Emigration of Algerian skills: the case of doctors

Following in the footsteps of the previous project, Migratory Experiences in Contemporary Algeria (CRASC, 2012-2015), this study is situated within the research perspective of Abdelmalek Sayad.

Indeed, it draws upon the model developed by A. Sayad regarding the "three ages of Algerian emigration to France" (1977). Without providing a full presentation of this seminal article here, we reproduce the section that summarises the history of this emigration:

"(...) Initially, until (approximately) the aftermath of the Second World War, the history of Algerian emigration to France was intertwined with the history of a peasant society struggling for survival, which expected emigration to provide the means to perpetuate itself as such. In a second stage, for a mass of peasants who were not only impoverished but totally proletarianised, emigration constituted a privileged opportunity—perhaps the only one afforded to them—to realise the aspirations that their new condition both authorised and forbade. More recently (especially since Algerian independence), completing a process already underway for over three-quarters of a century, emigration eventually led to the establishment in France of an Algerian community that is relatively autonomous, both with regard to the French society it lives alongside and the Algerian society from which it originates."

Furthermore, new indicators regarding Algerian emigration have been identified: the actors of the migratory phenomenon (women, Harraga, intellectuals; and no longer just peasants); the destinations (Spain, Germany, the UK, the USA, Canada; and not only France); and the return of immigrants (rather than permanent settlement in the host country). All these phenomena, observed since the 1980s, do not fit A. Sayad’s model and have led certain researchers to speak of a "fourth age" (Collyer Michael, 2012: 109-113).

In this project, the migration of skills is considered one of the major indicators of this "fourth age" of Algerian emigration, or at least a "post-third age". Unlike the profile of emigrants described by A. Sayad—who were essentially peasants—these "fourth age" emigrants are characterised by their high qualifications and their sector of activity, namely the tertiary sector.

Theoretical Debate and the CREAD Study

Despite the importance of research into these new actors for the sociology of Algerian emigration-immigration, we must note the scarcity of studies in this field, particularly case studies. However, the latest study by CREAD (2015) is highly significant. It provides not only statistical data on the migration of Algerian skills but also useful theoretical insights, particularly the distinction between the "pessimistic" and "optimistic" schools of thought. While the former is Marxist-inspired with its centre-periphery model, the latter is neo-classical, advocating "the benefits of scientific migration for humanity" (Ibid.: 10). The study concludes: "The opposition between these two schools of thought has evolved over time. It even seems that we are moving towards a certain consensus. We remain in search of compensation" (Ibid.).

The theoretical debate thus remains open, and this CREAD study encourages us to further investigate the migration of Algerian skills, specifically that of doctors, to contribute to research on the "fourth age" of Algerian emigration-immigration.

Practical Motives: The Public Health Sector

In addition to the theoretical motive, there is a practical one based on observations within the public health sector. For example, in 2000, there were 31 specialised hospital establishments; this number rose to 66 by 2012. During the same period, the number of polyclinics increased from 497 to 1,601, and the number of treatment rooms rose from 3,964 to 5,545 (Ministry of Health: 19-20).

Between 2000 and 2012, the number of practitioners in the public sector grew from 20,437 to 41,993 (specialists, GPs, dentists, and pharmacists). The coverage ratio improved from one practitioner per 786 inhabitants to one per 521 (Ibid.: 14). For paramedical staff, the numbers rose from 87,012 to 117,590.

Despite this considerable effort, regional disparities in medical staff coverage persist. Statistics from 1998 illustrate these disparities across the country:

The Northern regions (Centre, East, and West) account for 83.93% of medical staff and 86.15% of paramedical staff, while the percentages for the Southern regions are only 16.07% and 13.85% respectively.

The Migration of Doctors

The emigration of doctors further complicates the situation. While dedicated studies are rare, early indicators are telling:

The case of pulmonologists: In 2011, out of 73 pulmonologists identified by an ad hoc jury, only 7 remained in Algeria. The majority left to practise in French or Canadian hospitals, or in private laboratories.The situation in France: The Medical Council provides eloquent figures. The total number of doctors born outside France is 54,168. 40% of these originate from the Maghreb, half of whom are from Algeria (approx. 10,318). Crucially, 27% of these were trained in Algeria.

Finally, contrary to the common prejudice that being a doctor is a clear sign of social success, emigration does not automatically guarantee the immediate recognition of skills or the expected working conditions. Many face discrimination or racism. Surgeon Rédha Souilamas, in his work La couleur du bistouri (2012), illustrates the challenges faced in France, as does the issue of qualification equivalence in Canada (Marie-Jeanne Blain et al., 2012).

Research Questions

The project's motives translate into the following questions: Theoretically: What is the current state of research on the migration of skills (specifically doctors), and what theoretical frameworks underpin this research? Empirically:

What is the historical background of the emigration of doctors?What are the legal aspects of this phenomenon?What is its impact on the country's health economy?How was the migratory project of the immigrant doctor conceived and realised?What are the opinions of medical students regarding migratory projects?