For them, paradise is elsewhere. They want a better career and better salaries. But Morocco, also in shortage of nurses, is losing essential labor to its hospitals. Should we blame the countries that try to attract them?
Soufiane and Khadija welcome us to their apartment under construction. Workers are assembling a huge closet that will be used to put toys and clothes for their 2-year-old daughter Yasmine. A beautiful little girl with curls, who wants to present her collection of teddy bears to us.
Married for three years, Soufiane and Khadija live in a popular neighborhood on the outskirts of Casablanca. But now they are thinking of leaving.
Both nurses in the private sector, they dream of going to Canada. They have a vague idea of Quebec, its cities or its regions, but that doesn’t worry them. They are ready to settle anywhere, as long as they can be welcomed there, work, and earn a decent wage.
“Quebec is better than Morocco, I think. A life better than here for my little girl.”
Soufiane and Khadija, nurses in Casablanca, want to ensure a better future for their daughter Yasmine.
Why leave Morocco? Khadija responds with a long sigh as if she doesn’t know where to begin.
For motivation, wages, lists her husband. They may have 7 and 10 years of experience, but their salary does not change. It is set at 5,000 Moroccan dirhams per month, or about $650 Canadian.
If they were able to buy this apartment, it was at the cost of indebtedness which eroded a good part of their income. And at the cost of tireless work. I work during the day, says Soufiane. My wife works night shifts from 8 p.m. to 8 a.m., every other day. We have to take our little girl an hour from here to Grandma’s. We spend two hours a day in the car. After 12 hours of work, that’s a lot.
They want good schools for their daughter and hope to benefit from better medical coverage. Here, you have to pay for everything, explains Khadija. If my daughter is sick and we don’t have any money, they don’t treat her.
However, since our meeting in October, Morocco has extended access to health insurance, with the goal of universal social protection for the 37 million Moroccans.
Oumaïma inquires about her file with Youssef Cheddadi, director of New Life Canada, immigration consultant in Casablanca.
On the floor of a small building in the heart of downtown Casablanca, the New Life Canada agency supports candidates in a dozen professions sought by Quebec: nurses, early childhood educators, computer engineers, graphic designers, among others.
On the wall of his office, director Youssef Cheddadi hung a large photo of the Château Frontenac. His children are studying in Quebec. He receives about fifty requests a day. Those who knock on his door are, for two thirds, single people under 35 years old.
“People are always seduced by the pay gap. Then there is the concern for medical coverage and the health system. The search for security, a social safety net. And then, the education of children.”
He was visited by Oumaima, a 24-year-old nurse. It was the working conditions in Morocco that motivated her to leave. His salary in the public sector has stagnated at 6,500 dirhams a month ($852). His 12-hour shifts, one Sunday out of four, earned him 98 dirhams ($13) a day at the end of the year.
Overtime, when she does help, is simply not declared and is not paid. The salary is fixed.
“In my hospital, if we ask the question: how do you see yourself ten years from now? Everyone will answer you: we want to leave.”
This idea crosses the minds of all young nurses, according to the Moroccan Labor Union, Morocco’s largest union, which represents 60% of nurses.
For those who stay, it’s more pressure, deplores the nurse and union representative Zakariae Taabani.
After 4 or 5 years of experience, they want to go elsewhere , explains the provincial secretary of the UMT, Zakariae Taabani. He thought of it himself. Now married and a father, he prefers to stay, invested in his trade union mission. I decided to fight for the situation to improve.
He cites the recent example of a hospital in Casablanca, where 13 of the 60 nurses had their files accepted at the same time to immigrate to Canada. Thirteen departures. This was far from good news for this hospital.
“Those who stay have more pressure, more responsibilities. They find themselves in a very difficult situation to manage the services and continue to work.”
Impact on teams and care
Morocco has 30,000 nurses, but it needs 65,000 more, according to an official figure. It would be rather 100,000 more, estimates for its part of the Moroccan Labor Union.
Morocco needs this workforce all the more as it is in the process of extending health insurance coverage to its entire population.
To succeed in this royal project, men and women are needed! exclaims the doctor and professor in Casablanca Jaâfar Heikel, who is also a doctor in economics. It is not enough to put money and infrastructure. Who will take care of the patients if a good part of them leaves?
The doctor Jaâfar Heikel in his medical office in Casablanca.
Jaâfar Heikel deplores a lack of planning. For several years, we closed state nursing schools. We just reopened them. But what is serious is that we are now seeing a drop in demand for this job.
He attributes this disinterest to working conditions, to the huge pay gap between doctors and nurses. Lack of appreciation of the profession. Jaâfar Heikel is well placed to compare Quebec and Morocco. He studied medicine in Montreal and Sherbrooke.
“I worked in Quebec and the nurses are the doctor’s partners. Here, it’s a rather hierarchical relationship and it creates a lot of frustration, when they feel that they don’t have enough responsibilities and appreciation of their job.”
The pandemic has further highlighted the shortage of nurses, which has added to the exodus of doctors for many years.
I apologize for using that term, but there is a hemorrhage , he said. And it is important to understand why. Because the same causes will create the same effects. It is not enough to train more doctors and nurses. If you have a bucket that has a hole in it and you fill it with water, you’re never going to fill it!
Critical needs in the countryside
The shortage of nurses affects large cities and rural areas very inequitably. When asked how the health system is doing in his region, Fedoua Bouhou rolls his eyes: The region, oh la la!… The activist for social and associative development lives in Tarmigte, near Ouarzazate, in southeastern Morocco.
Fedoua Bouhou deplores the lack of health care services in the communes around Ouarzazate.
We have one doctor for 60,000 inhabitants, so we suffer a lot! , exclaims Fedoua Bouhou, with a big smile. The only hospital is in Ouarzazate. Most of the rural communes in the region have only one dispensary, at best. But here, on the small roads in the mountainous area, distances are measured in hours, rather than kilometers.
She adds that to treat serious illnesses such as cancer or AIDS, you always have to travel to Marrakech (200 km) or Rabat (500 km).
“Pregnant women die during childbirth because they don’t have easy access to the hospital.”
Poverty also causes people to give up going to the doctor or the pharmacy. For treatment, the use of medicinal plants is still widespread. Many merchants sell them in the souk of Skoura, a small town 44 km from Ouarzazate. Even during the pandemic, the sick resorted to herbal teas from the elders , said Brahim, a 47-year-old man who shops weekly at the market.
Fatima, 69, at the Skoura souk.
Photo: Radio-Canada / Myriam Fimbry
Before, there were itinerant doctors who went from village to village, says a 69-year-old woman of modest origin, Fatima. Now it’s over. We go straight to the hospital, only in extreme cases.
Skoura, 24,000 inhabitants, has a community health center, but lacks resources. If it’s serious, they’ll send us by ambulance to Ouarzazate! indignant Brahim, 47 years old.
This raises the question of health infrastructure, the quality of roads, and more generally the attractiveness of the region, which is lacking to attract or keep executives, doctors, and nurses.
It is an ecosystem, a global question , says Khalid Esmaili, vice-president of the territorial municipality of Tarmigte. He calls for basic infrastructure, such as schools, essential to retain families.
Even with good pay, we don’t attract married people here. No matter how much we build hospitals, the question of human resources will not be resolved quickly.
Should the recruiting countries be blamed?
But meanwhile, the great seduction by other countries continues. The health professional who wants to leave Morocco now has a choice: France, Germany, Canada, United Arab Emirates, etc.
Anxious to do well and betting on the common language, Quebec launched a new recruitment program in 2022 for 1,000 nurses.
Of the first two cohorts, totaling 456 nurses recruited for refresher training in Quebec CEGEPs, 180 come from Morocco, or between a third and a half.
The Office of Quebec in Rabat, on the left, near the Badr mosque.
Our goal is to become leaders in international recruitment, explains the director of Africa immigration services, Hanafi Tessa, at the Quebec Office in Rabat.
The main recruitment activity, the Journées Québec targets sectors such as engineering, health, information technology, early childhood education, or construction. The Rabat office recruits French speakers in several African countries.
In Morocco, it works closely with the National Employment and Skills Promotion Agency (ANAPEC), a government agency, which also has an international placement mandate and preselects nurses for Quebec. In doing so, ANAPEC agrees to participate directly in their exodus.
These nurses are certainly not unemployed in Morocco but want to progress in their careers. Many are fleeing the private sector, which does not offer job stability and highly variable salaries. These are the people that Quebec is trying to target more.
“We are aware of certain challenges facing Morocco for certain professions, such as nursing. Therefore, we always try to find a balance between our two interests.”
It is a balance which is very difficult, and even utopian, however, says the doctor and expert of the Moroccan health system Jaâfar Heikel. Because everyone is looking for their interest.
He understands the interest of Quebec and that of professionals to go into exile. I regret it for my country, I regret it for the Moroccan health system, of course. But, on the other hand, today we are in a competitive market. I apologize for using the term, but it is a market. I don’t justify, but I understand.
He does not want to criticize the countries that come to poach a workforce that is essential to the Moroccan health system.
A clinic in Ouarzazate.
He sees the decision to immigrate as a pragmatic choice.
The one who will choose is the one who will have the best offer. Because in the end, everyone will make this balance between the emotional, the family, the means, the working conditions. He will do a sort of checklist and he will say: what is the score? Do I have a better score in Quebec or a better score in Agadir? In Casablanca, Rabat, Berlin or Paris?
And depending on the “score” he will have, he will decide whether or not to leave.
Same reasoning on the part of union representative Zakariae Taabani, who says he is happy for the colleagues who have left to improve their living conditions. They are good, they are doing service elsewhere, I can’t judge them or blame them , he said.
Instead, he throws the ball into the court of the Department of Health. He must listen to us, improve the working conditions of these nurses, so that they feel good here. Because immigrating is not an easy choice. If they felt better here, they would have stayed.
Oumaïma, a nurse in Casablanca, would like to immigrate to Canada, preferably to Quebec.
Does Oumaïma feel a bit guilty about leaving her country, which lacks nurses? Sincerely, yes, she said after hesitation. Morocco is a country that needs my skills. But, unfortunately, he did not create a favorable ground for me to stay.
She still has a twinge in her heart at the idea of leaving, leaving family, friends, the sun, and the cities she loves in Morocco. Honestly, it’s hard to leave. But there is a challenge in life. I’ll try. Maybe, if I leave, I regret? The main thing is that I tried.
Myriam Fimbry’s report was broadcast on February 12, 2022 at Désautels on Sunday.
