Supporting doctors who are refugees or asylum Seekers

Medical students have a part to play

Refugees and asylum seekers have had a lot of bad press, so it is time to make sure that there is some good news. With the right resources, refugee doctors could be one of those "good news" stories.

Among the thousands each month¹ who claim asylum in Britain each month and the much smaller numbers eventually given leave to remain there are many highly qualified professionals. These include doctors, who have to contend not only with the loss of country, family, and friends, but also with the loss of livelihood and professional status. The transition from life as a respected professional to life on the poverty line in astrange country is hard. No one is sure how many refugee doctors there are in Britain, but estimates have ranged from 500 to 2000, with large concentrations in London and some other major cities.

Whatever some politicians and journalists may think, refugee doctors do not want to live on benefits while their skills lapse. Not surprisingly, they want to work and to contribute to the social and economic life of this country in other words, to give something back to the country which has given them sanctuary. Furthermore, they are a valuable potential resource at a time when the NHS is so short of doctors that the government is seeking to recruit from abroad.²

Although in theory this should be a win win situation, most doctors will face several obstacles before they can return to practice. As refugees generally have little time to plan their departures, they may lack essential documents and have difficulty in obtaining references. To register with the General Medical Council they will all have to pass the International English Language Testing System (IELTS) and take the Professional and Linguistic Assessment Board (PLAB) examinations. Financial hardship, isolation, and benefit rules can make studying for these examinations difficult. Clinical attachments are important to help refugee doctors acclimatise to the British system and build their confidence, but such attachments are difficult to find and some trusts charge fees which refugee doctors cannot afford.

These problems were highlighted last year in the BMJ.³ Since then there have been some encouraging developments. In November 2000 two important government documents were launched one a Home Office strategy for the integration of refugees,⁴ the other a specific report on refugee doctors and dentists from the Department of Health.⁵

The BMA has worked with a wide range of organisations and individuals to move the needs of refugee doctors up the political agenda and to find practical ways of meeting those needs. A large and constantly growing Refugee Doctor Liaison Group meets regularly to exchange information and ideas and to monitor progress. Examples of projects currently in hand include:

• A voluntary database of refugee doctors, run by the BMA and the Refugee Council, to help to gauge how many refugee doctors there really are, where they are, and what they need.
• A mentoring scheme. The BMA has collected details of volunteers, and the Refugee Education and Training Advisory Service (RETAS) of the World University Service (WUS) is running a pilot scheme in the London area.
• A comprehensive information pack for refugee doctors, coordinated by the Jewish Council for Racial Equality (JCORE).
• Guidelines for clinical attachments.
• Work to improve the provision of English language teaching for IELTS candidates.

The BMA is launching a special package of benefits or refugee doctors not yet eligible for full membership, and the GMC has agreed to waive the fee for the first two attempts at part 1 of the PLAB test. We cannot change everything overnight, and many refugee doctors feel frustrated by the slow pace of change. Who can blame them? The climate is changing, however, and many small events individual doctors volunteering to help, individual trusts opening up their postgraduate meetings to refugee doctors, positive coverage in the media will all help.

Medical students can help by getting involved with local refugee support groups and encouraging local initiatives. There are 25 STAR (Student Action for Refugees) groups nationwide⁶ linked to MedSIN (Medical Students International). If you have any further ideas about what can or should be done, we would love to hear from you.

1. Home Office statistics. www.homeoffice.gov.uk/index.htm
2. Department of Health. NHS plan. London: HMSO, 2000.
3. Adams K, Borman E. Helping refugee doctors. BMJ 2000;320:887­8.
4. Home Office. Full and equal citizens: a strategy for the integration of refugees into the United Kingdom. London: Home Office, 2000. www.homeoffice.gov/ind/hpg.htm
5. Department of Health. Report of the working group on refugee doctors and dentists: advisory group on medical and dental education, training and staffing: overseas doctors sub­group. London: Department of Health, 2000. www.doh.gov.uk/medicaltrainingintheuk
6. Student action for refugees (STAR). www.star.org.uk