By Omar Dewachi

The recent failed terrorist plots that targeted the heart of London and Glasgow airport came as a shock for many as the identity and background of the suspects were revealed. Most of the detained were medical doctors who worked in Britain and who had Indian, Iraqi and Jordanian backgrounds. The fact that they were doctors was seen as a betrayal of the medical profession with its aim to save lives. However, the bigger shock in the UK was that these were overseas doctors who were working in Britain’s National Health Service (NHS), the main provider of health care to the country. As the new Labour prime minister, Gordon Brown, promised in his first press conference to review the NHS recruitment, more background checks and surveillance of overseas doctors is going to take place. However, one wonders how this surveillance is going to take place and who is going to pay its heavy price and consequences? Britain has always imported its medical staff from abroad using them as an expandable labor pool. In this wave of hysteria about background checks and surveillance, the contribution of the overseas medical population in building Britain’s NHS must not be forgotten.

Currently two thirds of the 277,000 physicians working in the NHS received their medical degree outside the UK, with the majority from South Asia. There are nearly 2000 Iraqi doctors working in the NHS after they fled the old Iraqi regime during the 1980s and 1990s. They were quickly given asylum, as the NHS needed physicians, especially in less desirable practices. With around 1.3 million employees the NHS is the world’s biggest employer after the Indian Railways and the Chinese Army.

Inaugurated in 1948 (almost one year after Britain’s withdrawal from India), the NHS represented a new era in the delivery of equitable health care based on a socialized notion of medicine. In 1963 Enoch Powell, the Tory Minister of Health, appealed to doctors from the new and old Commonwealth to expand the NHS. More than 18,000 young doctors answered the appeal. Hoping to specialize in Britain and acquire prestigious titles to further their medical careers back home, these doctors found themselves faced with systematic racism and discrimination, and many were excluded from academic and career-path jobs. They were treated as second-rate doctors, taking unwanted positions in inner city hospitals or serving the underprivileged areas of the country where no British doctor would want to work. Eventually many overseas doctors worked as general practitioners, supporting the fabric of primary care in Britain and contributing substantially to its post Second World War development.

In the last 25 years, particularly during the Thatcher and Blair reforms and expansions of the NHS, overseas doctors found themselves needed again with the opening up of a large number of subspecialties in the NHS. This time they were competing for consultancy jobs and many managed to secure career path positions in the NHS. During this period the British government allowed the NHS to make up for the shortage of medical staff by recruiting junior and senior medical doctors trained abroad.

Until recently, the NHS had always depended on recruiting overseas doctors to help keep its services running. However, in April 2006 Britain issued a new immigration law, which would no longer allow overseas doctors to work and complete their training in the NHS without work permits. This meant that overseas doctors were no longer able to compete for jobs in the UK, as the rule requires hospitals to prove that they failed to recruit a junior British doctor or an EU doctor before opening the job to doctors from other countries. The government has argued that this rule is meant to safeguard training jobs in the NHS for local British graduates, as the unemployment of the latter group has hit an unprecedented high.

The new rule has affected almost 20,000 overseas doctors who are in Britain to acquire medical licensure or find work. Many have spent an average of a year and a half preparing themselves to qualify to work in British hospitals. After eating up their savings on the high living expenses in Britain, fees and visas, these overseas doctors were informed that they could no longer work in the UK. Abandoned and betrayed, overseas doctors feel that their contribution to the history of Britain’s NHS will remain unrecognized.

The recent terrorist plots on the UK are likely to create a backlash overseas doctors in Britain. It is important to recognize that those who carried out these horrid attacks do not represent the thousands of honorable, hardworking professionals who have contributed for decades to Britain’s health system. However, with the new revisions of recruitment of the NHS, it seems that overseas doctors are going to pay, yet another heavy bill.

Omar Dewachi resides in Montreal. He is an Iraqi medical doctor, currently a PhD Candidate in Medical Anthropology at Harvard University. He has recently conducted fieldwork research in Britain on Iraqi overseas doctors . His thesis is entitled: “The Professionalization of the Iraqi Medical Doctor in Britain: Medicine, Citizenship, Sovereignty and Empire.”