Intended for healthcare professionals
The highest proportion of foreign medical students in Ukraine are from India. Sonia Sarkar reports on their experiences fleeing the invasion—and the uncertainty they have found on returning home
Shreyoshree Sheel, a first year student at Ukraine’s Ternopil National Medical University, loved the “academic discipline” of her university, which required her to take a test almost every day. Her life in Ukraine suited her. She speaks of picking up the language in markets, shops, and restaurants and of being with the friends she met from African nations. They cooked together, listened to music together, travelled together, and stayed together in the crisis, even during the evacuation. But that all came to a halt on 24 February 2022.
On that day, Sheel and four fellow foreign medical students picked up their passports, university documents, and food and rushed to an underground gym in the neighbourhood. Sirens were blaring in what turned out to be a mock drill by the Ukrainian Army. Sheel and her friends thought it was real. No one at the Indian Embassy answered the helpline. She decided it was time to leave.
Sheel had stocked up on biscuits, cakes, cereals, and juices, which helped them survive the 15 km walk to the Romanian border the day after the drill. But reaching their destination was a shock. The Ukrainian forces used pepper spray and fired bullets into the air to disperse the crowd, then allowed only Ukrainian citizens to cross the border. With no passage to Romania, Sheel and her friends took a bus to Ukraine’s border with Hungary. Finally, Indian embassy officials received her in Budapest and got her on one of the government’s chartered flights back to India on 7 March.
Sheel is one of over 18 000 Indian medical students who escaped the war zone when Russia invaded Ukraine on 24 February. Many travelled without food for 14 to 16 hours on foot. Some melted snow to collect water. Almost everyone was forced to move between border points looking for a safe passage to a peaceful neighbouring country, with minimal or no help from the Indian Embassy officials in Ukraine. They were being pushed and shoved by Ukrainian forces who prioritised helping their own citizens cross the borders first. And though they eventually managed to return home to India, they now wait to see where and if they can continue to study medicine.
Ukraine hosts over 76 000 international students from 155 nations,1 the highest proportion of which (18 429) are from India (the next highest are 8233 students from Morocco and 5470 from Azerbaijan2).
One reason is that only the top scorers in the Indian pre-medical entrance test, the National Eligibility cum Entrance Test (NEET), make it to the five year undergraduate course in Indian government medical colleges, leaving only private colleges as alternatives. “Affluent people can afford admission to these private colleges, which charge over Rs10m (around £100 000) for the five year undergraduate course,” says Rajeev Jayadevan, co-chair of the Indian Medical Association’s national taskforce for covid-19.
So, many aspiring doctors choose to go to smaller European countries, including Ukraine, where the fees for national universities and living expenses are less than half that of a private Indian college. In Ukraine, Indian students pay anything between Rs2.5m and Rs4m for a six year medical undergraduate course. They don’t need a high score in NEET or any other entrance exam to get accepted. And Ukrainian medical universities also offer courses in the Latin language, medical terminology, and bioethics, which aren’t taught in Indian medical colleges.
Mahek (who asked to use only her first name), an Indian citizen whose family lives in Dubai, chose to study abroad. She was due to start her course at Sumy State University in east Ukraine in March and arrived early to get used to the country. When the Russians invaded, she heard on social media that only Indians on the western side of the country were being evacuated and didn’t know how to escape her hostel, just 45 minutes from the border with Russia. “We were stuck with a minimal supply of food and water for two weeks. Initially, we drank tap water but after a week into war, and after the water supply was cut off due to explosions, we had to melt snow to drink,” says Mahek, who was later evacuated by the Red Cross and an Indian drug company who had offices in Ukraine. She was later flown to Delhi by the Indian Embassy in Poland.
Another foreign student, enrolled in a national university in Ivano-Frankivsk, said anonymously that the panic had started in December 2021, when US and UK nationals were asked to return to their home countries by their embassies. The Indian Embassy insisted that there was no threat, even up to the first week of February. The student could not afford the soaring airline ticket prices, which reached nearly Rs150 000 for a flight to Delhi from Kyiv. “The university too insisted that we should have 100% attendance since our clinical training had started, and there was no reason to panic,” says the student. In the end, none of that mattered as the invasion began. The student fled to Romania before being evacuated to New Delhi.
These students are among the many who are now trying to find some way to continue their medical studies. Six universities in Germany have volunteered to assist incoming Ukrainian students, but the position of Ukraine’s foreign students is unclear.
Mohammad Barkhaiz Bhat, a third year undergraduate student at Kharkiv National Medical University in Ukraine, told The BMJ that one of his friends from the United Arab Emirates has got admission to a medical school in Germany as a refugee. Sheel said that most of her friends from Africa have gone back to their countries and, where possible, were continuing their studies online. The Ministry of Higher Education in Morocco has set up an initiative to allow students returning from Ukraine to continue their studies in Moroccan faculties, but medical students currently studying in Moroccan universities have objected to the integration of students from Ukraine into public and private faculties.3
Arya Aldrin, a second year student in National Pirogov Memorial Medical University in Vinnytsya, has started online classes from her university but doesn’t know what will happen in June when she starts her third year, which requires practical classes. Aldrin returned to her home in the Indian southern state of Kerala, which is dealing with about 3500 medical students evacuated from Ukraine. She says that she would like to study in Poland, Hungary, or Germany but that would be dependent on fees being on a par with the Ukrainian universities.
Bhat’s Ukrainian university had promised to start online classes, but that hasn’t happened yet. “A large chunk of the course in the third year is practical based learning, so online classes won’t be helpful for too long. But I don’t know how safe it will be to go back to Ukraine after the war is over,” he says. “Our future will be saved if the Indian government accommodates all Ukraine returned students into government medical colleges,” but it is unclear if this is possible.
The National Medical Commission, which governs medical education in India, said on 4 March that the foreign medical graduates with incomplete internships due to covid-19 or war will be allowed to complete the remaining part of their internship in India.4 But under current rules, a student cannot shift their medical course from a foreign university to an Indian one. At the time of writing, the commission is not in favour of changing the rules to absorb these students into India’s medical colleges and has instead deferred to the court of the federal government. Lav Agarwal, joint secretary at the Indian health ministry, said at a press conference on 3 March that “relevant steps” will be taken by appropriate divisions.
In March, two separate public interest litigations were filed in India’s Supreme Court by different sets of medical students returning from Ukraine seeking specific guidelines or direction for students displaced by the war, in terms of admission and continuation of their medical studies in Indian colleges.
Some officials are trying to help. The state of Telangana has promised to bear the educational expenses of over 700 students to enable them to complete their medical education. West Bengal plans to make room for first, second, and third year students in its private medical colleges, as long as the National Medical Commission gives permission, and will extend financial assistance to these students towards their course fee. The state also said that it intends to offer internships to fourth, fifth, and sixth year students in state run hospitals.5 The Indian founder of the United Arab Emirates’ Gulf Medical University has also stepped forward to provide displaced Indian students from Ukraine with free places and scholarships.
But there is no coordinated approach to this aid, nor does it tackle what will happen after the students have completed their undergraduate studies—currently, all medical graduates from abroad are required to intern for 12 months in the institute where they studied before passing the Foreign Medical Graduates Examination to practise in India and get a provisional registration with state medical councils.
Samuel Koshy, president of the Kerala unit of the Indian Medical Association, says it will be difficult to accommodate these students in over occupied state run colleges. He told The BMJ that over 95 000 medical students graduate every year, and that’s “enough” to meet the country’s demands. For now, he says, most students have little option but to continue online courses where they can before going back to Ukraine once the war is over or trying to pursue their course in any other country.
Sheel is currently studying her university’s online classes for over eight hours a day, five days a week. “I don’t have any problems with the online classes for another year,” she says, “A year after, I would like to go back to Ternopil.” Her social media profile still displays the flag of Ukraine. “I am really, really missing my Ukrainian life,” Sheel says. “It was a good life.”
Provenance and peer review: Commissioned; not externally peer reviewed.
Competing interests:I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
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