all he knew of
Germany at the time were “Mercedes, BMW, Bayern Munich, World War I, World War II and the Berlin Wall.” He had never planned a life outside the Middle East. Yet he set off for the German embassy in Ankara in February 2015, armed with his medical credentials. For once, they were all he needed. It took Mohammed 30 days to get a short-term travel visa, to be replaced by a student visa upon arrival. In March 2015, he flew to Frankfurt.
IT ISN’T ALL SMOOTH SAILING for Syrian doctors. Mohammed knows by