The Unsung Heroes: Refugee and Asylum-Seeking Medical Students and Doctors in War and Peace

This article was exclusively written for The European Sting by Ms. Sadia Khalid, early-stage researcher (ESRs), medical writer and research engineer at Tallinn University of Technology (TalTech), Estonia. She is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

The field of emergency and trauma medicine has unveiled the profound risks faced by healthcare professionals operating in zones of violence. It is an unfortunate reality that we frequently hear news about attacks on healthcare workers in regions such as Ukraine, Yemen, South Sudan, Afghanistan, Syria, Central, and Latin America. These attacks often take the form of physical assault, obstruction, violent searches, and psychological threats and intimidation. In war and conflict zones, where NGOs and local healthcare staff work tirelessly day and night to save lives, emergency services in some facilities are suspended. As a result, both patients and medical personnel are forced to flee without completing necessary medical treatment. Shockingly, violence against healthcare workers has been on the rise for at least a decade.

Violence and discrimination against migrants have widely discussed topics in many countries, and unfortunately, medical staff, including asylum-seeking doctors, are not exempt from such challenges. Foreign doctors can face prejudiced and discriminatory attitudes and behaviours from both patients and their own colleagues. These negative attitudes, which may be based on race, ethnicity, religion, skin colour, language, and other factors, can be pervasive and make it difficult for foreign doctors to settle down. This difficulty is further compounded in war zones, where the psychological safety and support of foreign doctors may not be prioritized in understaffed and underfunded healthcare facilities. Beyond facing day-to-day discrimination, foreign doctors are also vulnerable to violence and complaints from locals.

Even in peaceful developed countries, foreign doctors, including those seeking asylum, encounter discrimination and violence due to exclusionary circumstances. They are often encouraged to serve socioeconomically disadvantaged immigrant and minority populations residing in unpopular geographical locations. These areas, characterized by higher levels of social unrest and crime, are often undesirable for local graduates. It is crucial to acknowledge that when recruiting internationally trained medical graduates for diversity and addressing staffing shortages, simply addressing the issue of recruitment is not enough. Retention and support for these new recruits are equally important.

Epidemiological studies have recognized emergency departments (EDs) as high-risk settings for violence against healthcare workers. The 24-hour unrestricted “open-door” policy, which aims to provide continuous care to the public, along with the capacity to treat patients with various acuities of illness and the political focus of EDs, make the staff particularly vulnerable to violence. Numerous reports from ED staff members highlight the prevalence of substantial and significant violent behaviours.

The impact of violence against emergency service providers, along with the challenges of dealing with victims of violent crimes, causes significant physical and mental distress, ultimately affecting work productivity and patient care. Furthermore, intentional injuries, including suicide, violence, and the consequences of war, continue to astonish us daily. Research analysis reveals alarmingly high mortality rates from firearm injuries in the least developed and developing countries compared to their neighbouring counterparts. The use of firearms is becoming increasingly prevalent in society, with firearm injuries ranking among the leading causes of trauma, alongside road traffic accidents.

 In many cases, we find ourselves contemplating the aftermath of vicious terrorist wars that have left large quantities of firearms distributed throughout populations. As we deepen our interest and research, additional contributing factors to high rates of violence become apparent. These factors include a culture that condones male violence, high rates of poverty and inequality, unemployment, gang formation associated with the drug trade, and a sense of political disenfranchisement. Flawed foreign policies, political polarization, and concerns about the resurgence of political violence further complicate the situation.

In the face of these challenges, healthcare professionals in emergency medicine have realized that they cannot merely serve as bandage-wielders. They must actively engage in initiatives that prevent violence and contribute to the creation of peace-enabling societies. The concept of “Peace through Health” becomes increasingly significant, emphasizing the importance of health professionals’ involvement in international relations and foreign policies. Emergency department staff members, being at the forefront of medical care and interacting with every aspect of the healthcare system, are well-positioned physicians and healthcare providers to advocate for their patients, communities, and society at large. They witness the shortcomings of public health policies and possess the ability and power to address these issues daily.

The engagement of health professionals with war has a long history. Healthcare providers have always sought to mend the injuries inflicted by war and conflict due to flawed foreign policies. However, these functions were often intertwined yet separated, stemming from two different systems within human society: the sphere of warfare and that of healthcare providers. These functions originated from distinct castes, social groups, and decision-making spheres. While some individuals, whether involved in warfare or civilian diplomacy, decided between war and peace, others dedicated themselves to repairing the damage wrought by violence.

To provide optimal healthcare and public health services, it is imperative to create and sustain a peaceful environment. Without peace, true health cannot be achieved. Physical safety and well-being are essential for meeting basic human needs and fostering a healthy society. In this context, it is vital to highlight the difficulties faced by immigrant and asylum-seeking doctors, who exhibit remarkable bravery and resilience both in times of war and peace. They embody the true spirit of warrior-soldiers, risking their safety to provide healthcare and save lives. As a society, we must prioritize their protection, integration, and recognition as valuable members contributing to the healthcare system. Furthermore, ensuring their access to quality medical education is crucial, as it empowers them to continue their noble mission and serve their communities with excellence.

Conflict of interest:
The authors declared no conflict of interest.

Reference:
1. Phillips PJ. Workplace violence against health care workers in the United States. N Engl J Med. 2016; 374:1661–9.

2. Ghulam.M.et al. (2015)

Pattern of bony injuries among civilian gunshot victims at tertiary care hospital in Karachi, Pakistan,

Chinese Journal of Traumatology, (p161-163), Doi:/10.1016/j.cjtee.2014.10.003.

About the author

Sadia Khalid, early-stage researcher (ESRs), medical writer and research engineer at Tallinn University of Technology (TalTech), Estonia. She has been working on her PhD research project  “The role of Helicobacter pylori intestinal microbiota in the development of liver diseases. under supervision of Dr. Pirjo Spuul at Faculty of Science, Institute of Chemistry and Biotechnology.,TalTech. Her current research interests include Molecular Medicine, cell biology, infectious diseases, bacteriology, hepatology, and gastroenterology. I believe in the mission of public health, safety, and awareness.