A 2026 meta-analysis of the Arab region reports a prevalence of 70.7% migration intention among 21,614 medical trainees included, while the Nile Valley reaches 74.3%. The expansion of training is insufficient to offset deficits and international mobility of healthcare workers in the region. A systematic review and meta-analysis published in October 2026 in the Journal of Epidemiology and Global Health included 31 studies documenting the scale of the phenomenon, while several Gulf countries depend heavily on non-national nursing personnel, with proportions varying according to Gulf countries, documented between 60% and more than 90%.
The essentials
- In the MENA region, training more doctors does not reduce the shortage of healthcare workers: emigration outflows can worsen local deficits.
- 74.3% of medical trainees in the Nile Valley region declare they want to emigrate, compared to 41.5% in the Arabian Peninsula, according to a meta-analysis of 31 studies published in October 2026 in the Journal of Epidemiology and Global Health.
- Several Gulf countries depend heavily on non-national nursing personnel, with proportions ranging between 60% and more than 90%, while contributing to draining human resources from neighboring countries.
- The MENA region represents more than 20% of the estimated global shortage of 10 million healthcare workers by 2030, according to the WHO.
- Saudi Arabia and the United Arab Emirates have launched policies to localize health sector jobs, but struggle to close a structural gap that wages alone cannot resolve.
74%: what one figure conceals
Migration intention does not guarantee departure. But when three-quarters of a medical cohort express this wish before even practicing, the signal exceeds individual whim.
The 2026 systematic review aggregates 31 studies conducted in Arab countries and appears in the Journal of Epidemiology and Global Health. It distinguishes two sub-regions with different trajectories. The meta-analysis reports 74.3% migration intention among medical trainees in the Nile Valley. In the Arabian Peninsula, this rate falls to 41.5%. The thirty-point gap between the two zones says something essential: migration of healthcare workers obeys less to a universal aspiration than to specific local conditions.
In Egypt, the salary of a newly qualified doctor in the public sector remains very low compared to international standards. The same qualification is remunerated significantly higher in the United Kingdom or Germany. The trade-off is mathematical before it is cultural. Trainees are fleeing an impossible economic equation, not showing disinterest in their patients.
This mechanism is observed in other contexts of skilled worker mobility. Emerging countries facing automation face a comparable trade-off: productivity gains remain captured by economies that attract talent, while the origin economies absorb the costs of training.
The Gulf depends on what it cannot train
Saudi Arabia, the United Arab Emirates, Qatar and Kuwait share the same contradiction. They have sufficient oil revenues to finance cutting-edge hospitals, but remain dependent on healthcare personnel trained or born abroad and are not yet self-sufficient.
The result is structural dependence on foreign healthcare workers: According to studies included in the meta-analysis, the share of expatriate nurses varies in Gulf countries, from 60% in Saudi Arabia to more than 90% in several others, originating mainly from the Philippines, India, Egypt and Morocco. These flows have their own logic: they simultaneously satisfy Gulf demand and the aspirations of MENA region graduates. But they impoverish the health systems of origin countries.
Saudi Arabia attempted to correct course. Its healthcare professions regulatory authority, the SCFHS, has implemented since 2020 a progressive localization policy for medical positions, with sectoral quotas and hiring bonuses for nationals. SCFHS 2025 data show progress in the nationalization rate for clinical functions, but technical specialties—anesthesiology, intensive care, radiology—remain dominated by expatriates. Training a Saudi anesthesiologist takes ten years. Replacing a Philippine anesthesiologist recruited this year takes ten days.
The United Arab Emirates took a different direction. Rather than quotas, they invested in partnerships with foreign universities to create accelerated medical training programs on their soil. Cleveland Clinic Abu Dhabi and Johns Hopkins University Hospital in Bahrain are two examples of this model: foreign institutions training locally, but whose graduates remain subject to the same salary pressures as their counterparts in the region.
Multiplying schools is not enough
Since 2000, the number of private medical schools has doubled in the Eastern Mediterranean Region. Egypt today has more than forty medical universities. Morocco opened six new faculties in fifteen years. Jordan, a country of nine million inhabitants, trains more doctors per capita each year than France.
This expansion responds to understandable logic. Governments identified the shortage of healthcare workers and chose the most visible response: build schools, increase cohorts, produce graduates. This reasoning assumes that graduates remain in the country. The departure of locally trained personnel can transfer to receiving countries the benefit of skills financed partly by origin countries.
The calculation is documented for other regions. Sub-Saharan Africa trains doctors who leave massively for Europe and North America, as the dynamics observed for other strategic resources show: the raw material is local, the added value goes elsewhere. In the MENA region, the raw material is human.
According to the 2026 WHO Africa report, the African Region represents a significant share of the estimated global deficit of 10 million healthcare workers by 2030. This figure is a projection, not a certainty. But the direction of the trend is documented: the production of graduates increases, training workforce and capacity advance, but not fast enough to meet the growth of needs and inequalities in distribution.
Working conditions weigh as much as salaries
Reducing medical migration to a salary problem is a convenient simplification. It directs policies toward bonuses and incentives, which produce limited effects.
The meta-analysis in the Journal of Epidemiology and Global Health identifies several factors other than income in the migration intentions of interviewed trainees. War and insecurity rank first among reported repulsion factors, followed by financial insecurity and then poor working conditions: public hospital service overload, lack of equipment, absence of continuing education, exposure to violence in facilities. Career prospects rank next: in several countries in the region, advancement in public medicine depends on personal networks more than clinical competence. Finally, civil liberties and political stability weigh, particularly for women physicians in Egypt and Sudan, who express higher rates of desire to migrate than men in included studies.
This last point deserves attention. Women now represent more than half of medical students in several Arab countries, including Morocco, Tunisia and Lebanon. They form a medical generation that did not exist thirty years ago. If this generation leaves en masse, the shortage deepens twofold: in numbers and skills.
Jordan offers an interesting case. The country has been exporting its doctors since the 1970s, and has developed in parallel a medical industry oriented toward regional patients, with medical tourism representing a significant source of revenue. This bifurcation allowed maintaining a high-quality private sector attracting Jordanian professionals who would otherwise have migrated to the West. But it left the public sector under-resourced, reproducing within the country the fracture that the entire region experiences at the international scale.
The use of these graduates by receiving countries
The United Kingdom and Germany are among the main destinations for doctors trained abroad. The British system depends on it in a documented way: the National Health Service counts a significant number of doctors trained in Egypt and Pakistan.
These receiving countries have a direct interest in the continuation of these flows. A doctor recruited abroad costs significantly less to train than a local doctor, given that the duration of medical studies is eight to twelve years depending on the country. Migration can transfer to receiving countries the benefit of skills trained in origin countries and worsen shortages there.
Codes of conduct exist to regulate these practices. The WHO adopted in 2010 a global code on the international recruitment of health personnel, recommending that wealthy countries not actively recruit from countries with critical shortages. This code is non-binding. Its application remains voluntary, and private recruitment agencies are not subject to it.
The question of governance of these flows joins that of state capacity: without institutions capable of enforcing rules and creating attractive working conditions, retention mechanisms remain wishes.
Solutions that work, partially
A few experiments in the region show that the trend can be bent, without coercion.
Morocco launched in 2021 a territorial family medicine program, combining an installation bonus in rural areas and a continuing education pathway funded by the state. Early cohorts show retention rates in target areas higher than previous programs. The scheme remains modest in scale, but it documents that territorial anchoring is possible when working conditions are dignified.
Tunisia opened another path: bilateral agreements with France and Germany regulating temporary migration. Tunisian doctors leave to work abroad for defined periods, two to five years, with a return obligation negotiated with receiving countries. These agreements remain fragile and difficult to enforce. But they represent an attempt to transform a suffered brain drain into managed mobility.
Saudi Arabia pursues a third approach: public-private partnerships for local training, with financial incentives for practice in the Saudi public sector after graduation. The Vision 2030 program set an ambitious objective for localization of senior medical positions. Current data show this objective is out of reach for technical specialties, but achievable for general medicine and pediatrics.
None of these approaches solves the problem alone. All share a common assumption: retention cannot be decreed. It is built through working conditions, career prospects and institutional stability that bonuses cannot simulate.
The question posed by this meta-analysis remains unanswered: how can a region that trains its healthcare workers properly keep them without closing its borders? The answer is not limited to medical schools. The capacity, balance and quality of training are among the necessary levers, but opportunities after graduation remain an important factor, among several determinants of healthcare worker departure: working conditions, stability, security and career training or advancement.
Sources
- Systematic review and meta-analysis of medical trainee migration intentions in the Arab Region, The Lancet Psychiatry, April 2026
- WHO State of the Health Workforce in Africa 2026 (World Health Organization, Geneva)
- Saudi Commission for Health Specialties (SCFHS), 2025 data on localization of medical positions
- WHO, Global code of practice on the international recruitment of health personnel, 2010 (updated 2023)
- Morocco Ministry of Health, evaluation report on the territorial family medicine program, 2024
