A gaping wound: Iran's healthcare system plunged into crisis mode as medics migrate abroad

Since the outbreak of the coronavirus pandemic last year, Iran was among the countries hit hardest with a high number of infections and mortality rate in the face of the authority’s inability to impose nationwide lockdowns and poor handling of the pandemic.

Nearly two years on, Tehran is facing yet another major challenge to its already exhausted healthcare system as many of its medics leave the country to seek a better future abroad.

The Medical Council of Iran, a non-governmental organisation and the main national regulatory body for health care professionals, has recently announced that more than 3,000 healthcare workers applied for "Good Standing" documents to leave the country – 1,000 of which occurred in the past summer alone.

"Recently, the number of requests for emigration has increased six-fold, from 200 to 300 a year to 1,500"

The exodus of highly educated and talented Iranian professionals is not a new phenomenon, but the departure of health care professionals has seen an unprecedented rise in recent years.

While there is no accurate data on the exact number of medics who have left Iran, there are different estimates varying from 100 to 500 cases per month. A member of the Supreme Council of the Iranian Nursing Organization (INO) was quoted by local media earlier this month as saying, "Recently, the number of requests for emigration has increased six-fold, from 200 to 300 a year to 1,500." 

Although different estimates exist about the number of healthcare professionals who have already left Iran, all officials and related bodies cite the lack of any adequate tracking system. According to them, the announced estimates are only based on requests for "Good Standing" certificates, indicating that the actual number is much higher.

Why are medics leaving Iran?

In spite of a significant dispute over the number of migrants, there is an apparent agreement on the reasons behind the exodus of Iranian medical professionals. Some factors that cause medics to seek employment abroad include delayed salary payments, untimely or inaccurate bonus payments for coronavirus outbreaks, as well as a lack of social freedom and political uncertainty.

Mehrnaz is an Iranian doctor who moved to Germany earlier this year to continue her education. Speaking to The New Arab, she expressed happiness about her decision which was initiated before the pandemic. “There are many reasons why people like me decide to leave. In Iran, the residency period is one of the toughest periods where they simply treat you as a junior student who has to take intensive shifts with almost no salary,” she said.

Although she acknowledged that the situation in other countries, including Germany, may be quite different, she noted that she receives a good salary while studying for her speciality, which is enough to have a quality life and also save some money.

The situation is even more dire among the nurses as they are faced with serious problems such as long-hour shifts due to a shortage of staff, lack of job security, and low salaries among others.

Mahsa is a young Iranian nurse in Tehran. “I am in the process of moving to one of the European countries. I have already received a job offer and I am just waiting to receive my visa,” she told The New Arab.

Mahsa added that her current salary is just about $200 a month while this is the daily bonus a nurse can receive in Europe for working in the Covid-19 sections of the hospital. “Of course I prefer to work in a place where I am treated better, have an easier working condition and at the same time have a much better income.”

A shortage of medical staff

Back in May, Tasnim News Agency published a report about the shortage of medical staff, including doctors and nurses and how it had affected the country's handling of the coronavirus pandemic which has left more than 112,000 dead and over 5.6 million infected so far.

"Some factors that cause medics to seek employment abroad include delayed salary payments, untimely or inaccurate bonus payments for coronavirus outbreaks, as well as a lack of social freedom and political uncertainty"

Citing statistics from the country's health organisation, the report said that Iran’s physician per capita is just 11.7 per every 10,000 people, significantly lower than the 30-40 per capita ratio among the G20 group of countries. Even in comparison to regional countries, Iran has one of the lowest physicians per capita, falling behind countries like Syria, Tajikistan, Turkey, Oman, Qatar, and UAE among others.

The report further stressed that the situation is even worse when it comes to specialist physicians. While the per capita ratio for specialist doctors is over 20 in many countries, Iran has a shocking per capita of 5.9 for every 10,000 people, placing it below other regional countries like Mongolia, Oman, Turkey, Qatar, and Saudi Arabia among others.

The situation is not any better in the nursing sector. According to the Iranian Nursing Organization (INO), for every 10,000 people, there needs to be 50 nurses. However, figures released by the World Health Organization (WHO) shows that Iran only has 16.3 nurses for every 10,000 people, indicating a shortage of around 150,000 nurses considering the country’s population of 84 million.

This is while Iran has been among the countries with the highest fatalities among its healthcare workers during the coronavirus pandemic. According to Dr Mohammadreza Zafarghandi, the head of Iran’s Medical Council, around 300 health workers have died in Iran, most of them doctors and nurses.

The serious shortage of doctors and nurses in Iran has led to series of problems including the rise of inequality in access to healthcare staff, a growing dissatisfaction about the quality of health service, an increase in costs for medical treatments and medical errors.

Against the backdrop of an increasing number of professionals leaving Iran and a growing shortage of medical staff, some have warned that the country may need to hire foreign doctors as soon as 2040.

Despite all odds, Iranian healthcare authorities have consistently rejected the warnings about the shortage of physicians.

Dr Abolfazl Bagheri-Fard, the deputy health minister for education was quoted by local media earlier this month saying that the country’s “physician per capita is 17.1” and added that “based on our plans, this figure will reach above 18 by 2025” which he described as an ideal figure.

Maysam Bizaer is an analyst and commentator on Iran’s foreign policy, politics, and economy. He is a frequent contributor to international media and US-based think tanks covering the Middle East.

Follow him on Twitter @m_bizar