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The exodus of Indian students fleeing the war in Ukraine has exposed long-standing problems plaguing India’s medical education system.

In recent weeks, thousands of Indian medical students have arrived back at home. Although they have made it to safety, many may soon find their lives at a standstill, unable to transfer their credits and resume their studies.

“The main concern of each and every student is what will happen next,” Saransh, a medical student at Ukraine’s Sumy State University who preferred to use only his first name, told Times Higher Education. He had only three months left to finish his degree before the war began.

Yet India’s problem with medical education long predates the conflict that has forced students to flee Ukraine, said Yatharth Gulati, co-founder of the consulting group Rostrum Education.

For years, fierce competition at public universities has pushed many Indian medical students abroad, often to Eastern Europe, where entrance barriers are lower and courses cheaper. But on their return, about half of these students fail to pass India’s certification process to work as doctors, Gulati estimated.

Despite these poor outcomes, agencies paid to recruit students to universities in countries such as Ukraine, Russia and China have proliferated in recent years.

“Lots of agencies representing these universities are recruiting students in bulk and not telling students what the long-term effect will be,” Gulati said, which often means that these students “spoil” their prospects.

Unlike the Indian students headed to the U.S. or Britain to pursue medicine, who tend to come from wealthy backgrounds, those bound for countries such as Ukraine, Russia or China are often of more modest means.

This was the case for one student who spoke with Times Higher Education. The student, whose family has taken out loans to fund his studies, is among the thousands who have waited more than two years for China to reopen its borders so they can finish their medical degrees.

Because those stuck in this situation tend to be the children of working-class parents, they “don’t have a lot of voice when it comes to making this an issue,” said Gulati.

Many of these students could not afford to start their education afresh, even if they wanted to. Places at Indian public universities are coveted and competition is stiff, and the alternative—private universities—varies in quality and charges steep tuition fees.

Even for those who finish their degrees, work in India is not guaranteed. But now, with the issue thrust into the public sphere, there may be greater hope that policy makers will pay attention.

In a recent speech, India’s prime minister, Narendra Modi, acknowledged the need for more domestic medical education, suggesting that private institutions might increase their intake.

“Our children today are going to small countries for study, especially in medical education,” he said. “Can our private sector not enter this field in a big way? Can our state governments not frame good policies for land allotment regarding this?”

Private institutions are often expensive and their quality can be hit-or-miss, while creating public universities from scratch takes time, said Gulati, who argued that India’s government would need to make more places available at public medical schools.

“Otherwise, they will never be able to meet the demand. This is something they have to do—otherwise this phenomenon will keep going on, if not in Ukraine, then in Russia or Georgia or somewhere else,” he said.

Nevertheless, Gulati said, some students and their families will have to face the hard reality that not everyone is cut out to be a doctor.

“Indian parents have this mind-set: ‘Either become a doctor or don’t do anything,’” he said. “But not everyone can become a doctor.”

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