DOCTORS AND ISLAMIC STATE Time for tighter checks on medical schools? The British students who have fled to to work while studying in Khartoum have exposed the weakness of the system for accrediting medical schools worldwide, Duncan Gardham reports

he UK General Medical Council is A group of 11 medical students and recently University of Medical Sciences and Technol- relying on foreign governments qualifi ed doctors (believed to be seven Brit- ogy (UMST) in Khartoum, a private university to approve the medical degrees ons, one Canadian, one American, and two established in 2007. Last week, seven British it accepts with no further checks Sudanese) fl ew from Sudan to work in Syria students were among a party of 12 from UMST, on the quality of teaching. The in March, raising further questions about who travelled to , believed to be trying to Tpractice raises questions about the reliability the infl uences that young students can come enter Syria, the Foreign Offi ce has confi rmed. of teaching in countries such as Sudan, which under while studying abroad. UMST is one of 12 colleges in Sudan reg- has been attracting students from B ritain Many of the students (above right), it istered by the World Directory of Medical partly because medical colleges there are emerged, came from UK families of Sudanese Schools (www.wdoms.org), relied on by the cheaper and easier to get into. background and had been studying at the GMC. Sudan is just one of several countries

Islamic State creates jihadi health service Many doctors in war zones seek to remain independent, but the situation in Syria and is forcing them to take sides

Since the militant group Islamic the injured mujaahideen [holy stethoscope and handgun. He State took over large tracts of fighters]! Imagine the reward of wrote in January that he would Syria and Iraq about a year ago helping a bro go back 2 batle!” be “posting medical advice to local doctors have been forced The group of medical students the mujahideen, including first to pledge allegiance or flee, aid who left Sudan to work for Islamic aid tips” along with “health workers have retreated, and the State in March drew international updates from the Islamic state” group is attempting to train or attention to what seems to have and the inevitable “analysis & recruit a health service workforce been a steady flow of Western advice regarding issues of jihad & made up of medical jihadists from educated Muslim doctors drawn aqeedah [belief].” around the world. to support the militant group. However, it was his tweet on 3 On 24 March Omar Hussain, a One, who describes himself January that gained most attention British man from High Wycombe, as a “muhajir [emigrant] medical from supporters of Islamic State, Tareq Kamleh, from Perth, whose tweeted: “O Muslim doctors, doctor” was tweeting under the who re-tweeted it as proof that the mother is German and father is stop treating the Kuffaar [infidels] alias Abu Layla al-Shami and group was able to run itself as a Palestinian (above). & come Sham [Syria] & help featured a photograph with a fully fledged state. Calling himself Abu Yousef “First glimpses of the new Al-Australi, he called on Muslim Kobane Mosul Dam Islamic state medical school . . . doctors to move to areas Hassakeh Mosul opening soon inshAllah in controlled by Islamic State, saying Mount Sinjar Raqqa,” he wrote, accompanied there is no lack of medicine or

Deir al-Zour by a picture of a smart, cement equipment but qualified medical Baiji building with railings outside. care is needed. Tikrit SYRIA Qaim Later he added: “It’s great Yet little is known about what Baghdad to see that many people both healthcare is really being provided Ramadi Falluja brothers and sisters from a wide to the thousands of civilians who range of nationalities have applied give birth, get ill, and face death to the Medical College.” in the war zone that Islamic State IRAQ IS areas of influence. The recruitment push continued controls. Dominant as of April  with a video released in April Reports from Mosul in Iraq that usurped the NHS logo and suggest that the fighters have replaced it with “ISHS.” It featured attempted to force female doctors an Australian paediatrician called to be fully covered, including

22 4 July 2015 | the bmj DOCTORS AND ISLAMIC STATE

A group of medical students and doctors flew from Sudan to work in Syria in March, raising further questions about the influences that young students can come under while studying abroad

university offers a qualification accepted by One student who studied medicine in Khar- the GMC. toum explained on social media that he went Parents of the students who went to Syria to study there not to get in touch with his roots explained that they saw the Sudanese medi- but because he had “missed out by a couple of cal school as a good way for their children to grades” on an offer from a London university qualify while also getting in touch with their to study medicine. roots. It is not known how many students He wrote on social media: “Had the choice from families with origins in countries such as of doing biomed but that don’t fit in my future Sudan, Yemen, Somalia, or Pakistan are now plans. Very close friend of mine already com- struggling against Islamic extremism that have studying in these countries, but new medical pleted his first year in Sudan. medical schools on the list—Afghanistan and schools have opened in some of those coun- “Checked the uni with the General Medical Yemen have six colleges each and Somalia tries, suggesting that this is a growing market. Council and they said a degree from their [sic] is has two. Syria has seven, including colleges in Pakistan, which provided 218 candidates for recognised in the UK. So AlHamdulilah [thanks the contested cities of Homs, Aleppo, and Deir a licence to work in the UK last year (more than be to god] still get to study medicine + it’s recog- Ezzor. Sources familiar with the Sudanese medi- any other country), has 90 colleges registered nised worldwide + in a Muslim c­ountry.” cal world say that UMST does not have the same in the World Directory of Medical Schools. To practise medicine in Britain after study- academic reputation as Khartoum University’s It’s clear that some students are going to ing abroad students have to prove that they medical school, once known as the Kitchener foreign universities because they didn’t get have an “acceptable overseas qualification” School of Medicine. Nevertheless, the private the grades for their first choice of university. and then pass the Professional and Linguistic wearing gloves, while treating the worst war zones of recent patients. There are also reports times, from Bosnia to Afghanistan. of staff and patients being In Syria he started working in an segregated so that women can area controlled by the moderate only treat women and of female Free , which patrolled hospital staff being prevented large swathes of Aleppo, and his from working after dark. The biggest fear was the barrel bombs reports, based on un-named local being dropped by helicopters sources, cannot be verified. of the Syrian regime, but that changed on his last visit. Too dangerous to help “You don’t ever know as a As would be the case anywhere Westerner, how safe you’re really else in the world, amid going to be. All it takes is a phone “You don’t ever know, as a Westerner, how safe you’re really going to be. coordinated international call—and everyone has a mobile A knock at the door could be calling you for a casualty or to take you away” bombing and fighting on the phone. A call could go to Islamic David Nott, surgeon, London ground, the local population State, al-Nusra, or a faction of from Aleppo that Nott had worked the young British doctor who was has more than ordinary medical al-Qaeda. A knock at the door with decided to go on a diplomatic detained by regime forces at a needs. Yet even the hardiest aid could be calling you for a casualty mission to heal the rift. check point within a day of arriving workers have had to keep away or to take you away. That’s Islamic State “killed him, ripped in Aleppo and killed in custody. over the past year . the issue, your safety can’t be his face off, and dismembered him “You have to enter the country David Nott, a consultant general guaranteed, and not only because just because this poor doctor tried illegally from Turkey and the regime and vascular surgeon at the Royal of the conflict. It is a really, really to mend bridges,” Nott said. looks at you as a terrorist— now you Marsden, St Mary’s, and Chelsea dangerous place to go at the In most other conflicts “doctors are a terrorist to one side and an and Westminster hospitals, moment.” are always looked after and infidel to the other. This is far more returned from Syria last October In 2013, Nott said Aleppo treated with some reverence dangerous than other war zones.” and admits it is now too dangerous was full of Islamic State fighters because they are able to cure “You have to go to dangerous except for supporters of Islamic but they “weren’t as extreme as people and alleviate human places but I always think it’s going State. In the space of a few weeks they’ve become.” suffering,” Nott says. In previous to be alright. It’s something in me; Aleppo, the highly contested city But in January and February conflicts he had been able to treat I don’t believe that is unrealistic. I in northern Syria, went from “safe- 2014, the and both sides—Palestinians and can offer help and that’s all there ish” to a nightmare in which he Islamic State came into conflict Israelis in Gaza, Hutus and Tutsis is. If I don’t go, no one will.” dreaded every knock on the door, as Islamic State set its sights on in Congo. But thanks to Islamic State, he told The BMJ. other rebel factions rather than But the threats in Syria began even Nott believes it is too Nott made three trips to Syria the Syrian regime, and the factions from President Assad’s regime dangerous to travel to Syria now. and has volunteered in many of fought back. One of the doctors with the death of Abbas Khan, Cite this as: BMJ 2015;350:h3487 the bmj | 4 July 2015 23 DOCTORS AND ISLAMIC STATE

Sudan university at centre of radicalisation claims UMST (pictured right) is owned by One of the students in the Mamoun Mohamed Ali Humeida, group who recently went to who is also the health minister Syria, Lena Abdel Gadir, is for Sudan’s capital territory, reportedly an A grade student Khartoum State. UMST claims on who grew up in a village in its website to have been set up Norfolk and whose parents, to serve the educational needs who are of Sudanese origin, of Sudanese, African, and Arab are both doctors. In Khartoum, students, but its fees of $12 000 she expressed support for to $13 000 a year mean that it is radical Islamist groups through seen locally as “a place for rich social media. However, she was kids,” says a report by the news following other Twitter posters magazine Africa Confidential.1 who posted regular updates It also offers foundation on Islamic State, expressed courses to students who have support for the killers of Charlie not completed qualifications education in Sudan, but UMST is organisation called the Islamic Hebdo magazine staff in Paris, equivalent to the UK’s A levels. not seen as particularly exposed Cultural Association had been and last August had shared a Humeida is a staunch member to those elements, unlike the spreading radical views on video by Ahmad Musa Jibril, a of the ruling National Congress International University of Africa, the UMST campus, and in any Palestinian American preacher Party, the Islamist party that has also in Khartoum, whose students case students would not have popular with European and North run Sudan since a military coup in have gone on to join movements had to travel far to meet radical American jihadists. Her embrace 1989. He owns a private hospital such as al-Qaeda, al-Shabaab preachers in Sudan. Since the of extremist views was apparently as well as several other training in Somalia, and Boko Haram in group of nine students left to worrying her parents, but she centres, according to Africa Nigeria. Remarkably, even this work in Syria, Humeida has was unrepentant, tweeting, “You Confidential.1 university features on the World reportedly banned the Islamic know times are rough when . . . There has been controversy Directory of Medical Schools. Cultural Association from holding your mum keeps referring to you over the influence of Islam in It seems, however, that an meetings at the university. as da3ish [ISIS].”

As­sessments Board (PLAB) test, made up of a A new school is added to the directory when standard. This will depend on accrediting agen- three hour multiple choice test and an hour and the government in which the medical college cies being established in every country or region 40 minutes practical exam. The GMC also sets a is located sends information to show that the to assess the quality of every existing and new minimum standard that courses must be taught college is “operational and recognised locally.” medical school. Without the accrediting agency’s in English and involve 5500 hours of study but stamp of approval, a graduate from a medical does not check that the standard is met. Unregulated education school in, say, Sudan would not be able to pass But Richard Wakeford, a fellow of Hughes Niall Dickson, chief executive of the GMC, licensing tests to work in other countries. Hall, Cambridge, and an expert in the assess- defends the system for accepting qualifica- “There are thousands of students going to ment of professional competence, said that tions from overseas medical schools, saying unregulated private medical schools around the “world gave up trying to actually accredit that medicine was a “global profession” and the world,” said Dan Hunt, co-secretary of the medical schools years ago, moving merely to that it would be “ridiculous to expect any Liaison Committee on Medical Education, the list them, excluding only the ropiest.” medical regulator to quality assure every authority that accredits medical education Wakeford’s research shows that the third medical course in the world.” programmes in the US. “Sixty new private most common nationality of people taking the He added that there were “plenty of courses medical schools have opened in Brazil in the PLAB test is British, indicating that thousands where we will not even consider applications last four years. But they have no accrediting of students are travelling abroad to study medi- from their graduates” and that doctors had process there. A lot of entrepreneurs are tak- cine and then returning to practise in Britain. to jump “a series of hurdles” before they are ing advantage of people. It’s a huge problem.” The acceptable qualifications are based on granted registration in Britain. Hunt said that in the US the body that pro- the list compiled by the World Directory of “Where we do have concerns about an vides licensing exams for students who have Medical Schools. overseas medical school, we do not allow trained outside the US, will from 2023 no The directory’s website says that it seeks to graduates from that school to apply for regis- longer accept any applicant from a medical “protect patients and to meet the needs of soci- tration,” Dickson added. The world directory school that is not recognised by an official ety,” by ensuring that “a doctor has attended a is a starting point—no more than that.” accrediting agency. genuine medical school of good standard, and The GMC has recently reviewed the PLAB But so far there are only three such accredit- has demonstrated the competence required to test and has embarked on a “series of changes ing bodies—one in Turkey, one for the Carib- become a certified medical doctor.” But it cau- as part of our ongoing commitment to main- bean region, and the liaison committee in the tions that a listing does not denote recognition, tain and increase standards,” Dickson added. US. accreditation, or endorsement by the World Globally, there are moves afoot to try to Duncan Gardham security journalist, London Directory of Medical Schools or by the partner strengthen the system for ensuring that these [email protected] organisations.” schools provide an education of a very high Cite this as: BMJ 2015;350:h3511

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