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Removing barriers for immigrant medical professionals is critical to help fight Coronavirus

By Silva Mathema 

Hospital bed booths are set up at the Javits Center, which is being turned into a temporary hospital to help fight COVID-19 cases, in New York City on March 27, 2020.

Getty/Eduardo Munoz AlvarezHospital bed booths are set up at the Javits Center, which is being turned into a temporary hospital to help fight COVID-19 cases, in New York City on March 27, 2020.

Immigrant doctors, nurses, and other health care workers are on the front lines in the fight against the spread of COVID-19 in the United States. With the coronavirus pandemic straining health care systems, some states, such as New York and New Jersey, have taken steps to bolster their workforce by suspending requirements and making it easier for immigrant and foreign-trained doctors to join the fight. Connecticut is asking retired doctors and nurses to volunteer to serve, and the New York University Grossman School of Medicine and four medical schools in Massachusetts are allowing current students to graduate early to start helping right away.

The Liaison Committee on Medical Education, under the American Medical Association and the Association of American Medical Colleges, released guidance for medical schools considering similar early-graduation policies.

The COVID-19 pandemic is projected to peak starting in the next two weeks, with patient need far exceeding the capacity of the health care system in many areas. Increasingly more front-line providers are getting sick, which exacerbates the shortage and worsens the situation.

Nearly 29 percent of all U.S. physicians, 22 percent of nursing assistants, and 38 percent of home health aides are foreign born; together, foreign-born workers make up 17 percent of the entire health care and social services industry.

But there are many challenges for immigrant medical professionals who work in this country. Even under normal circumstances, immigrant doctors must overcome numerous hurdles, ranging from unfair state licensing requirements to rigid visa rules, to practice in the United States.

Paradoxically, COVID-19 has actually heightened the barriers faced by badly needed immigrant medical professionals. For instance, office closures and the suspension of visa services at consulates overseas are severely hampering the ability of health care professionals to get medical licenses, obtain visas, and remain in status. Federal and state policymakers, as well as the Educational Commission for Foreign Medical Graduates (ECFMG), an entity that certifies international medical graduates (IMGs) to work in the United States, must immediately work together to lift barriers and enable immigrant and foreign-trained health care professionals to quickly serve in COVID-19 hot spots. This column outlines actions that the federal government and states should take to increase health care service capacity in U.S. cities and localities immediately.

The federal government should immediately increase the number of immigrant doctors serving where they are needed most

Immigrant doctors commonly utilize J-1 visas for their residencies before turning to the Conrad 30 waiver program, or J-1 waivers, to continue practicing in the United States and gain a pathway to lawful permanent residence. Other immigrant doctors come through the H-1B program for high-skilled workers. In either case, U.S. Citizenship and Immigration Services (USCIS) and the U.S. Department of State must remove roadblocks, even if temporarily, to allow more immigrant doctors to practice.

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Expedite and automatically extend work authorizations for immigrant health care professionals

All types of immigration-related applications are getting delayed or even jeopardized for a variety of reasons. For example, there are widespread closures of USCIS offices that interact with the public to help process these applications, suspension of routine visa services in U.S. consulates around the world, and cancellation of medical board exams that are essential for a physician to get licensed.

While the administration recently announced that it would continue to process employment authorization extension applications using previously submitted biometrics, that does not solve the problem for initial petitions for which biometrics cannot now be collected, nor does it relieve health care professionals working today from having to take the time to apply for an extension and hope for a timely adjudication. USCIS should grant automatic extensions of work authorizations to allow immigrant health care professionals to continue their vital work in these critical times.

The United Kingdom just announced that it will automatically extend foreign doctors’, nurses’, and paramedics’ visas that were going to expire before October.

Another prudent action for the State Department would be to encourage consular officers to waive interview requirements for medical professionals if they do not appear to be ineligible for the visa.

The State Department late last week issued similar guidance with respect to all first-time and returning H-2A and H-2B applicants—temporary agricultural and nonagricultural workers, respectively. It is no less important that the United States at this time have access to skilled health care professionals willing to assist the country’s response to the virus.

Suspend restrictions on where immigrant physicians with H-1B and J-1 waivers can work

Immigrant physicians with H-1B visas are restricted from changing employers without extensive paperwork, and their status is contingent upon the ability and willingness of employers to sponsor them. With suspended services and delayed processing due to COVID-19, being able to shift quickly to hospitals that are stretched thin, including to rapidly created field hospitals, is critical—and yet all but impossible under the current system. Similarly, immigrant physicians with J-1 waivers cannot change employers easily unless there is an “extenuating circumstance.”

USCIS should waive all geographical restrictions and define any transfer related to assisting the fight against COVID-19—including both treating COVID-19 patients and serving general medical needs that would otherwise strain the country’s fragile health care system—as an extenuating circumstance. USCIS should also suspend Simeio filing requirements for H-1B health care workers, which require them to file an amended petition to practice in a new location. In response to COVID-19, the Army Corps of Engineers is looking into converting 114 facilities across the country into temporary hospitals and is already transforming the Javits Center in New York City and the TCF Center in Detroit. The new locations are quickly going to need medical professionals to staff them—removing burdensome bureaucratic hurdles will ensure that this is possible.

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States must cut red tape to make it easier for immigrant doctors to serve in high-need areas

Although the federal government holds the key to increasing the number of immigrant doctors, states should also take steps to remove roadblocks in order to quickly increase their health care workforce.

Ease residency requirements for foreign-trained doctors

The number of years of U.S. medical residencies required for foreign-trained doctors to get licensed in the United States—regardless of how many years of experience they have in other countries—is often higher than it is for a graduate from a U.S. medical school. States should at least apply the same standards to IMGs as they do to U.S. medical graduates.

In these desperate times, New York Gov. Andrew Cuomo (D) recently issued an executive order to temporarily allow foreign-trained physicians who have at least one year of U.S. graduate medical education to provide medical care in the state. New Jersey Gov. Phil Murphy (D) also signed an executive order granting temporary licenses to doctors with licenses in foreign countries; other states should follow suit.

This month, the ECFMG matched more than 7,000 IMGs to residency programs all over the United States; among them, more than 4,200 are noncitizens. This means that there are thousands of doctors who are qualified to help with the COVID-19 crisis but have not yet started their U.S. residencies to get a license. Many of these IMGs may already have years of residencies completed in other countries. States should work with the ECFMG to identify countries that have education standards similar to the United States, recognize residencies completed there, and allow these medical professionals to join the fight against COVID-19 immediately.

Allow unmatched immigrant doctors without licenses to help

States need to work with the ECFMG to identify immigrant doctors who, despite having passed the U.S. exams, were not matched with a residency program in the United States and as such are unable to fulfill state licensing requirements. The number of residency slots available each year is limited and has been insufficient in the past to meet the demand of medical school graduates. Just last year, more than 2,800 foreign-trained doctors who are not U.S. citizens passed the required levels of the U.S. Medical Licensing Examination but were not matched with a residency. States have created programs for people with a medical education who for one reason or another cannot get into a residency program; these types of programs can ensure they continue to work in some capacity. For example, Missouri enacted a law in 2017 allowing medical graduates who are “resident[s] and citizen[s] of the United States” or “legal resident alien[s]” and who have completed two levels of the U.S. Medical Licensing Examination but have not started their residencies to serve as assistant physicians. The same type of new professional category can be used to allow immigrant doctors who did not get into residencies to contribute amid this workforce crunch.

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The ECFMG should enable more immigrant doctors to join the workforce

The ECFMG has been responding swiftly to the COVID-19 pandemic. Following the announcement that the United States was suspending routine visa processing, it worked with USCIS to make sure that more than 4,200 foreign-trained doctors who were approved for a J-1 visa could get their visas processed. These doctors were supposed to travel to the United States to begin their residencies in July 2020; the ECFMG should push for them to start earlier to help with the pandemic.

There is more that the ECFMG can do in the fight against COVID-19. Immigrant doctors with J-1 visas must complete their residencies in an accredited graduate medical school approved by the ECFMG and the State Department. At least temporarily, the ECFMG, in coordination with the State Department, should relax its rules and allow J-1 visa holders to easily transfer to COVID-19 hot spots even when those places are not ECFMG or the State Department approved.

Conclusion

Even before the COVID-19 pandemic hit the United States, the nation was facing a severe and growing shortage of doctors. As cases of COVID-19 increase to heretofore unimaginable levels, and new hot spots emerge nationwide, states, the ECFMG, and medical schools are taking extraordinary measures to increase capacities and staff of health care facilities. Unfortunately, the Trump administration’s ongoing push toward restrictive immigration policies is trending in the opposite direction, as evidenced by the continuing effort to end the Deferred Action for Childhood Arrivals (DACA) initiative, which has allowed an estimated 27,000 health care professionals to work when and where they are needed most. Congress also has the power to make numerous legislative changes to ensure that immigrant doctors, from DACA recipients to those with J-1 waivers, can contribute more fully and stay and work in the United States if they choose to do so. There is so much more that the federal government and states can still do to help the country get through this public health crisis. This is a time to rise to the occasion and utilize all available resources to fight the pandemic.

Silva Mathema is an associate director for policy on the Immigration Policy team at the Center for American Progress.

The author would like to thank Gregory H. Siskind from Siskind Susser for providing his expertise.

Source: Americaprogress.org

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Netherlands, IOM launch Global Migration Initiative to protect people on the move

COMPASS will provide vulnerable migrants including victims of trafficking and unaccompanied or separated children access to a broad range of protection and assistance services.

 The International Organization for Migration (IOM) and the Ministry of Foreign Affairs of the Netherlands launched the Cooperation on Migration and Partnerships for Sustainable Solutions initiative (COMPASS) at the beginning of 2021. COMPASS is a global initiative, in partnership with 12 countries, designed to protect people on the move, combat human trafficking and smuggling, and support dignified return while promoting sustainable reintegration.

The initiative is centred on a whole-of-society approach which, in addition to assisting individuals, will work across all levels – households, communities, and the wider communities – and encompasses the following partner countries: Afghanistan, Chad, Egypt, Ethiopia, Iraq, Lebanon, Libya, Mali, Morocco, Niger, Nigeria, and Tunisia.

“We want to mobilize families, peers and communities to encourage informed and safe migration decisions, protect migrants, and help those returning home reintegrate successfully,” said Monica Goracci, Director of the Department of Migration Management at IOM.

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“One key component is also undermining the trafficking and smuggling business models through the promotion of safe alternatives and information sharing to reduce the risks of exploitation and abuse by these criminal networks.” Vulnerable migrants, including victims of trafficking and unaccompanied or separated children, will have access to a broad range of protection and assistance services such as mental health and psychosocial support, while migrants in transit who wish to return home will be supported with dignified return and reintegration.

Community level interventions will focus on improving community-led efforts to address trafficking in persons and smuggling of migrants, and support sustainable reintegration of returning migrants. COMPASS will work with national and local governments to enable a conducive environment for migrant protection, migration management and international cooperation on these issues.

“The Ministry of Foreign Affairs is pleased to launch the COMPASS programme in cooperation with IOM, an important and longstanding partner on migration cooperation,” said Marriët Schuurman, Director for Stability and Humanitarian Aid of the Ministry of Foreign Affairs of the Netherlands.

READ  39 migrants die as boats sink off Tunisia's coast

“The programme is a part of the Dutch comprehensive approach to migration with activities that contribute to protection and decreasing irregular migration. Research and data gathering are also important components, and we hope that the insights that will be gained under COMPASS will contribute to broader knowledge sharing on migration and better-informed migration policies.”, added Schuurman. The initiative has a strong learning component, designed to increase knowledge and the uptake of lessons learned, both within the programme and beyond its parameters. COMPASS will actively contribute to global knowledge that supports countries in managing migration flows and protecting vulnerable migrants such as victims of trafficking. The implementation of COMPASS is set to start soon.

The Ministry of Foreign Affairs of the Netherlands, as the donor to the COMPASS initiative, pledges its active support to partner countries to improve migration cooperation mechanisms within its long-term vision. 

IOM, the leading inter-governmental organization in the field of migration, contributes its expertise as the technical implementation partner to the initiative. IOM works closely with governmental, intergovernmental and non-governmental partners in its dedication to promoting humane and orderly migration for the benefit of all. 

READ  Nigerian girl held captive in Lebanon cries for help

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A child, 40 others drown in shipwreck off Tunisia

Photo: Mediterranean Sea

UNHCR, the UN Refugee Agency, and the International Organization for Migration (IOM) are deeply saddened by reports of a shipwreck off the coast of Sidi Mansour, in southeast Tunisia, yesterday evening. The bodies of 41 people, including at least one child, have so far been retrieved.

According to reports from local UNHCR and IOM teams, three survivors were rescued by the Tunisian National Coast Guard. The search effort was still underway on Friday. Based on initial information, all those who perished were from Sub-Saharan Africa.

This tragic loss of life underscores once again the need to enhance and expand State-led search and rescue operations across the Central Mediterranean, where some 290 people have lost their lives so far this year. Solidarity across the region and support to national authorities in their efforts to prevent loss of life and prosecute smugglers and traffickers should be a priority.

Prior to yesterday’s incident, 39 refugees and migrants had perished off the coast near the Tunisian city of Sfax in early March. So far this year, sea departures from Tunisia to Europe have more than tripled compared to the same period in 2020.

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UNHCR and IOM continue to monitor developments closely. They continue to stand ready to work with the national authorities to assist and support the survivors, and the family members of those lost.

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Ethiopian migrants return home from Yemen with IOM support in wake of tragic boat sinking

Yemen: Stranded Ethiopian migrants prepare to board an IOM-facilitated flight from Aden, Yemen, to fly home to Addis Ababa. Photo: IOM/Majed Mohammed 2021

One hundred and sixty Ethiopian migrants have returned home safely from Yemen today with the assistance of the International Organization for Migration (IOM), just one day after a perilous journey across the Gulf of Aden claimed the lives of dozens of people, including at least 16 children.

More than 32,000 migrants, predominantly from Ethiopia, remain stranded across Yemen in dire, often deadly, circumstances.

“The conditions of migrants stranded in Yemen has become so tragic that many feel they have no option but to rely on smugglers to return home,” said Jeffrey Labovitz, IOM’s Director for Operations and Emergencies.

At least 42 people returning from Yemen are believed to have died on Monday when their vessel sank off the coast of Djibouti. Last month, at least 20 people had also drowned on the same route according to survivors. IOM believes that, since May 2020, over 11,000 migrants have returned to the Horn of Africa on dangerous boat journeys, aided by unscrupulous smugglers.

READ  Dozens of migrants die in 30 days 

“Our Voluntary Humanitarian Return (VHR) programme provides a lifeline for those stranded in a country now experiencing its seventh year of conflict and crisis. We call on all governments along the route to come together and support our efforts to allow migrants safe and dignified opportunities to travel home,” added Labovitz.

COVID-19 has had a major impact on global migration. The route from the Horn of Africa to Gulf countries has been particularly affected. Tens of thousands of migrants, hoping to work in the Kingdom of Saudi Arabia (KSA), now find themselves unable to complete their journeys, stranded across Djibouti, Somalia and Yemen.

While the pandemic has also caused the number of migrants arriving to Yemen to decrease from 138,000 in 2019 to just over 37,500 in 2020, the risks they face continue to rise. Many of these migrants are stranded in precarious situations, sleeping rough without shelter or access to services. Many others are in detention or being held by smugglers.

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“We cannot find jobs or food here; Yemen is a problem for us,” said Gamal, a 22-year-old migrant returning on the VHR flight. “I used to sleep in the street on cardboard. I could only eat because of the charity people would give me and sometimes we were given leftovers from restaurants. I never had much to eat.”

Since October 2020, in Aden alone, IOM has registered over 6,000 migrants who need support to safely return home. Today’s flight to Addis Ababa was the second transporting an initial group of 1,100 Ethiopians who have been approved for VHR to Ethiopia. Thousands of other undocumented migrants are waiting for their nationality to be verified and travel documents to be provided.

Prior to departure on the VHR flight, IOM carried out medical and protection screenings to ensure that returnees are fit to travel and are voluntarily consenting to return. Those with special needs are identified and receive specialized counselling and support.

In Ethiopia, IOM supports government-run COVID-19 quarantine facilities to accommodate the returnees on arrival and provides cash assistance, essential items and onward transportation to their homes. The Organization also supports family tracing for unaccompanied migrant children.

READ  Sudanese provides safe haven to fellow refugees in Libya

Across the Horn of Africa and Yemen, IOM provides life-saving support to migrants through health care, food, water and other vital assistance.

Today’s flight was funded by the US State Department’s Bureau for Population, Refugees and Migration (PRM). Post-arrival assistance in Addis Ababa is supported by EU Humanitarian Aid and PRM.

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