I am writing my student fellowship paper under the broad topic of health worker “brain drain,” so I have been keeping an eye out for related news stories. Two stories that caught my eye in the past few weeks were about the health worker migration from civil war torn Syria and economic-crisis ridden Sudan. In Syria for example, half the doctors in Homs and all of the country’s nine psychiatrists have recently migrated. In Sudan, 1620 doctors left the country last year compared to 338 in 2008. In countries like these, especially Syria where medical personnel have been targets of violence, solutions to stem the migration or replenish the ranks seem particularly futile. Additionally, these countries’ self-inflicted wounds, including civil wars and poor administration, complicate matters. Not only do these internal struggles diminish the probable efficacy of potential solutions to the brain drain, but they also negate the perceived responsibility of the countries receiving these migrants, diminishing their will to help counteract the deleterious effects of the brain drain.
Civil war stricken countries like Syria present especially difficult cases for developed nation responsibility and intervention. But these news stories led me to think about brain drain and responsibility that results from war, specifically wars waged by developed nations in developing ones. A prime example is the recent war in Iraq. The Brookings Institute estimates that 20,000 of the 34,000 Iraqi doctors in the country in 2003 have migrated, and only 1525 had returned as of 2009. They also cite that 2000 Iraqi physicians have been murdered and 250 have been kidnapped over the same period. 50% of surveyed Iraqi doctors living both in Iraq and abroad said they had been threatened. A recent article in Lancet describes that before 2003 the major problems facing the Iraqi healthcare system stemmed from drug shortages and poverty. These problems have been superseded by violence and failing infrastructure in the intervening years. The brain drain has likely been exacerbated by these new threats.
There are internal factors that have played important roles in the brain drain. Weaknesses in the Iraqi healthcare system can be traced back to the Saddam Hussein regime, including a 90% cut into funding due to war and sanctions in the 1990s. Furthermore, corruption plagues the current regime leading to waste and unequal resource sharing throughout the country. But, the Iraq War seems to be the proximate cause of the recent brain drain. Also, the US significantly supports the current Iraqi government.
There have been some attempts made by both the US and Iraq to improve the health landscape. The US has spent billions of dollars on reconstruction in Iraq, but the results have left a lot to be desired. Much of the money dedicated for health was spent on building projects rather than training and retention of health workers, or improved security for them. The Special Inspector General for Iraq Reconstruction found that 12 out of 24 randomly assessed health projects had major deficiencies. Additionally, while the Lancet article cites recent growth in national health spending, it points to a lack of administrative expertise due to brain drain that mirrors the overall lack of medical expertise throughout the country.
In my paper, I discuss various theories that attribute responsibility to developed countries to assist with or at least help implement solutions for retention of health workers in developing countries. In the case of Iraq, though, broad theories of cosmopolitan duties or global interdependency are seemingly unnecessary. The US clearly shares at least some of the responsibility for the health worker brain drain since 2003. The violence and general security threats still pose a significant obstacle in implementing solutions. But this should not stop the US from attempting solutions like incentivizing the return of health workers from the diaspora. The WHO considers health workforce shortages to be a key obstacle to meeting the Millennium Development Goals. Return migration of health workers could go a long way towards improving healthcare access for all Iraqis. The United States’ responsibilities in Iraq should not end with the withdrawal of troops, and helping remedy the effects of the brain drain since 2003 is imperative towards rebuilding a healthy Iraq.