Long before he started medical school in Baghdad, Ahmed Al-Sarray knew he wanted to make a difference in people’s lives. By the time he graduated in 2015, that search for purpose evolved into a passion for health care in times of crisis. Even a grueling medical residency in the hardest-hit emergency rooms and trauma wards of Baghdad’s war-torn hospitals wasn’t enough to deter him. But the militants were. As rival militias flooded Al-Sarray’s emergency ward starting in 2017, he found himself fighting for his own life as much as those of his patients. Militia leaders demanded that he care for their fighters before other patients, and threatened to kill him if he attended to their enemies. After losing colleagues in violent attacks, he fled for the United States—but he never abandoned his commitment to heal.
So when COVID-19 hit Al-Sarray’s adopted home of Los Angeles, he thought it was the perfect opportunity to put his medical background to use. “I have the skills, I have the training, I have the passion to help,” he says. What he doesn’t have is an American medical license. So Al-Sarray, who was granted asylum in the U.S. in 2018, can’t practice medicine in the country, due to strict licensing rules for foreign doctors.
Instead of working as a doctor, Al-Sarray is doing what he sees as the next best thing: helping the City of Los Angeles fulfill its pledge to offer a COVID-19 test to anyone who wants one. He’s working as a safety officer at a testing site at Dodger Stadium, where, instead of baseball games, 6,000 tests are being administered every day. He admits he’s disappointed to be off the front lines, helping sick patients in the hospitals. But the work he’s doing “is the same thing,” he says. “There is no cure, no vaccine for COVID-19. Testing is the most vital part of stopping this disease. So if I can help stop the spread, then I am happy to do whatever I can as a response to this pandemic.”
The Iraqi doctor-turned-COVID-tester is just one of 165,000 refugees and immigrants who have medical training in the U.S. but are unable to work in their field due to licensing rules, according to research from the Migration Policy Institute, a nonpartisan think tank. Regulations vary from state to state, but by and large all would-be doctors must pass the local medical board exam, and then apply for a three-to-five-year residency internship at a teaching hospital. “Even though you have been practicing for years in another country, when you come to the States, in order to get licensed, you will have to redo a residency program,” says Jacki Esposito, director for U.S. Policy and Advocacy at World Education Services (WES), a non-profit organization that provides credential evaluations for international students and immigrants planning to study or work in the U.S. or Canada.
The application process for residency programs, which is notoriously difficult and competitive for American medical students, is even more challenging for foreign-trained doctors. Many programs also limit the amount of time an applicant is allowed to take between completing medical school and starting a residency. “For the most part, there is no recognition of your experience outside the U.S.,” says Esposito. “So internationally-trained doctors, just by virtue of the fact that they didn’t train in the United States, and have not trained for a long time because they have been practicing in their countries of origin, they don’t have that recent education experience to even qualify for those residency programs.”
Confronted with the prospect of years of study, expensive exams and the uncertainty of even qualifying for residency before they can start working in their field, many migrant and refugee doctors opt for jobs offering more immediate paychecks. Some are now working as taxi drivers or cleaners. Others, like 35-year-old Afghan doctor Ameena Yosefzaie, patch together babysitting jobs and DoorDash driving gigs to make ends meet as they study for the medical exams that will let them start over from scratch in the U.S., even though they have years of experience back home.
Like many others, Yosefzaie is especially eager to help as the longstanding shortage of health care professionals in the U.S., particularly in rural areas and underserved communities, becomes all the more acute amid the COVID-19 crisis. “I hear there is a shortage of doctors and nurses in California,” says Yosefzaie, who now lives in Sacramento. “It’s frustrating. I wish I could help but I am not allowed to work as a doctor. So maybe I can help in another way.”
In some states, the urgent need for health care professionals to help with the outbreak is prompting officials to loosen the rules. Colorado’s governor signed an executive order permitting foreign-licensed healthcare professionals to contribute to the COVID response. New Jersey’s governor temporarily authorized foreign-certified doctors to serve in specific contexts. And in New York, Governor Andrew Cuomo is letting doctors accredited abroad provide patient care in hospitals if they have completed at least one year of graduate medical education in the U.S.
There are also many other areas, such as testing or contact tracing, where medical experience comes in handy, even if a U.S. doctor’s license is not required. That’s where people like Al-Sarray and Yosefzaie can play a role. “Most refugees and immigrants are working in this country, paying taxes, and not getting any benefits in return,” says Al-Sarray. “I’m here to help. Not to be helped. I’m a doctor and worked for two years in my country. I want to use that experience to help the American people.”
Al-Sarray found his testing job through a new online platform set up by the International Rescue Committee (IRC), a humanitarian organization that connects refugees in the U.S. with employment and educational opportunities. The portal, called refugees.rescue.org, allows refugees and immigrants with medical degrees from abroad to register their interest to work in the fight against COVID-19. They list their credentials, where they are based and whether they are willing to travel. They can also say if they are interested in pay-only positions, or if they would like to hear about volunteer opportunities as well. More than 540 health professionals from 42 countries have signed up since the platform launched in mid-May. They are mostly doctors and nurses, but also firefighters, dentists, microbiologists and more.
“At a time when the U.S. health system is hugely overburdened, when there is a scarcity of human resources, and there is a large pool of underutilized nurses and doctors with foreign medical degrees, it seemed very necessary to connect the need with the supply,” says Hans Van de Weerd, IRC vice president of resettlement, asylum, and integration. “These are the ‘essential workers’ on the front line against COVID-19, many of them having already faced war and health emergencies at home and who are now volunteering to step back into the fire for the country that welcomed them.”
Van de Weerd was surprised to see that nearly three quarters of those who registered on the IRC’s platform said that they were willing to volunteer. A lot of refugees are tired of staying home and doing nothing, he says. They want to help, and use their skills, but they may not know where to go. “Maybe a doctor wants to treat people; a nurse wants to take care of patients. It’s not so surprising, if that was your calling, that you now want to do that in your new country as well.”
For Al-Sarray, that was exactly the case. He has spent the past two years perfecting his English and studying for his upcoming U.S. medical board exams. If he does well, he plans to apply for medical residencies in September. Even though he had just completed his residency before fleeing Baghdad, he says he doesn’t mind another three years as long as he gets to work with patients. He registered on the IRC’s site as soon as he heard about it. “The whole reason I wanted to be a doctor was to help people, so I looked for chances to volunteer,” says Al-Sarray. “I didn’t want to sit at home not contributing anything.”
In late May, Al-Sarray got a call: California was dramatically expanding its free COVID-19 testing facilities in partnership with a local aid organization called CORE (Community Organized Relief Effort); did he want to oversee the security protocols as a health and safety manager at one of the test sites? He immediately said yes. It wasn’t until he completed his training and signed his contract that he realized it was a paid position. “I didn’t care. I just wanted to be part of this response,” he says.
CORE, a relief organization co-founded by American actor Sean Penn in the wake of a devastating earthquake in Haiti in 2010, is now managing 37 testing sites across the U.S., including in Chicago, Detroit, New Orleans and the Navajo Nation. So far it has it has administered more than 310,000 tests. As it grew, the group partnered with the IRC to tap its database of skilled healthcare professionals. CORE’s method of administering COVID-19 tests benefits from healthcare experience, but does not require a medical license. So hiring medically-skilled refugees “feels like a win-win,” says Benjamin Bashein, CORE’s vice president for partnerships and communications. “They might not be certified to work in this country, but they still have the technical background to contribute.”
The refugees’ language skills and diverse cultural background are also an asset for a testing program directed at underserved communities and communities of color. At one newly opened testing site in Atlanta, CORE was able to provide not just medical expertise, but interpretation in 13 different languages, including Amharic, Arabic, Burmese, Kiswahili, Somali and Tigrinya. “To work with these new Americans who have been resettled with the IRC is gratifying,” says CORE Co-Founder and CEO Ann Lee. “CORE appreciates these dedicated volunteers, who enable us to scale and provide free COVID-19 testing to vulnerable communities throughout the United States.”
Both the IRC and WES hope that the database and the partnership with CORE will lead to greater opportunities for immigrant health professionals down the line, as well as a more streamlined process for getting them into the U.S. medical system. “To the extent that we can turn the situation into something that can meaningfully impact those 165,000 people’s lives while improving access to health care, that would be a positive outcome,” says the WES’ Esposito. “We know that there are urgent needs for licensed health care staff and there are also needs to fill other public health roles,” she says, noting a growing need for contact tracers within the U.S. “These are roles where immigrants and refugees can really contribute. There are roles where you don’t need to change policy to make sure that people are going where they are needed.”
Although Al-Sarray is confident that eventually he will make it as a doctor in the U.S., he is thrilled to be playing a role in the pandemic response now, no matter how small. Before starting his training program as a safety officer for CORE, Al-Sarray boosted his infectious disease knowledge and personal protection equipment skills by watching instructional videos from the Centers for Disease Control and Prevention and the World Health Organization. Within a few hours of starting work at Dodger Stadium in late May, he was already adjusting the test-handling protocols to help minimize the risk of contagion. By the end of his first day, he was giddy with a sense of accomplishment.
“Now that I am in the front lines, I am even more excited because I am seeing first-hand the amount of people that we are helping,” he says. “Being a part of such a large testing site really makes you feel like you’re contributing to the response. I feel like I am making a difference.”
—With reporting from Carlo Barrera/Los Angeles