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The Daily Rhino
Wednesday, July 04, 2007

SHO me the exit
Cross post on Pickled Politics.

of the suspects arrested under suspicion of involvement with the terrorist attacks over the last few days are NHS junior doctors or medical students. Britain's threat level has only today been stepped down from 'critical' to 'severe' and heightened security at airports remains in place. As a shifty-looking NHS junior doctor flying out of the UK on Friday, these events have had particular resonance.

Almost three months after junior doctors were in the news protesting a disastrous job shortage, a friend at work quipped "I think some of these guys are taking their MTAS protests a bit far." Hey, perhaps these guys were just pissed off at being laid off...

Mohammed Asha

"Brilliant": Mohammed Asha topped his class several times.

Two Iraqi doctors seem to be at the heart of the attempted terror campaign, thought responsible for both the Glasgow Airport attack and two unsuccessful bombs in London two days prior. A British cleric working in Iraq had recently been informed of an impending attack on Britain by an Al Qaeda leader, with the ominous warning that "the people who cure you will kill you."

The suspects, of Iraqi, Saudi, Indian and Jordanian origin, have opened a debate on the role overseas doctors play in the British health system. It is a widely acknowledged fact that the NHS survives on the contribution of doctors trained abroad. Many would go so far as to say that the NHS would not exist today had doctors from the sub-continent buoyed it through its early decades. Today approximately 128,000 of the 277,000 doctors on the GMC Register are from overseas medical schools.

The requirement of a work permit for foreign junior doctors only came into place last year, as the UK was producing more doctors itself (many of whom are now leaving for Australia, New Zealand and Canada). Medical Student Newspaper covered the fact that even overseas undergraduates in British medical schools, who pay almost £100,000 in tuition fees, were instructed to apply for work permits despite being halfway through training.

The normal vetting process for doctors involves a professional and linguistic assessment (the PLAB) and a probation period working in the NHS before a full registration is offered. Doctors from the EU are exempt from these checks. No doctors are specifically questioned on their political views.

Members of British Muslim medical groups, such as Dr Abdula Shehu of the Muslim Doctors Association, are afraid there will be a backlash against Muslim doctors. To me, this sounds improbable. Doctors can't be picked out on the street - most people know doctors via being treated by them. I doubt people will suddenly assume their family GP Dr Hussain is a terrorist.

However not much has been said about medical students, who interact with a far more diverse group of people than doctors. We have previously touched upon the religious fanaticism that lurks on British university campuses and I'm sure there will be sympathisers amongst British Muslim students, just as there is likely to be some ill will toward normal Islamic students.

What appears to be happening is a questioning of Britain's reliance on overseas doctors. Gordon Brown has already pledged a review of NHS recruitment and 'skilled migrant workers' background checks. Intelligence agencies said they will have to "widen the net" when searching for potential bombers. A somewhat romantic illusion that doctors are above activities like terrorism has been laid to rest, but the debate over the ability to cure and kill is a fascinating one.

The Times today revealed details of the two Indian suspects, now known to be cousins. Both spent most of their time in the UK socialising only with other foreign doctors, often just Indians. Details of the other suspects' lives is patchy, but again most character testimonies have come from Muslim friends and acquaintances. In my hospital accomodation, a cluster of several apartment blocks, several are populated solely by immigrants. It is quite possible to have a job in the NHS and live with, work with and socialise with only those from outside the UK.

The disparate group of eight people seem linked only by two things, being Muslim and medicine.

The NHS is prohibited from actively recruiting from countries at risk of a 'brain-drain' (though less than a quarter of recruitment agencies the NHS uses has signed up to this), but a doctor from such a country is entitled to apply independently. A huge proportion of the NHS is accounted for by foreign workers, with thousands of doctors from 150 countries, nurses from the Phillipines, India, Ghana and Nigeria or cleaners from Nepal, Ghana and Nigeria. These countries' health systems are woefully understaffed.

In the wake of 7/7, we clutched at straws for what might have driven those men to kill. Poverty, social deprivation, a lack of feeling British. This time, whilst I can assure you juniors doctors are not flushed with money, they are certainly not on the poverty line. These doctors had no call to feel British as they weren't, but it seems apparent they resented the country they had chosen to work in.

Their reason for attacking the UK might have been the same as previous terrorists, but how did they become subject to such extreme views in spite of their high educational level and respected job? Much could be speculated about doctors from Iraq - they sought revenge for a fallen friend, an insult to their country - but then why were Indian Muslims angry?

I realise I am posing more questions than I am answering. I do not feel increasing security checks on skilled migrants will solve the problem. We do not know if some of these men (and woman) were radicalised in the UK. For me, and many like me, the very nature of the NHS is under scrutiny. A thoroughly British convention, it is a puzzling behemoth of nations. Isolation for someone new to the UK is very easy in the NHS - how many other mass employers routinely provide cheap digs next to your workplace combined with 60 hour weeks?

The NHS remains perpetually over-stretched and under pressure to cut waiting times; see more patients; improve treatments. None of this is possible without sufficent staffing, frequently drawn from the countries that need medical professionals the most. Whilst not apparently linked to recent events, the fact the NHS is driving thousands of its best and brightest abroad every year can only be worrying.

I'll end with an anecdote. After the Tsunami, I spent a month working at relief camps around Sri Lanka's coast. I returned to Heathrow with a shaved head, a month's tan, a big rucksack and four days of stubble. The security officers saw me a mile off and took me to a special area where they searched me and my bags. They rummaged through sweaty clothes and pirate DVDs, firing a series of questions at me.

As soon as the chap looking through my bag found my stethoscope, both officers immediately packed everything back in and apologised for bothering me. I was sure the "I'm a doctor" line would be an evergreen get-out clause for airport security. Oh well, wish me luck this weekend.

(Kind of related, I thoroughly recommend Michael Moore's new film, Sicko.)

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