Regret, return: the migration of doctors from Middle East conflict zones
BMJ 2025; 389 doi: https://doi.org/10.1136/bmj.r989 (Published 22 May 2025) Cite this as: BMJ 2025;389:r989
In December 2024 Ghanem Tayara, a Syrian GP who was working for the NHS, returned home for the first time since 2013. Back then, Tayara was added to a list of exiled Syrians who would be arrested at the border by Shu’bat al-Mukhabarat al-’Askariyya, the military intelligence service that propped up the Ba’athist regime of dictator Bashar al-Assad. That regime, which for 13 years deliberately targeted healthcare workers, fell on 8 December 2024.1
Tayara recalls crossing the border back into Syria from Lebanon. “It was very emotional for me, the tears fell and fell,” he tells The BMJ.
Tayara is one of many migrant medics returning to Syria with the skills and motivation to help in the rebuilding of public infrastructure and civil society as a fragile peace unfolds. Health officials estimate that 30-60% of doctors had left the country since the beginning of the civil war.2 The fall of the regime has given them the chance to return home.
Yet for all the resources and expertise they bring back, returnees represent a tragedy for nations that face a medic brain drain in times of war.
From Syria to Gaza, Israel, Lebanon, and Yemen, healthcare workers have fled from nations in conflict and economic crisis in the Middle East, with the healthcare systems of richer nations—particularly the Gulf States—reaping the benefits.
The World Health Organization code of practice on the international recruitment of healthcare workers says that “member states should discourage active recruitment of health professionals from developing countries facing critical shortages of health workers.”3 A similar code of practice, listing 47 countries, was published by NHS Employers and updated in 2024.4 Neither code explicitly mentions conflict zones.
The many departed
In 2021 WHO estimated that 40% of skilled doctors had left Lebanon5 as an economic crisis gripped the region; figures are thought to have increased since the 2024 Israeli invasion of the south of the country.
Yemen has seen a mass exodus of its native born and foreign national doctors since the outbreak of civil war in 2014, as attacks on healthcare facilities and infrastructure mounted and healthcare workers’ pay became erratic.6
In Gaza, 16 of 36 hospitals remain partially functional, with few doctors remaining who have not fled or been killed or imprisoned, according to presentations to the UN on 12 February.7
Outward migration of doctors from Israel has also soared; one in five doctors have left the country since 2023, the year the Israeli government proposed changes that would dismantle external and internal checks on the executive’s power and the latest Israel-Gaza war began.
Push and pull
“The state of Syria’s healthcare is heartbreaking,” says Tayara. “Primary care is non-existent, medicines are in short supply, and healthcare workers are not receiving wages unless there are donations from benefactors in the private sector.”
Alongside poor pay and lack of professional development, war and civil strife are major push factors for migrating medics.8 War doubles a nation’s expected doctor emigration rate.9
Basheer Al-Selwi, head of the International Committee of the Red Cross’s health response in Yemen, says that the pull factor for Yemeni doctors to Gulf states is “huge.”
“Experienced doctors and nurses have left Yemen, specifically to Saudi Arabia and the United Arab Emirates (UAE), where they are offered a better salary in countries with no conflict,” he said. “They are looking for a better future for themselves and for their kids—but it’s a serious problem for Yemen.”
Saudi Arabia and the UAE offer, respectively, a premium residence programme and a “golden visa” to medics, with overseas doctor assessments and language tests typically less onerous than UK or US equivalents. Salaries are up to four times that of doctors’ home nations.10 Qatar offers perks to migrant medics including tax free income, housing, and education allowances for children.11 Exiting doctors who fail to achieve overseas accreditation can, however, vanish into interminable waits for accreditation abroad, other professions, or clandestine practice.12
An Organisation for Economic Cooperation and Development report defines “doctor poaching” by rich countries who fail to train sufficient doctors as a “quick and inexpensive fix” for poor planning.13 But it’s hard to criticise those who flee their countries searching for a better way to live, or to save their lives.
Tayara tells The BMJ he does not criticise the choice of any healthcare professional to flee a country at war. “If you are a Syrian doctor who is going to be put in prison any minute, what use is staying to you or your people?” he asks. “Why not leave, save yourself and your family, and continue to practise medicine?”
Tragic consequences
Data show, however, that few medical migrants return to their source nations on a permanent basis. According to a 2010 report from researchers at the University of Ottawa many “return of talent” programmes to attract doctors and nurses to go back to their country of origin either fail or come at a very high cost.14
Doctor exodus means a plunging number of healthcare workers per capita and disappearance of expertise that routinely proves fatal for local populations.
In Syria, specialists in oncology, anaesthesia, vascular surgery, and neurology are scarce. In 2022, in Lebanon, four young children died within weeks of each other as there were no paediatric heart surgeons left in the country to manage their cases.15
Fewer than half of births in Yemen are attended by a skilled birth professional,16 with many health facilities lacking midwives and other trained healthcare providers. Yemen has one of the highest rates of maternal mortality in the Middle East and North Africa region, with 470 women per 100 000 live births dying from obstetric complications.
After brief visits, Tayara is returning to Syria later this month, undaunted. He is working, he says, to help plug gaps in medical supplies, including chronic shortages of dialysate for renal dialysis, and to arrange specialist catch-up training in cardiac surgery as well as vocational training for a new generation of Syrian healthcare workers.
“It feels good to be in Syria, but there is much work to do,” he says.
Leaving, reluctantly: a Gazan medic’s story
Husam Abukhedeir was head of the neurosurgery department at Al Shifa, the largest hospital in Gaza, when war broke out between Israel and Hamas on 7 October 2023.
Abukhedeir, 43, trained in Jordan and Sudan but returned to his native Gaza in 2005, determined to practise medicine in his home country and initially working as a hospital GP. Specialising in neurosurgery, Abukhedeir practised through the three week war between Israel and Gaza in 2008-09 and for a year of the recent conflict, when Al Shifa faced hundreds strong waves of patients after Israeli airstrikes levelled residential buildings in Gaza. He recalls seeing children as young as 2 with crushed skulls and concrete or wooden shards piercing their faces, plus many patients with no surviving family or means of identification.
Abukhedeir left Gaza in November 2024. In 2023 Israeli forces had put Al Shifa under siege and cut supplies as they looked for what they claimed to be a Hamas command centre. By June 2024 the hospital was in ruins.17 With the department he founded razed and fearing for the lives of his young family, Abukhedeir accepted a job in the UAE, where he now works as a neurosurgeon for a private clinic. He said, however, that it’s not always easy for war traumatised medics to adapt to doctoring in times of peace.
“I am haunted by my experiences at Al Shifa and I worry every day about the cost to my community: in lost lives, demolished buildings, and human capital,” he said.
Abukhedeir is in exile in the UAE as Gaza awaits its fate; he holds out hope that he can return to rebuild and help his community.
Doctor poaching: the ethical debate
The debate around richer countries importing doctors from poorer countries has become more voluble in recent years.18
The UK takes an ethical stand against poaching medical staff from low and lower-middle income nations, as well as those on WHO’s red and amber lists of countries with healthcare worker shortages.19 In a 2024 update to the Department of Health and Social Care code of practice for the international recruitment of health personnel in England the government said it “remains committed to be a force for good in the world, and support better health and care both within and beyond our shores,” in a context in which there is projected to be a shortfall of 10 million health workers in low and lower middle income countries by 2030.20 Practice often doesn’t follow rhetoric, however, with recent reports showing a sharp rise since Brexit of healthcare personnel from red listed countries.
In Gulf nations, foreign doctor inflows are criticised, but principally from an anti-immigration stance. In 2024 UAE Gulf News published a guide for foreign doctors on the cost, process, and requirements for practising in the country.21 Coverage in Qatar often focuses on Gulf countries’ need to recruit overseas medics to plug human resources gaps.22 In Saudi Arabia a 2022 policy introduced a target for 60% of jobs in “health specialisation professions” to be filled by Saudi nationals to tackle the underemployment of Saudi locals (there is a 7.1% unemployment rate among Saudi citizens). Migrants account for 57% of nurses and 60% of doctors.23
Footnotes
Additional research by Moran Barkai.
Commissioned, not externally peer reviewed.
No competing interests.