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On the morning of Feb. 14, just a few days before the one-year anniversary of the Ukraine war, Mohit Kumar, an Indian medical student in Ternopil, a city in western Ukraine, was headed to his class, when the siren went off once again. Kumar, still learning to suppress his trauma, rushed to an underground shelter at the Ternopil State Medical University campus. He stayed there for a couple of hours before it was time to return to classes and to the reality of living and studying in the war-torn country.
A year before, when Russia invaded Ukraine on Feb. 24, Kumar had been ready to celebrate his birthday. That’s when he heard the sirens for the first time. A disturbing incident, it stayed with him. “When we heard the news of a possible Russia-Ukraine conflict, most of the Indian students studying medicine in Ukraine were dismissive of it. We never thought something like this could happen. But the sirens were a rude shock. It dawned on us on the morning of February 25, when we finally reached the Romanian border by taxis and large vans, which we arranged ourselves, and walked for over six miles on foot,” says Kumar. Eventually, he left for India as part of the Indian government’s Operation Ganga, through which over 22,000 Indian nationals were evacuated from the neighboring countries of Romania, Hungary, Poland, Moldova and Slovakia. Most of them were medical students — Indians are the largest group of foreign nationals studying in Ukraine, accounting for nearly 24% of the total number of international students.
Medical students from India were dominating the news cycle for the second time. Earlier in 2020, over 23,000 Indian students, most of them studying medicine, were stranded in China because of the Covid-19 lockdown restrictions, which prompted several news reports on why they chose to study there. The presence of Indian students in other countries spotlight the fight for a medical education in India.
India has 654 medical colleges, which by most accounts is the highest in the world. Despite having over 99,000 spots in both public and private universities, these numbers are dwarfed by a rising number of students looking to make a career in medicine. In 2022 alone, over 1.8 million students registered for the National Eligibility Entrance Test (NEET), the competitive exam used to admit students to both public and private medical colleges in India. It is the only requirement to get admitted to medical schools in India. Of these, only 56% students were able to pass the exam, still exponentially higher than the number of seats available. For instance, a prestigious medical school like the All India Institute of Medical Sciences (AIIMS) in Delhi has only 20,000 seats. In such scenarios, students opt to retake the exam multiple times till they get in or choose private colleges, with exorbitantly high fees.
For the past few years, countries such as Ukraine, China and Russia have emerged as destinations for Indian medical students, owing to acute competition in India’s limited, affordable government-run medical colleges and the exorbitant fees of studying at private medical schools. The tuition for a medical degree in Ukraine can cost between 1.5 and 2 million rupees ($18,000 to $24,000) for a six-year program. In China, it is from 300,000 to 700,000 rupees ($3,600 to $8,400) annually. Meanwhile, private medical schools in India charge an annual fee of 1.2 million rupees ($13,900), or nearly $70,000 for the entire program. This makes a foreign education in these countries a more affordable option. In China, there are several universities that offer programs in English, and students can work in India thereafter.
Moreover, NEET is one of the most difficult entrance exams in the country, fostering cutthroat competition among students. It’s not uncommon in India every year to find over a dozen new reports of student applicants dying by suicide after failing to pass the exam. No official data exists for NEET candidates, but the country’s National Crime Records Bureau data in 2022 found that student suicides saw a record increase in the past five years, with failure in exams as one of the main reasons. In 2020, a total of 12,526 students had died by suicide, while in 2021, this figure rose to 13,089. Earlier in February, a 17-year-old boy, Abhishek, died by suicide in the northwestern state of Rajasthan after spending over two years preparing for the NEET exam in Kota, a town famous for being a national hub for tutoring centers for competitive exams. The depth of this problem can also be seen in demands to ban the NEET, with the government of the southern state of Tamil Nadu being a forerunner in urging the central government to do so. Indeed, medical education in the country takes a toll on young lives, with millions of candidates.
Moreover, the competition to get into private colleges is also high, said Dr. Aqsa Sheikh, Assistant Professor of Community Medicine at Hamdard Institute of Medical Sciences & Research in Delhi. “In private medical colleges like ours, the fee is very high; where at times it can be over 10 million rupees ($121,000), which is a big amount. Hence, for many students, choosing countries like Ukraine is the only option.” Furthermore, the drive behind becoming a doctor is “aspirational” in a country like India, said Dr. Shaikh, a path to a better standard of living, as the majority of them hail from small towns where opportunities are limited. For many, therefore, the consequences of losing the opportunity due to the war and starting all over again are higher.
Born to a middle-class family in the small north Indian town of Basti, Kumar chose Ukraine because it was cheaper and easier to get admitted to. Despite getting a good score in NEET, he was unable to secure admission in a medical school in India. In 2021, the external affairs ministry said that over 18,000 Indian students were admitted to educational institutions in Ukraine. With about 45 medical schools in Ukraine, it is considered an affordable option by Indian students, many of whom are unable to clear the NEET with a good enough score.
Even after returning to India, Kumar continued his studies in an online format, but in the final year, it was essential for him to be in person to gain practical knowledge and experience required to be a doctor, said the 27-year-old. When he decided to return to Ukraine in September last year, he lied to his grandmother and other family members. “They would have never let me leave. I still talk to them and lie about my whereabouts. If things go bad, I will move to Poland or Hungary perhaps.”
The anxiety to finish the medical program and to start his career prompted him to return. “It was a dream to be a doctor and I could not leave that dream for anything,” said Kumar, who is one of the 1,000 Indian students who returned to the war-torn country last year, despite advisories from the Indian government in October, warning against the “deteriorating security situation.”
The reason for returning was simple. “The Indian government wasn’t giving us any clarity about how our education will be carried forward and completed. They had already said that we cannot study in an Indian medical college, so going back was what many of us thought. Ternopil, being in the west of Ukraine, wasn’t as affected by the war,” he said. However, there are days when the electricity isn’t there for three to four hours and the studies are disturbed, or the sirens are incessant, prompting their teachers to teach them in the underground shelters. “But this is better than not being sure of finishing our studies,” he said.
For many, the fight is to finish the education in which they invested thousands of dollars and spent several years; for many it is about not having any alternatives. On being asked if Indian students from Ukraine would be able to continue their study in India, Dr. Bharti Pravin Pawar, the junior minister for health in the government of India, had informed the Indian Parliament in July last year, that there was no provision in the Indian Medical Council (IMC) Act, 1956 and the National Medical Commission (NMC) Act, 2019, as well as other regulations, “to accommodate or transfer medical students from any foreign medical institutes to Indian medical colleges.”
Meanwhile, Animesh Kumar, 23, from the central Indian state of Jharkhand, decided to transfer to neighboring Russia. He was in the third-year of medical school at Vinnytsia National Medical University in Ukraine, when the war broke out and he had to be evacuated and returned to India in March. He had to pay extra money to the “agents” to recover his documents from the Ukrainian university and transfer to Russia.
The transfer was necessary and he had to complete his program at a university in person. The NMC refused to recognise online classes, he said. “It clearly said that if we undertook online classes, our degree will not be valid in India and they would not give us a license to practice,” he said. However, it allowed Indian students to opt for an “academic mobility programme,” under which they could choose to complete their education in other countries. The program was suggested by Ukraine to offer the route of temporary relocation to other universities, but the degree will be awarded by the parent Ukrainian university. This allowed many Indian students to choose countries like Poland, Russia and Hungary to finish their program.
Hence, Animesh Kumar and hundreds of Indian students chose Russia, as they found similarities between Russian and Ukrainian languages, the credit system was similar, apart from the fee structure. “Most of us can’t afford to take transfers in the countries part of the European Union as their fees are very high.”
But transfers are also a tricky situation for many. The Foreign Medical Graduates Examination Regulations (FMGE) – introduced in 2021 to ensure that foreign medical graduates fulfills the requirements of education and training equivalent to the Indian criteria – mandated that the entire program, training and internship of a student should be done in the same foreign medical institution throughout the course of study. This barred transfers for students enrolled in foreign medical universities from 2021 onward and after. Since Animesh Kumar had enrolled at his university in 2019, he was allowed to transfer.
Indian student Advait, who was at Russia’s Tambov State University, which was also affected by the war, appeared for this exam. “My university initially said that they wouldn’t cater to those students who would choose to go home when the war began,” he said. Eventually, he returned to complete his program, cleared the FMGE exam, and is set to begin his medical career in India.
Sumit, 23, is from Sonipat, in the state of Haryana, a town which has recently hosted multiple expensive private universities. He was a student at Dnipro State Medical University, when his education was interrupted by the war. After spending a few months at home, he chose Hungary to complete his program as there was no scope of getting admission in India. He is now studying at the University of Debrecen and is one of 1,000 Indian students who moved to the country. “A large number of students went back to Ukraine, but I didn’t want to go back to the war. It was a scary idea to live in conflict and spend time in shelters and bunkers whenever things turned dangerous,” he said.
For many of his classmates in Ukraine, life now revolves around days of peace and fear. “The anxiety that many of them face is distressing.”
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