Conflict scatters skilled health workers across borders. Rebuilding health systems means creating trusted ways for displaced professionals to put their qualifications back to work
Ask health ministers what collapses first when a health system comes under strain, and most will point to buildings, medicines and cold chains. Ask them what is hardest to bring back, and the answer is almost always health professionals. When Syria’s war forced a decade’s worth of doctors, nurses and technicians to leave, many ended up next door in Lebanon. They had the skills. But licensing rules, accreditation requirements and restrictions on employment meant many could not legally use them. They were ready to serve, but could not.
This is the challenge at the centre of the health workforce almost everywhere conflict and displacement meet. We speak of shortages as if the problem were a lack of trained people. Often it is not. It is a lack of a system that lets trained people work.
I’ve led the World Health Organization’s work in the Eastern Mediterranean, a region deeply affected by conflict, displacement and protracted emergencies, so this is not a theoretical issue for me.
A global workforce problem
It is also a global problem, not merely a regional one. A Ukrainian doctor in Poland whose temporary right to practise, granted early in the war, is now expiring, faces a full licensing exam and a language test to be able to keep treating patients. A South Sudanese nurse in Uganda must pay out of pocket to have her own credentials reverified. Different crises, the same problem: a health system fractures, its workforce scatters and years pass out of practice while people survive the same crisis as their patients. Rebuilding hospitals is a matter of money and time. Rebuilding a workforce is a matter of trust, standards and political will – far harder to restore.
Forty years ago, the Ottawa Charter on Health Promotion challenged governments to create the conditions in which people and communities could achieve better health. It called for supportive environments, stronger community action and health services oriented to people’s needs. In a world of displacement and protracted crises, I believe that logic must extend to the people who deliver health too.
War and displacement can break those conditions. This can happen anywhere.
Yet each case is treated as a bureaucratic problem, solved, if at all, case by case. None of them is actually individual. Together they describe a global workforce crisis, made worse by the absence of a shared system to solve it.
This is not only about mobility for its own sake. The WHO already discourages recruiting from countries whose own workforce is most fragile, and rightly so. The people we are talking about were not recruited away from anywhere. They were forced to flee. The question is whether their skills get used or not.
Making qualifications portable
So what would it mean to take the Ottawa Charter’s promise seriously in a world defined by multiple crises? It would mean treating accreditation and licensing as core health infrastructure, the same as a hospital or a cold chain, and building mechanisms, within regions and between them, for mutual recognition of qualifications, so a South Sudanese nurse in Uganda can do the job she trained for.
This is not hypothetical. Across the Persian Gulf, health regulators already use a common infrastructure for primary- source verification of professional credentials. Verification is not the same as mutual recognition, but it shows that some of the infrastructure needed to make qualifications more portable already exists.
It needs an institution persistent enough to hold the process together after the novelty wears off, which is precisely what a body with universal membership is for. This is a case for health multilateralism. When ministries cannot resolve mutual recognition alone, the WHO can convene and hold that process together.
After conflict, the single hardest thing to rebuild is the health workforce. For Timor-Leste, 24 years since independence, this has been one of its priorities. While building capacity at home, the country must also rely on bilateral exchange programmes.
Forty years on, the Ottawa Charter’s promise remains unfinished. In a world of displacement, enabling trained health professionals to use the skills they already have is one part we can solve. It is a matter of trust, creating the confidence that certified professionals can be relied on wherever they trained. It is a matter of impact, getting a skill that already exists to the patient who needs it instead of losing it to paperwork. And it is a matter of value, giving a trained health professional the opportunity to care for people.
That is exactly the kind of challenge I would address, should I have the privilege of leading the WHO next.
