Ukraine Fallout: No Paved Road for Indian Medical Students

The future of international students rescued from the conflict zone of Ukraine is unfolding like a Kafkaesque nightmare. Ukraine was home to over 76,000 foreign students, according to government data from 2020. Nearly a quarter of the students were from Africa, and India easily accounts for the highest portion with over 20,000 students.

The reality hit home towards the end of February when an Indian medical student was killed in shelling in the Ukrainian city of Kharkiv after he left the bunker he’d been sheltering in to buy food. India’s foreign ministry confirmed that S Gyanagoudar, 22, had died in shelling in Kharkiv and said it was in contact with his family.

The students—studying medicine, engineering and business—are an important part of Ukraine’s economy. But with Russia launching the biggest European invasion since the Second World War, thousands of them have fled, hundreds are still trapped, and many remain uncertain about the fate of their education.

The worst affected students from India are those pursuing a degree in medicine. They are caught in the maze of 21st Century bureaucracy—hoops and hoops of complicated procedures that are bound to leave them as traumatised as fleeing the besieged land of Ukraine.

About 20,000 students in various stages of their medical education have returned to India and about 10,000 are thinking if they can complete their education in Poland, Armenia, and Hungary, according to news sources.

“We woke up to shelling and noise of bombings at 5 am Kyiv time on February 24, and that is what made us aware of the danger we were in,” Ishita, a fifth-year medical student in Odessa National Medical University, told Education Post.

“Living in the fear of going to the bunkers was the scary part as we had heard stories from friends in Kyiv and Kharkiv, who had to go to the bunkers on the very first day. Bunkers are like graveyards, they said, cold, dark and with no bathrooms or provisions for food. We had to be dressed and on our toes all the time.” she added.

Ishita and her friends didn’t want to go the bunkers but she said that if it was needed they would have had to. “We were waiting in Odessa for two days hoping for the Embassy or the Indian government to evacuate us. And then we were told that we had to reach the border on our own.” They took a bus early on February 26 for the Romanian border and the 12 hour journey turned to 24 hours as the route was chosen to ensure security.

“Around 7-7.30 am we heard shelling again. We heard the sirens. We were confused whether to leave or not. It was a risk staying at that place and a risk leaving that place. So it was in your hands which risk you wanted to take. So we decided to leave.

The bus dropped us 14 kms before the border because it was very crowded. There were Ukrainian refugees, Arabs, and other refugees. We walked for 14 kms to reach the border, spent a night on the border in the freezing cold of minus 5 degree and snowfall. We were standing all the time, for 15/16 hours because we were waiting in a line. Finally on 28th early morning we could cross the order. Things were better in Romania as we got a shelter; we were there for 3 days. Then we had an evacuation flight after three days which took us to our destinations, to Delhi and Mumbai respectively as per the schedule provided by the government. Form there student were taken to their respective cities.”

Ishita is in the last semester of 5th year and has one more year to go and we quote her at length. “Thankfully, I had cleared my 1st licence exams. So I was just left with my 2nd licence exam. It is a problem for me because it was just one more year and I would have been done with my studies. But it is what it is. When we got here we were told that 20,000 plus students would be taken care of and would be given admission here in India. I highly doubt that because we all know that the number of medical seats India has at the moment and the very reason we had to go out. Students go out to Ukraine, Russia, China, Armenia, Kazakhstan because there are no seats available for students, even those who deserve it.

So even when the government says they are going to give us seats and give us the facility to study here, I highly doubt it; I can’t trust them somehow after what I have seen and faced on the border. What I would really like from the government is at least give the students of 4th and 5th year a chance to get admission here because we are just hanging by a thread. I am sure the 6th year students will get their degree from Ukraine only as it is just 2/3 months left and the 2nd licence exam is cancelled for them. But for 4th and 5th year students, it is scary because it was hardly any time left and we now don’t know what the future holds. We are hoping that the government comes up with some answers on how to proceed from here.”

The Indian Medical Association (IMA) has asked PM Narendra Modi to ensure the suffering students are accommodated in medical schools in India by increasing 2-5 percent seats in all government and private medical colleges in the country.

In a statement, the IMA said, “All the evacuated medical education learners who are Indian citizens and have procured admissions there upon seeking eligibility certificate from the statutory authorities in India and at various stages of progression there be adjusted as a one-time measure in existing medical schools in the country through an appropriate disbursed distribution keeping in mind the geographic locational interest of the said learner, directing that the said incorporation in the concerned medical college being one-time should not be taken as an increase in the annual intake capacity and should be permitted to go in for progression in the respective Indian medical schools for the remainder of their MBBS course.” The IMA can only recommend and it is the Medical Council of India (MCI)/National Medical Commission (NMC) that enacts rules and is the body that can change or reframe them.

The impasse

Under the present rules, if one wants to shift degrees from a foreign university to India, the only way to continue education is to start over from the beginning of the course. Hence, there are few options for the furtherance of the academic progress of the evacuee students in order to find a way out of the state of despair.

This situation highlights that in India just one out of every 16 aspirants is enrolled into medical college. With such competition, many students are either unable to pass the exam or end up with low grades. This deprives them from getting admission to prestigious colleges, particularly those run by the government. This fact adds for another reason that there are no entrance tests to pass in order to obtain admission to medical schools in Ukraine. The students only need to pass the NEET in India to be considered for admission to Ukrainian colleges.

These students can also return to India to work as interns, take the NEXT qualifying test (formerly known as the Foreign Medical Graduate Examination), and practise medicine within the country.

As citizens of the country, these students have the right to file a Public Interest Litigation (PIL) in India to protect their future education. Recently, a plea of this nature has in fact been filed in the Delhi High court by the Pravasi Legal Cell.

In relation to petitions filed seeking evacuation of Indians stranded in Ukraine amid the Russian invasion, the Attorney General for India K K Venugopal on March 21 submitted that 22,500 Indian students have been evacuated from Ukraine by the Government of India along with nationals from 20 other countries.

With regard to the issue of continuation of education of students who have been brought back owing to the Russia-Ukraine conflict, the Attorney General submitted that the Government of India is looking into the issue and will take a decision, Live Law reported.

“There should be a consensus for the relatively more proficient institutions to tie up with the other international institutions to accept Ukraine-return students during this plight.

The financial administration of the UN and the United Nations for Youth must allocate financial support for International universities to accept more students whose studies were halted abruptly due to this war. This way, the crucial years of their careers will not be wasted,” said Naresh M. Gehi, an Indo-US Lawyer and the Director of Gehis Immigration and International Legal Services based in Mumbai, India.

Under the Foreign Medical Graduate Licentiate Regulations, 2021 of the National Medical Commission in India, a doctor’s degree can be obtained if:

• The medical degree is of the duration of 54 months.
• There is a track record of a minimum of 12 month long internship at the university where the student is pursuing the degree.
• The medium of learning is English, if the foreign University is approved by WHO,
• The student needs a permit from the Government of India/NMC/MCI, and
• There is a 12 month internship record from India.

Finally, the student has to pass the National Exit Exam (NEXT) to get the licence. To further pursue Medicine in India to complete their degree, the Ukraine returned students will have to crack the Foreign Medical Graduate Exam.

“There has to be some new policy to take care of this extraordinary situation caused by the Russian invasion of Ukraine because the law as it stands today does not allow for the absorption of these students. The major challenge which the policy framers will face would be: can two ‘unequals be treated equally’ and the students who have failed to meet the admission criterion in India be treated at par with those who have,” said Ajay Brahme, Advocate, Supreme Court of India, told Education Post.

“This whole situation reveals some sad facts. First is the stark truth that we do not have enough educational opportunities for our own students. We are simply unable to nurture the great “demographic dividend” by training, and then retaining, young people who want to be doctors. There are about 600 medical colleges (of which around 300 are government-run) in the country that offer around 90,000 seats (about 45,000 government seats) for a Bachelor’s degree in medicine (MBBS), and approximately 16 lakh aspirants compete for these. The cost for the entire degree ranges from 40,000 rupees to 6 lakhs in government colleges and can range from 80 lakhs to 1.5 crores in private colleges. Only some public medical colleges can boast of decent-quality faculty and infrastructure, but even these suffer from faculty shortage and infrastructure-overloading, especially in the connected hospitals. A large number of private colleges are just teaching shops,” Anurag Mehra, Professor of Chemical Engineering and Associate Faculty at the Center for Policy Studies, at IIT Bombay, wrote in an Opinion piece for NDTV.com.

Why students prefer Ukraine?

Reports claim that the majority of Indian students in Ukraine study medicine. Ukraine has the fourth-largest number of graduate and post-graduate specialisations in the field of medicine in Europe. Some of Ukraine’s state-run universities are well-known for providing good education, and it is believed that Indian parents prefer to send their children to these institutions rather than pay a large fee to enrol into a lesser-known private medical college in India.

While government medical universities are affordable to aspirants, private medical institutions charge huge fees. According to Quartz India, Ukrainian medical colleges are a boon for students who are unable to get seats at government institutes or afford the hefty prices charged by private institutions in India. The universities in Ukraine are less expensive – MBBS costs in Ukraine range from $3,500 to $5000 annually (that is Rs 2.65 lakh to Rs 3.8 lakh), which is affordable for Indian students.

In a private medical college in India, an Indian student might expect to pay anything from Rs 50 lakh to Rs 1 crore. In comparison, a student studying for a six-year medical degree in Ukraine will only need to pay a fraction of that. Along with low tuition fees, Ukraine offers various benefits such as low-cost food and housing.

The NMC reports that there are 605 medical colleges in India, with a total of 90,825 MBBS seats available each year. While this figure appears large, it pales in comparison to the 1.6 million candidates that attempted the NEET for MBBS admissions in 2021.

The distress of students

“The immediate challenge is to explore what can be done for these students who are back in India. Perhaps the simplest thing is to wait for the war to end. Some Ukrainian colleges have started online classes for the current semester but it is uncertain how long these will last. There is the uncertainty of when the damaged infrastructure will be restored. Some states – Tamil Nadu, Odisha, Kerala, Karnataka – have pleaded with the Union government to accommodate the returning students in Indian medical colleges. This is potentially quite messy as it will involve deciding which colleges induct these students and at what cost. Plus these measures could face legal challenges from students who did not get admission to Indian institutions through the NEET process and did not go abroad. There is already the pending matter of students who left China midway through their studies and have not been able to resume them because of the travel restrictions imposed by China. Another option may be to explore admission into non-medical but healthcare-related courses in India. The best bet may yet be looking out for transfers to other European nations – many have offered such transfers including the UAE. Ukrainian universities have agreed to help out by providing all relevant documents, and education-consulting companies are already working on possible arrangements. The cost of the transfer may be covered by special loans that the government could facilitate as a relief measure. Credit transfers will work in this case and the study done so far will not go to waste,” Mehra wrote.

The Public Health Foundation of India (PHFI) unites some of the world’s most renowned public health specialists, teachers, trainers, researchers and practitioners and is committed to bring about a significant positive change in the Indian public health scenario.

“What about the young students returning from Ukraine? It is unlikely that they will be able to resume their education there — the political turmoil is likely to continue even if the war ends soon. Their families too will be reluctant to send them back. Present regulations do not permit them to continue their education in Indian medical colleges. Even if the NMC permits it as a special case, other students who qualified the NEET but did not make the cut for medical admission, and stayed back in India, might protest.

“The government could perhaps support these students by enrolling them in a BSc (Public Health) programme that can be run by schools of public health and medical colleges. They can graduate in three years to commence careers in public health, where their earlier medical education can add value. Since the National Health Policy of 2017 calls for Public Health Management cadres to be established in every state, this could initiate a programme for large-scale training of public health professionals. In any case, the sad state of the students in Ukraine must catalyse reforms in Indian medical education,” K Srinath Reddy, President, PHFI, wrote in an article for the Indian Express.