Exclusion on the Frontline: The discrimination, racism and Islamophobia impacting Muslim healthcare professionals

Person walks past a sign for the NHS or National Health Service in London, UK. The National Health Service (NHS) is the shared name of three of the four publicly funded healthcare systems in the United Kingdom [Getty Images]
12 min read
03 December, 2021

The NHS is the fifth largest employer in the world and prides itself on its diverse and inclusive values. Ethnic minority staff compose 40 percent of the workforce (Gov.uk 2020).

The NHS has been at the forefront of our fight against the Coronavirus over the past several months. However, this very pandemic also exposed discrimination and bias against NHS professionals from racially diverse groups and faiths. Research by ITV News in 2020 disclosed that during the pandemic, ethnic minority doctors were pressured to work in frontline roles without adequate PPE compared to their white colleagues.  

These minorities were also less likely to raise concerns which may have contributed to excess infections and mortality rates. More than 90 percent of doctors who died serving on the COVID frontlines were from an ethnic minority background, but a media report analysis indicates that over 50 percent of doctors who died during the first wave were Muslim.  

The Muslim Doctors Association site states: "Approximately 10 percent of the medical workforce is Muslim, but the proportion of Muslim doctors who have died was significantly higher. In the NHS, Muslims are under-represented in positions of leadership but over-represented in Covid-19 casualties."

"Through the lens of intersectionality, one can see how ‘layer after layer of inequality’ intersect to increase vulnerability and discrimination faced by Muslim doctors"

Research prior to the pandemic also revealed that ethnic minority healthcare workers are more likely to experience bullying, harassment, disciplinary action and more serious sanctions at work.

MDA shares: Inequalities persist in treatment, experiences and opportunities for the development of ethnic minority doctors as highlighted by unequal achievement in medical education and training, leadership representation, ethnicity pay gap, abuse and complaints by patients and CQC inspection data"

A large king fund study highlighted that Muslims in the NHS experience the most discrimination as compared to any other religious group. Based on the Muslim Doctors Association qualitative outreach and engagement studies, "Muslim doctors experience discrimination, prejudice and exclusion at work through stigma, stereotypes, limited career opportunities and a lack of belonging and workplace support."

This report explores the drivers of disparities and discrimination along with their impact. Institutional policies can also be discriminatory against Muslim staff. The Prevent policy has reportedly created a climate of mistrust and fear. A survey by Huffington Post and the British Islamic Medical Association exposed Islamophobia in the NHS while revealing that 80 percent of Muslim doctors had experienced it.  

In addition, dress code policies can prevent women from pursuing a surgical career, and during the pandemic, a lack of culturally sensitive PPE may have contributed to excess infections and deaths among male Muslim doctors.

More disturbing is the increase in violence and hate crimes targeting Muslims in the UK. Muslim adults are more likely to be victims of racially motivated hate crimes than non-Muslims (Home Office, 2018). This disturbing trend increases every year and includes the targeting of Muslim women.

A rapid review conducted by the Muslim Doctors Association (Shahid and Abdulkareem, 2018) confirmed a ‘Triple Penalty’ observed in other sectors. Through the lens of intersectionality, one can see how ‘layer after layer of inequality’ intersect to increase vulnerability and discrimination faced by Muslim doctors who have multiple protected characteristics as defined by the Equality Act 2010 (Wiley, 2018)

Shahid H, Abdulkareem B (2018). The triple penalty: Muslim doctors in the NHS. Muslim Doctors Association. Wiley E (2018). Layer after layer of inequality. London: British Medical Association
Shahid H, Abdulkareem B (2018). The triple penalty: Muslim doctors in the NHS. Muslim Doctors Association. Wiley E (2018). Layer after layer of inequality. London: British Medical Association

Islamophobia Awareness Month (IAM) is a campaign held every November to deconstruct and challenge stereotypes about Islam and Muslims and to raise awareness and encourage reporting of Islamophobic hate crimes. It also showcases the positive contributions of British Muslims to society and provides a platform for people of all backgrounds to engage with Muslims.

The term "Islamophobia" was first coined by the Runneymede Trust in 1997, but it was only in 2018 that the All Party Parliamentary Group (APPG) on British Muslims adopted a formal definition that has since been accepted by the Labour Party and a number of UK cities.

Islamophobia: APPG definition: Islamophobia is rooted in racism and is a type of racism that targets expressions of Muslim-ness or perceived Muslim-ness.

During Islamophobia Month 2020, The Muslim Doctors Association partnered with The Grey Area to launch an in-depth survey that explored the perceptions and experiences of Muslim healthcare workers in the NHS.  Ultimately, the data would feed into healthcare policy to tackle structural discrimination, Islamophobia and wellbeing issues affecting Muslim healthcare workers. The survey was kept anonymous to encourage participants to respond freely and without fear of any negative repercussions.

Live Story

In 2020 and 2021, the survey disseminated a detailed questionnaire through the Muslim Doctors Association and ethnic minority healthcare networks as well as allies including NHS Muslim Network, NHS Muslim Women’s Network, British Islamic Medical AssociationAPPS UKFair Play Talks, The British Somali Medical Association and Ask Doc. The inclusion criteria were UK-based healthcare professionals with a patient-facing role. The questionnaire included demographic data and explored experiences at work and wellbeing.

The primary goal of this survey was to understand the experiences of Muslim healthcare professionals working in the NHS and, to analyse the prevalence and impact of discrimination and exclusion connected to the faith identity of Muslim healthcare professionals. Results were compiled and published in a report called Exclusion on the Front Line.

Unsurprisingly the report revealed that the majority of Muslim health care professionals have experienced systemic bias and interpersonal prejudice in their careers.

"It is important for faith networks to be adequately resourced and funded to avoid cultural taxation on already marginalised colleagues"

At an organisational level, Muslim healthcare professionals have been passed over for promotions and face bias in their day-to-day work.

The report shares: "Bias, prejudice, discrimination, and racism are in fact evident across the entire professional spectrum of a Muslim healthcare professional – from medical school to job applications and recruitment to workplace-based assessments, postgraduate exams and career advancement. Muslim healthcare professionals also reported differential treatment around career opportunities such as project allocation as well as flexibility around work times and workload."

These are similar to race-based disparities documented in the literature but Muslim healthcare workers also experience an additional dimension of faith-based discrimination that includes hostility and verbal abuse specifically related to their religious identity.

The Grey Area Research conducted in 2019-2020 to capture the workplace experiences of Black, Asians, multi-ethnic professionals working in the public and private sector revealed similar findings wherein participants reported bullying and harassment on account of their faith and cultural practices.

Exclusion on the Frontline shared that many are uncomfortable openly practising their religion which, in turn, prevents them from showing up authentically. "Eight in 10 experienced negative assumptions about their religion and 7 in 10 reported perceived or overheard negative stereotypes about Muslims in the workplace.

Others have felt socially avoided, ignored, bullied, ridiculed and disrespected because of their faith (that includes comments from patients like: ‘I am not to be trusted as I am a Muslim’ and ‘Get the f… out of my country.’ Participants shared that ‘racism was rife’ and widespread throughout the NHS across multiple leadership levels."

Open-ended survey answers exposed several traumatic incidents of abuse, microaggressions and discrimination.

"Participants shared that ‘racism was rife’ and widespread throughout the NHS across multiple leadership levels"

Participants also reported difficulties practising their faith through prayer, fasting, time off for religious festivals, alcohol-related social events and networking opportunities. "These compound experiences of discrimination and exclusion and are consistent with Islamophobia. Employers failed to accommodate reasonable requests to practice their Muslim faith while those same requests were granted to non-Muslim colleagues."

Credit: British Islamic Medical Association
Credit: British Islamic Medical Association

Exclusion on the Frontline further revealed reveals that at an interpersonal level, bias, prejudice, and discrimination can originate from patients and colleagues including both clinical staff, managers, and human resources. When Muslim healthcare workers experience racial and religious discrimination from patients in the presence of other white or non-Muslim colleagues, those workers do not receive support or intervention from their healthcare colleagues.

"These collective experiences have a profoundly negative impact, with respondents reporting symptoms of stress, burnout, anxiety and depression, insomnia, and strained relationships with colleagues.

Over one-third of Muslim healthcare professionals have sought psychological or emotional support from friends, family, colleagues, and professional counsellors due to work-related stress. Eight in 10 Muslim healthcare professionals suffer anxiety at work upon hearing news of Muslim-related terrorism. Over half of surveyed professionals also believed that a higher number of Muslim doctors lost their lives compared to other faith groups during COVID-19."

Live Story

The report findings validate the need to prioritise and address discrimination, racism, and Islamophobia across NHS organisations and regulatory teams.  

Muslim healthcare workers do not fit neatly into one category of the Equality Act 2010, thus we must explicitly recognise Islamophobia as a type of discrimination and oppression that goes beyond race and religion, and often includes a gendered component that affects professionals differently in hospital versus primary care settings.

The Muslim Doctors Association’s qualitative work reveals penalties faced by Muslim healthcare workers go "Beyond the Triple Penalty." This necessitates an intersectional lens to explore their different experiences at the individual, subgroup, and organisational levels. In addition to conventional mentoring, reverse mentoring would bring the added benefit of challenging stereotypes and assumptions and building understanding and empathy.

Survey respondents shared their desire to see more people who look like them in senior leadership positions. They can also benefit from mentorship opportunities. Two-thirds of respondents believed there is a lack of senior representation and Muslim role models in the workplace.

"It’s encouraging to note however that in spite of the formidable issues Muslim medics face, 6 in 10 remain optimistic about the future"

Dr Hina Shahid and Hira Ali, the survey architects, insist that change must come from the top. Accountability must be established for departments and management that fail to funnel people up the career pipeline while discouraging stereotypes that negatively influence that path.

To effectively counter bullying and other forms of provocations, businesses must actively deploy mitigation, not just containment, strategies. They should also develop, monitor and review progress on a regular basis.

Marginalised groups are often short-changed in reviews and miss out on critical talent assessment discussions. Organisations must question bias when evaluating performance reviews to ensure promotions are not skewed in favour of dominant groups. Career progression is more achievable when there is an equal representation at leadership and senior management levels. Respondents were aligned on the value of leadership and empowerment training which could help improve their self-esteem and confidence. Protected leadership training and purposeful workforce investment will ensure leaders have real influence and agency rather than knee-jerk tokenistic representation.

Live Story

Survey participants emphasised the need to move beyond standalone training to meaningful dialogue, learning, and reflection. Respondents stated that they felt that bystander training and unconscious bias training for managers and colleagues would be helpful. However, on their own, these are unlikely to lead to meaningful or sustainable solutions. Safe spaces for ongoing learning, reflection, and constructive dialogue will help create inclusive work environments.

The report authors believe that creating awareness and constructive dialogue will also help normalise mainstream religious practices such as praying, fasting, and wearing the hijab so that they are not perceived as negative, extreme, or threatening. This will help re-humanise Muslim professionals as multidimensional beings who can bring their whole selves to work.

"Creating awareness and constructive dialogue will also help normalise mainstream religious practices such as praying, fasting, and wearing the hijab so that they are not perceived as negative, extreme, or threatening"

Celebrating Eid and other religious festivals can facilitate positive representation and help Muslim colleagues feel included and valued. Some non-Muslims colleagues have participated in the Ramadan Challenge and such activities can build solidarity, camaraderie, and compassion. Celebrating and commemorating faith festivals, interfaith week, and Islamophobia Awareness Week can make Muslim healthcare workers feel included, heard, valued, and celebrated at work, while enabling managers and colleagues to understand challenges and how best to address them.

Exclusion on the Frontline recommends: "The NHS has a zero-tolerance policy around abuse and discrimination; this must be implemented with accountability. Zero tolerance policies should also explicitly include Islamophobia."

There must be a clearly defined process for reporting and addressing incidents of Islamophobia with safe psychological passages for victims who raise concerns. Dr Hina Shahid recommends that the NHS recognises Islamophobia as an unacceptable form of discrimination and adopts the APPG policy on Islamophobia.

Respondents also reported that they would like to see more faith networks at work. One-third of respondents stated they sought emotional and psychological support, predominantly from friends, family, and informal networks. This may be due to a lack of formal support offered through work.

Dr. Hina Shahid further notes: "It is important for faith networks to be adequately resourced and funded to avoid cultural taxation on already marginalised colleagues. During the pandemic, faith-sensitive counselling was offered for the first time to Muslim NHS staff through an initiative spearheaded by the NHS Muslim Network; this type of psychological support should be widely available and not limited to the pandemic period."

In the 12 point action plan proposed by the report, one of the point states: "The NHS Workforce Race Equality Standards (WRES) and NHS Workforce Disability Equality Standards (WDES) have brought awareness to under-representation and discrimination amongst groups with specific protected characteristics.  These standards have also enabled transparency and accountability to NHS Trusts for actions and progress.

A similar metric is needed for NHS workers from faith backgrounds to monitor progress and bring accountability to unfair policies and actions. The report recommends that any policies proposed in NHS Trusts and organisations must undergo a robust intersectional EDI assessment that reviews the impact on each protected characteristic. There must be clear processes for how conflicts are managed."

Finally, change is not possible unless the policy environment changes in kind. This requires authentic allies to push their MPs and government to adopt a definition for Islamophobia and to challenge the negative media stereotyping of Muslims that fuels bias, prejudice, and discrimination.

Book Club
Live Story

It’s encouraging to note however that in spite of the formidable issues Muslim medics face, six in 10 remain optimistic about the future. It’s important to acknowledge that every institution has its shortcomings.

By creating awareness and actively working to address challenges, we will be able to overcome institutional bias and give a fair chance to all those who have risked their lives to protect all of us.

It is only fair that those who have tirelessly worked day and night to prioritise our safety should benefit from a work environment that prioritises their psychological safety, makes them feel included and offers them a sense of belonging and equity at the very least.

Hira Ali is an author, writer, speaker, executive leadership coach & D&I thought leader. She is the Chief Executive Officer at Advancing Your Potential and author of Her Way to the Top: A Guide to Smashing the Glass Ceiling. Hira's second companion book, Her Allies: A Practical Toolkit to Help Men Lead through Advocacy, invites men to join the gender equality movement.

Follow her on Twitter: @advancingyou