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"I'm a doctor but I don't practise here," explains Faduma Hussein, a refugee doctor from Somalia. She would like to be working as a family planning doctor, but says she was not given the necessary guidance and advice when she arrived in England in 1994. She regrets not taking the necessary exams. "But now it's too late," she says.

Hussein has 19 years' experience as a doctor in Somalia, where she became a consultant gynaecologist. She now works as a lay health adviser at the Community Health Project in Waltham Forest, London, helping refugees and asylum seekers to register with a GP and carrying out health promotion work. She is also an adviser in African Well Women clinics, working with women who have experienced genital mutilation.

Hussein believes that applying their skills should be made easier for refugee doctors, whose knowledge should not be wasted "working in a restaurant".

"There are a lot of refugee doctors who come to this country not because they want to work but because they come running. They have the knowledge. Something has to be done for them," she says.

Hussein is by no means the only refugee doctor whose medical skills have gone to waste. A database set up in May 2001 by the British Medical Association lists 865 refugee doctors who want to work for the NHS. Nearly half are from Iraq and Afghanistan, while other common countries of origin include Iran, Pakistan, and Sudan. The NHS is short of thousands of doctors, so why aren't these trained medical staff being snapped up as soon as they are granted refugee status?

The answer centres on their qualifications. Many find that the medical training they received in their home countries does not permit them to be registered with the General Medical Council, the registering body for doctors in the UK.

As a result, in order to practise, most have to go through a tough requalifying process. This starts with a language exam, the International English Language Testing System, and is followed by a test of their medical knowledge by taking the two-part Professional and Linguistic Assessment Board (Plab) exam.

Finding out how to requalify can be a hurdle in itself, and the cost is vast. Many refugees survive on benefits while they study, and finding the money to sit the exams is difficult. The language exam costs £78 and, although the GMC has waived the fee for the first two attempts at part one, all doctors must pay the £430 fee to sit part two.

"I can't understand how people manage to survive," says Edwin Borman, chairperson of the BMA's international committee.

Those who can, get jobs, although these tend to be menial and unrelated to medicine. Others are forced to rely on the support of family and friends. But Borman insists the requalification process for refugee doctors should not be made easier.

"We are clear on this. Refugee doctors, in exactly the same way as other doctors coming from outside the European Economic Area, should meet all the criteria. They are necessary quality safeguards."

Many refugee doctors who have gone through the process say that, although they hated it at the time, they understand why it was necessary, Borman says.

Although the BMA stands by the current requalification process, it would like easier access to "clinical attachments" - placements in hospitals or general practice settings. These can be difficult to set up and, amazingly, some hospitals have tried to charge for them.

Preparing for the exams is difficult, and several programmes have been set up to assist refugee doctors with their studying. The Refugees Into Jobs project runs a weekly club attended by about 15 doctors. A Kenyan doctor who requalified 20 years ago helps attendees to prepare for the exam by answering past Plab questions.

Mohamed Deria, senior initial assessment officer at the project, says that refugee doctors do not question the exam process. "They accept the tests. What they can't accept is that after the whole process they don't get a job easily," he says.

The situation has improved over the past two years, with people now waiting about six months to start work once they have passed the exams. Before, some had to wait as long as three years, he says.


Yet the issue is more than merely passing the exams and finding a job. John Eversley, honorary senior lecturer on the Refugee Doctors Programme at Queen Mary University of London, says refugee doctors continue to face barriers when they have entered the labour market.

Those who get into a first job that is not a training post may "end up in the backwater", he says, in work that nobody else wants and which offers no continual professional development.

"Even if they get into a training post, it may not be the speciality they originally trained for or worked in. People have to take what's there," he says.

Given the current shortage of doctors, it would be foolish for the NHS to overlook this group. Financially it makes sense - it costs just £4,000 to retrain a refugee doctor compared with the £200,000 cost of training a medical student from scratch. And the service delivery argument is clear too, as refugee doctors can offer cultural and linguistic understanding that is often lacking.

Current trends on how to tackle the NHS recruitment crisis have included bringing in health professionals from overseas. Such initiatives may solve problems in the short term but, as the saying goes, there's no place like home, and most international workers eventually want to return. For once, refugee workers have the long-term advantage, as, after obtaining asylum, going home isn't an option.

Another way to requalify 

"I've been through hell and back," says Elizabeth Olayokun. She has just requalified as a doctor after discovering an alternative to the Professional and Linguistic Assessment Board (Plab) route.  Olayokun left Nigeria for safety reasons in 1986 and believes it is too dangerous to return. She says her family was persecuted by the government because her father was the leader of the Liberal party. She recalls police arriving at her house to make arrests and says her father was imprisoned for most of the 1970s. 

After studying medicine in Russia, Olayokun arrived in England with her young son in 1994. To pursue her career in medicine she set about studying for the Plab, but she had so little money she couldn't afford the textbooks. 

She got by on paltry savings from her job in Russia, and her husband sent money from Nigeria when he could. Olayokun failed the Plab exam three times. During a study session with some doctors she heard about a course at St George's Medical School in Tooting, south London. Passing the United Examining Board exam at the end of the course would allow her to practise as a doctor, without having to go back to the Plab. 

She started the course in 2001, and has just qualified after equalities grant-making organisation the Stone Ashdown Trust paid for her to sit her final exam. She is now waiting to start work as a junior house officer. Her career in medicine looks bright but for others not so because the course - which cost her £15,000, most of which she still owes - is being scrapped owing to a lack of funding.  

Olayokun believes the government should find the money to fund the course. "Plab is not the right route. From my experience, Plab does not give you what you need to work as a doctor," she says.