Roua Shaweesh (right), a paediatrician, with the mother of a newborn with severe birth defects. Image Credit: NYT

When Ayham Ebrahim fled the war in his native Syria in 2016 and joined his wife, a paediatrician, in Germany, he was eager to continue his career as a doctor of internal medicine.

But after arriving in the country that was offering them refuge, instead of finding a system eager to put his talents to use, Ebrahim said, he encountered hurdles and delays that left him discouraged, demoralised and frustrated.

It took months before he could even apply for refugee status. That delayed the start of his required German-language classes. Then, his wife was offered a temporary job at a research hospital in Heide, some 50 miles west of Kiel, the capital of Schleswig-Holstein state. So he moved with her.

But no professional-level German-language classes were offered in the smaller city, so he was forced to commute two hours each way to complete the course.

“It was the longest and coldest days I have ever lived,” Ebrahim said recently.

“It has been really tough. While on the train to attend my language class, I had moments when I thought I couldn’t do this,” he added, while sitting in his doctor’s coat in the cafeteria of the West Coast Clinic, known by its German initials WKK, in Heide, shortly after he had begun an internship there.

Economists predict that by 2020, Germany could face a shortfall of 1.8 million skilled workers for posts as diverse as doctors, restaurant wait staff and hotel cleaners. Medical professionals are expected to be among the most desperately sought foreign workers in Germany in the coming years.

While no country allows foreign doctors to work in their country without ensuring they meet local standards, the Syrians in Germany complain the system here is complicated: There are, for example, different accreditation departments in each of the nation’s 16 states, which they say often have different standards; and the process is riddled with wait times of several months between registration exams, adding to the difficultly.

In the years since more than 1 million people poured into Germany seeking refugee status and a better life, much effort and resources have been expended on the question of whether the new arrivals could contribute to Europe’s biggest economy. Recent numbers show they can — but only if allowed.

According to figures from Germany’s Federal Employment Agency, 306,570 refugees — more than one-quarter of all those registered — had jobs that contributed to the social welfare system as of May. Although that is a small fraction of the 63 per cent of Germans holding full-time jobs, or 44.94 million, the numbers have been steadily increasing.

When parliament reconvenes after its summer recess, Chancellor Angela Merkel’s government plans to draw up a bill that would make it easier for foreigners to seek work in Germany. An initial proposal circulated last month calls for foreign candidates to have the necessary qualifications, to speak German and to have a job offer that ensures they can support themselves.

The more than 3,370 Syrian doctors already treating patients in German hospitals and clinics are not likely to be affected by the new legislation.

The proposal, which the government hopes to put to a vote in parliament before the end of the year, comes at a time of increasingly toxic debate over refugees in Germany. A recent outbreak of violence in the eastern German city of Chemnitz is indicative of the rise in nationalist fervour. Far-right activists called on supporters to take to the streets to “defend” their country from immigrants after the fatal stabbing of a 35-year-old German man. An Iraqi and a Syrian are suspected of the killing.

The government plan also comes amid the rise of the anti-Muslim party Alternative for Germany, or AfD, which entered parliament last year as the strongest opposition party. AfD has been one of the loudest voices against the idea of including a clause in the legislation that would allow asylum-seekers who learn German and find jobs or traineeships while waiting for decisions on their cases to stay in the country after they are rejected.

“We have seen a million people enter the country through uncontrolled immigration, and that should not be legalised after the fact,” Bernd Baumann, head of the AfD’s parliamentary caucus, said in August.

Still, the country is scrambling to fill the vacancies among medical professionals left by retirees and a generational shift that is being worsened by employees’ demand for a stronger work-life balance and a preference by young people for more part-time positions.

Even so, the head of the doctors’ association in Germany wants to introduce a requirement that foreign doctors from outside the European Union must pass a written exam equivalent to that taken by German medical students, amid concerns that too many foreigners are producing fake medical qualifications from their home countries.

Although the idea faces opposition from others in the medical profession, the prospect is terrifying to Ebrahim and other colleagues. Already, they face stringent language and licence exams before they are allowed to practice, and they argue that asking them to effectively retake a medical exam in a foreign language would be an unnecessary burden.

Mahmoud Jalloud, 43, a gastroenterologist from Raqqa, Syria, now living in Luneburg, southeast of Hamburg, spent his five first months in Germany teaching himself the language. After he finally landed in a class, he was surrounded, he said, by others who seemed to be there only to tick a box to receive their benefits.

“I finished studying medicine in 2000 and invested another seven years to specialise as a gastroenterologist,” Jalloud said. “Now I have to go through all of this to be recognised as a general practitioner, and God knows how long it will take before I am recognised as a gastroenterologist again.”

“I am just wondering why Germany is not making it easy for us refugees who are keen on learning, working and contributing to this community,” he added.

Many older doctors who came to Germany say they feel the same way. Some have found menial jobs washing dishes or selling kebabs to support their families in Germany. They are daunted by the hurdles they face to begin practicing again.

Aware of such obstacles, the WKK clinic has developed special programmes and support for newly-arrived staff members. Apartments on the hospital grounds allow new employees to live there while searching for a home. They are accompanied to the registry offices to complete their paperwork and are offered hospital bedside language coaching.

“We are very open and make sure that we take care of those who are coming to us from afar — whether they are coming from Lithuania, Syria or Bavaria,” said Sebastian Kimstadt, a spokesman for the hospital.

The assistance includes organising special language classes tailored to the terms that doctors will need to know, including complaints in the local dialect, “Plattdeutsch,” still spoken by many of the older patients. Language teachers also accompany foreign doctors on their rounds to help coach them on their bedside manners.

“It’s helpful — I really wanted to take part,” said Ali Eid, 31, who practiced in Syrian hospitals before he fled to Germany.

For the Syrian doctors, the steep learning curve in their new country also includes some social and cultural differences. Ebrahim’s wife, Roua Shaweesh, who treats patients in the WKK clinic’s paediatric ward, said she was surprised at how many German parents took their children to the emergency room for coughs and colds.

“You wouldn’t see that in Syria,” she said, adding that she had also not encountered in Germany many of the childhood illnesses common in her homeland.

Eid said he was surprised to learn that doctors addressed older patients directly when discussing severe, even fatal, illnesses with them. In Syria, the patients would be surrounded by their adult children and other family members, who would be a doctor’s point of contact, he said.

Overall, he said, he was impressed by the standard of medicine practiced in Germany and was happy to be able to contribute to his new community.

Asked if he would consider returning to Syria, he counted the years it would take him to finish his internship, his language lessons, residency and licensing exam before he could begin practicing in Germany.

“By then, I will be too old to start all over again,” Eid said.

–New York Times News Service