Being Highly Skilled and a Refugee: Self-Perceptions of Non-European Physicians in Sweden

Being Highly Skilled and a Refugee: Self-Perceptions of Non-European Physicians in Sweden ABSTRACT Both in popular imaginings as well as in migration scholarship, migrants are generally placed into different categories. We know, for instance, of refugees, family migrants, international students, and highly skilled migrants. This article seeks to document the narratives of people standing at the junction of the usually separated categories of “refugee” and “highly skilled migrant”, and to account for the complex criss-crossings of their professional and refugee identities. The article is based on semi-structured interviews with non-European medical doctors who came to Sweden as refugees. In order to make sense of how these highly skilled refugees understand themselves, what they identify with, and what social locations they occupy in the destination country, the article employs Rogers Brubaker and Frederick Cooper’s distinction between “identification and categorization” and “self-understanding and social location”. These concepts have further been developed by Richard Jenkins’s theory on social identity and Floya Anthias’s work on translocational positionality. The article points to the processual nature of identity, which is always partly self-constructed and partly determined by external categorisations, and hence makes the case against the essentialisation of migrants’ identities, be they “refugee” or “highly skilled migrant”. 1. INTRODUCTION This article takes its point of departure as the predominance of a grid-like understanding of migrants in which individuals are neatly placed into the categories of “refugee”, “highly skilled migrant”, etc. As such, these are often attributed characteristics that are not only disparate, but even contrasting, taking into account how refugees and highly skilled migrants are portrayed in popular discourse, for instance. Whereas refugees are prevalently depicted as passive victims and as a threat to the economic, social, and security welfare of the host countries;1 highly skilled migrants are often cherished for their contribution to the host societies and seen as an indispensable asset.2 Within the field of migration studies, definitions of refugees and highly skilled migrants barely allow for tangency and almost completely disconnected fields of research have been fostered. Refugees are predominantly bundled under the term “forced migrants”. This implies that their migratory move was initiated by external circumstances, such as war and persecution, rather than their own wish to follow, for instance, economic or other incentives. By comparison, highly skilled migrants are usually defined as those in possession of a university degree and/or extensive professional experiences who move abroad in order to find more rewarding employment. They are thus mainly categorised as a subdivision of labour migrants.3 Correspondingly, refugees and other involuntary migrants who did not migrate due to economic reasons are largely exempted from studies on highly skilled migrants.4 In the same vein, studies on refugees are rarely demarcated according to an individual’s professional affiliation. They most commonly delimit the examined group according to the refugees’ legal status, type of entry, nationality, ethnicity, and increasingly also gender.5 Granted, profession does play an essential role when discussing topics such as refugees’ labour market performance and integration, as well as their social inclusion and identity construction.6 However, even when such studies include highly skilled refugees, they do so without focusing on them. Exceptions do exist. For instance, Smyth and Kum7 explore refugee teachers’ professional re-emplacement in Scotland, and Willott and Stevenson8 analyse employment experiences and work attitudes among refugee professionals in Leeds. However, apart from these and a couple of other studies on highly educated refugees in the UK,9 research focusing on highly skilled refugees has been close to non-existent in other European countries. This article seeks to document the narratives of people standing at the junction of the categories of “refugee” and “highly skilled migrant”. In order to do so, the article focuses on highly skilled refugees’ understandings of their professional and refugee identities and how these are intertwined. More particularly, the article looks at how non-European medical doctors who came to Sweden as refugees10 understand themselves, what they identify with, and what social locations they occupy in the destination country. By exploring the realities of people standing at the intersection of “being a refugee” and “being a highly skilled migrant”, the article hopes to contribute to the empirical knowledge of this under-researched topic of highly skilled refugees. The article furthermore seeks to refine our understanding of who is a refugee and who is a highly skilled migrant. Thereby, the article contributes to the growing body of literature within migration studies that points to the fact that the refugee-(economic) migrant dichotomy represents an ideal type that rarely reflects the reality in all its multiple layers.11 The concept of “mixed migration” – a term coined by the United Nations High Commissioner for Refugees (UNHCR), yet analytically developed primarily by migration scholar Nicholas Van Hear12 – represents an example of an analytical tool that has been employed to highlight the continuum between forced and voluntary migration. The concept aims to capture the complexities of migration dynamics, i.e. the blending of motivations that drive people into moving, as well as the mixing associated with other stages in the migration process.13 Though this article is not concerned with highly skilled refugees’ motivations for migration or their migratory trajectories, the in-depth exploration of the self-perceptions held by non-European physicians who came to Sweden as refugees similarly refines our understanding of the “refugee” and “highly skilled migrant” categories. Namely, it underscores the blurriness of these categories’ demarcations and points to the continuity between the two. The next section of the article maps out the conceptual framework that enables us to grasp the intricate interplay between the refugee and professional selves as perceived by the non-European physicians who came to Sweden as refugees. The third section lays out the contextual setting of the empirical part of the study by outlining the regulations that frame the licensing process of non-European doctors in Sweden. The fourth section briefly presents the empirical study that this article is based on, i.e. it outlines the sample, how the employed material was generated, and the methods used in the analysis. The subsequent two sections are dedicated to the presentation of the material that was obtained through interviews with non-EU medical doctors: the first illustrates their perceptions and experiences as refugees in Sweden, and the second focuses on their realities as doctors. In order to capture the intricacies of the interviewees’ professional and refugee identities, as well as the context in which they transpire, the obtained material is presented at length. With the help of the theoretical framework, the presented material is discussed in the seventh section. The final section gives some concluding remarks. 2. CONCEPTUAL FRAMEWORK Many authors claim that the concept of “identity” has simultaneously come to mean both too much and too little. It is used to address too many elements at once: its application ranges from, for instance, portraying an individual’s core self to group identification processes. Concurrently, the concept often captures too little as it does not address the questions of identity production within specific contextual frameworks. In order to avoid this trap and to develop a heuristic tool that will enable us to engage with the multidimensionality of an individual’s self, this article conceptualises identity following Rogers Brubaker and Frederick Cooper’s14 distinction between “identification and categorization” and “self-understanding and social location”. The two categories are further developed by Richard Jenkins’s theory on social identity15 and Floya Anthias’s work on social location, which is captured in the notion of “translocational positionality”.16 The proposed conceptual eclecticism simultaneously incorporates structures that frame people’s lives and the agency these same individuals possess within given spaces. What is more, the proposed theoretical framework enables the portrayal of multifaceted identity-formation processes while at the same time depicting the underlying regularities. As de Haas points out: “Social theory formation is precisely about striking a delicate balance between the desire to acknowledge the intricate complexities and the richness of social life on the one hand and the scientific need to discern underlying regularities, patterns and trends on the other”.17 2.1. Identification and categorisation Speaking of “identification” shifts our attention away from the idea of identity as a static state of mind and being, i.e. as something that one has. Instead, the processual nature of the term emphasises the importance of analysing the dynamics of identity construction by looking at what we do. As Jenkins points out: identity is not simply out there, instead it must always be established. It is a process of being and becoming.18 The second major claim that Jenkins makes about the processes of identification is that both individual as well as collective identifications follow one basic model of internal–external dialectics. In order to better understand this mechanism, we have to make a short detour into Jenkins’s understanding of the human world. Leaning on Erving Goffman and Anthony Giddens, Jenkins distinguishes between three distinct orders of the world as constructed and experienced by humans: 1) the individual order, which consists of individual human beings and their perceptions of the world; 2) the interaction order, which is the world that is constituted of relationships between individuals; and 3) the institutional order, which is the world of organisation(s) and established ways of conduct.19 When it comes to the individual order, it is important to note that individual identification is always socially constructed, i.e. it emerges through the ongoing and simultaneous synthesis of self-identification (the internal element) and definitions of oneself by others (the external element). This dialectical interplay brings us to the interaction order: identification is not just what we think about ourselves; our self-understanding is also validated against what others think of us. What is more, not only do we identify ourselves according to the internal–external dialectical logic, but we also identify others through the same process. The institutional order represents a vehicle of categorisation that frames and shapes the identifications that occur at the other two levels, while simultaneously being influenced by them.20 This explains how identification and categorisation are interconnected. According to Jenkins, “categorization” is the external aspect of identification, i.e. the process by which people categorise others.21 Yet, categorisation does not need to be produced by a specific actor, as it can occur anonymously by means of, for instance, public discourses. While categorisation takes place at all three levels of the human world, it is important to single out the categorisation processes that occur at the institutional level – “the formalized, codified, objectified systems of categorization developed by powerful, authoritative institutions”.22 The modern State hence represents one of the most important agents of categorisation, since it has “the power to name, to identify, to categorize, to state what is what and who is who”.23 Yet, as pointed out above, even though the State may be powerful in its ability to construct social categories for people and other non-State actors as well as impose them, the State is not the only producer of identifications and categories, and its categories can be contested.24 2.2. Self-understanding and social location Whereas identification and categorisation are active terms that denote the processes enacted by specific actors or through specific means, “self-understanding” is a dispositional term that designates one’s sense of who one is, where one is located in a particular social setting, and thus how one is to act. In this way, self-understanding and social location are tightly connected with one another. Though self-identification is closely related to self-understanding, it is important to draw a clear distinction between the two. Self-identification is tied to an explicit discursive articulation, whereas self-understanding may be tacit. In relation to the process of identification (which is often affective), self-understanding is of a more cognitive nature and can only refer to one’s own understanding of who one is; it does not capture other people’s understandings.25 The dispositional character of these terms does not mean, however, that self-understanding and social location are unitary, never-changing entities. As shown in Floya Anthias’s understanding of social location, these positions change according to the different contexts we inhabit, as well as with time and space. As developed by sociologist Floya Anthias,26 the concept of “translocational positionality” is particularly useful within the field of migration studies because it takes into account geographical moves as well as transnational spaces. The concept aims to capture people’s identities in terms of social locations. Similar to Jenkins, Anthias rejects the idea of given identities and stresses the importance of understanding social locations as a dynamic practice that is dependent on context and can hence involve shifts and contradictions. The “translocational” part of the concept emphasises two things. First, the term highlights the multiplicity of the social locations – “social spaces defined by boundaries on the one hand and hierarchies on the other hand”27 – that we inhabit. Although Anthias uses the term “social location” specifically in relation to ethnicity, gender, and class, I also consider it applicable to migrant and professional positions. Both national and professional belongings are defined by boundaries and hierarchies: being a migrant means not being a native, which can be, on different occasions, both advantageous as well as disadvantageous. Also, being a physician means something else than being a nurse, for instance, and can be thought of as being “ranked higher” due to its better financial position and higher social status. We thus need to think of social locations in relation to each other since they are interrelated and produced relationally. Thereby, social locations are not only relative to one another, but are also situational, temporal, and subject to different meanings.28 Secondly, the term “translocational” points to the idea that even though migratory movement might entail geographical dis- and relocation, it does not mean that one becomes dislocated in social terms. Anthias emphasises that our social locations are not only multiple, but that they span across temporal and spatial terrains. She gives an example: “To be dislocated at the level of nation is not necessarily a dislocation in other terms, if we find we still exist within the boundaries of our social class and our gender”.29 She does concede, however, that the movement will transform our social locations and the way we experience them. The “positionality” part of the concept encompasses a reference both to social position (an outcome) and social positioning (a process), and thereby points to the intersection of structure and agency. Taken together, the notion of translocational positionality captures an individual’s position (structure) and positioning (agency) within the interplay of different social locations (such as ethnicity, gender, race, etc.) that are relative to specific temporal and spatial contexts. To illustrate her point, Anthias gives an example of a working class husband and wife from a minority background: the woman’s locations related to class, gender, and ethnicity put her in multiple, subordinated positions, whereas the man may be in subordination, for example, in relation to his employer, but be in a dominating position in relation to his wife.30 3. NON-EUROPEAN PHYSICIANS IN SWEDEN Nowadays, it is not uncommon to be treated by a foreign physician within the Swedish medical system. The percentage of practicing physicians who were trained abroad has grown steadily during the past decade and amounted to 27 per cent in 2014.31 The statistics furthermore consistently show that among these, approximately two-thirds received their education within the European Union/European Economic Area (EU/EEA) and the rest came from countries outside of the EU/EEA, migrating to Sweden mainly as refugees and family migrants. Among other reasons, the internationalisation of the Swedish medical sector is due to the insufficient number of domestic doctors, which has resulted in the need to recruit foreign professionals.32 Whereas recruitment had, until now, been mostly limited to the EU, the combination of the need for physicians with the realisation that a significant number of refugees possess these medical skills made some Swedish county councils (landsting) consider recruitment among refugees as well.33 If nothing else, this seems reasonable in light of the high admission numbers of refugees to Sweden. In 2015, Sweden received, in proportion to its population size, the highest number of asylum-seekers among the member countries of the Organization for Economic Co-operation and Development (OECD).34 Sweden received 162,877 asylum applications in 2015, in comparison to 81,301 applications in 2014 and 54,259 in 2013. The trend changed in 2016, when Sweden received 28,939 asylum applications.35 In 2015, when this study was conducted,36 medical doctors who were educated outside of an EU/EEA Member State or Switzerland had to provide official proof of Swedish language proficiency and were required to complement their training if they wanted to obtain a Swedish medical license. The scope of the supplementary training was based on an assessment of the doctors’ previous medical training. Specialists who had previously practiced medicine for at least 5 years had to complete a probation period (provtjänstgöring) of 6 months at a Swedish medical institution. During this time, the specialist worked under the supervision of the local head of the unit (verksamhetschefen), who provided a final assessment of the doctor’s competence and suggested, if necessary, possible additional training. Doctors with no completed specialisation had to first pass a medical knowledge test (the so-called TULE exam, or, in Swedish tentamensgruppen för utländska läkares examination), which was organised twice a year by the Karolinska Institutet37 in Stockholm and is comparable to the Swedish medical exam. During the 3-day exam, the doctors underwent one theoretical and two practical examinations. The doctors had to answer approximately 100 questions related to surgery, medicine, obstetrics and gynaecology, paediatrics, and psychiatry. The practical examination consisted of one surgical and one medical examination of a patient in which the doctor diagnosed an illness and suggested a treatment. As an alternative to the TULE exam, the doctors could also take part in a supplementary course (kompletterande utbildning för läkare, tandläkare och sjuksköterskor från länder utanför EU), which took place over two terms and was organised by the universities in Gothenburg or Linköping, or at the Karolinska Institutet in Stockholm. After the doctors had complemented their theoretical training, they had to complete an 18-month period of rotation (allmäntjänstgöring, or as it is called in short: AT), which provided them with practical experience in all parts of a hospital’s setting and medical disciplines. In the final step, all doctors had to pass a course on Swedish medical legislation and could then, finally, apply for a Swedish medical license. After the doctors receive the license, they can start their specialisation, which usually takes 5 years. 4. METHOD AND MATERIAL The analysis in this article is based on narrative material collected through semi-structured interviews with seven non-EU doctors who came to Sweden as refugees. The delimitation of the sample to one profession is grounded in the aspiration to tease out the profession-related considerations and factors that shape these refugees’ experiences. The focus on physicians is grounded in the idea that refugee doctors represent an extreme case38 of the contradictory social positions in which highly skilled refugees find themselves. These individuals belong to the esteemed occupation of medical doctor while simultaneously being connected to the category of “refugee” with its less favourable social imaginings.39 The focus on non-European medical doctors is based on the distinct regulations pertaining to EU/EEA and non-EU physicians wanting to work in Sweden (and the fact that refugees in Sweden come from non-EU countries). All individuals interviewed for this study completed their medical training in their home country or another non-EU country and some of them already had work experience before leaving for Sweden. Since the purpose of the study is to probe the nexus between individuals’ professional and refugee experiences, the rest of the sample characteristics, such as national background, time since migration, place of residence, and stage in professional career are considerably diverse. Though they are important, the differences between these prove to be insignificant for the conclusions of this research. The present article is based on interviews with four Iraqi doctors, two Syrian doctors, and one Malaysian doctor, three of whom are female and four male. The interviewees were between 26 and 57 years old and had been in Sweden between 1 and 25 years. At the time of the interviews, four of the interviewees worked as doctors, whereas three were still in the process of obtaining Swedish medical licenses. As the purpose of the study was to gather thick subjective accounts of the studied group rather than aiming towards generalisation across cases, the sample size is adequate.40 What is more, the reoccurrence of certain narrative elements suggests that the sample made it possible to reach an adequate level of data saturation. Contact with the interviewees was established through personal connections, various institutions and projects that are involved in the licensing process for non-EU physicians, social media, and the individuals’ workplaces. Four interviews were conducted in person, whereas the rest took place over Skype. The interviews lasted between 54 and 94 minutes. With the permission of the interviewees, all interviews were recorded and later transcribed. All of the interviews were conducted in English, except on one occasion when the interviewee switched to Swedish at the beginning of the interview. The explorative, in-depth interviews had traits of life-story and narrative interviews: the interviewees were invited to talk about their professional experiences before and after coming to Sweden, as well as about their asylum-seeking process in Sweden and the path to obtaining a Swedish medical license. By trying to capture the individuals’ perspectives, it was hoped that the interviews would grasp the nuanced and positioned nature of these refugee-professionals’ perceptions, feelings, and understandings and provide a close-up of the experiences this little-explored group has lived.41 The second step of the analysis consisted of scrutinising the obtained narratives. This was done through coding by which the material was categorised, which facilitated its interpretation. 5. BEING A REFUGEE 5.1. Insecurity, dependence, and passivity A prominent feature in the interviewees’ narratives was a sense of insecurity in relation to how things would turn out in Sweden. According to many of them, their initial period in Sweden was full of uncertainties. Would they receive asylum and, if so, when? Where would they live? Would they be able to work as doctors? Rashid42 said: “Before we got the residence permit, we didn’t know what was going to happen. Anxiety maybe. We were scared. We didn’t know what will happen, everything was strange”. Those who had lived in Sweden for some years and had already obtained their Swedish medical license were happy that their situations and futures were clearer. As Fatin said: “[W]hen one first came here, one has to see. One doesn’t know what one should do, how life will look like. But now, now I know what I want to be, how life is going to be. Economically, psychologically, everything is clear, one knows how it will be.” The topic of insecurity is tightly connected to the feeling that the interviewees’ lives were not in their own hands. Their emplacement in Sweden depended very much on regulations, external circumstances, and even luck. This feeling of dependence and powerlessness was especially present with regard to obtaining a residence permit and – as will be shown in Section 6.3 – the process of obtaining a Swedish medical license. Furthermore, the narratives concerning the refugees’ initial time in Sweden point to long periods of waiting and passivity. Khalid recounted how he waited for the decision concerning his asylum application: And you cannot do anything in that waiting time. Just sit in those apartments of the Migration Board, or in a camp […] I was so sad and depressed, to sit there just eating and sleeping without do[ing] anything. And I tried to get books from the library to study Swedish or do something. But I couldn’t. Also, people living with me in the apartment, so, like, just people apply for asylum and do nothing. Just drinking and taking hash, so, it was so bad for me. It was so bad for me.Here it is important to note that the expression “to sit [around]” had an explicitly negative connotation for the interviewees. In particular, Rashid used the phrase often in order to express something negative. When I asked him if he remembered a period in which he was unable to work as a doctor, he replied: “If you count that [initial] period [in Sweden]. But I had something to do. I was learning Swedish. I validated my grades and went to courses. So, I wasn’t like […] I didn’t just sit at home and do nothing”. 5.2. Being a refugee, being a foreigner The interviewees understood themselves as refugees in two ways. On the one hand, they knew they were refugees in legal terms, i.e. because they had applied for asylum in Sweden. On the other hand, they understood themselves as refugees because of particular life circumstances, i.e. the way they had travelled to Sweden, their unfamiliarity with the language, their dependence on the Swedish welfare system, and their experience of how others treated them. Fatin explained why she felt like a refugee during her initial time in Sweden: “Because you come as a refugee. I know myself that I applied as a refugee. I don’t know language, language is very important. We go shopping and we speak in English. It didn’t feel like home”. Even if Yi Hui was, legally speaking, not a refugee,43 she claimed that her life situation in Sweden made her into one: Because when we were studying Swedish and studying for the exams, we were not financially secure, we were much financially dependent on the government to give us, to pay us the benefits and when we were waiting for our residence permit, I lived together with the refugees too. So, we were treated as refugees.Rashid, however, who came to Sweden with the assistance of smugglers, had applied for asylum and lived in a detention centre, but refused to apply that term to himself: When one says “refugees”, there is a big difference if one is in a refugee camp like all those from Syria who have no water, no medicine, they are tired, it rains on them, snows on them. Or a refugee here in Sweden who lives in an apartment, who can take a walk to [the supermarket] and buy himself food, cook at home, watch television, or google on the Internet. So, that is a good life. So, I cannot say that I felt like […] The word refugee or asylum-seeker, it means something bad, or worse than it was. I didn’t feel like this. […] I always felt like a stranger.Rashid was not the only one who spoke of himself as a foreigner. Take Noor, for example: “But I think that we, foreigners, are always afraid, we are little bit sensitive, we are little bit […] You know what is ömtålig [fragile]? We can be injured, insulted easily. Because we feel like we belong not to this place”. The interviewees talked of themselves as foreigners mostly in relation to the situations that occurred after their asylum application process had finished. As Sections 6.3–6.5 show, they felt like foreigners because of how they were treated in work-related and private situations. Thereby, it is important to note that even though many had the feeling that they were treated as foreigners, they all expressed the same insecurity as to whether or not their interpretations of other people’s actions were correct. As the recollection from Hayder below shows, many were uncertain whether the Swedes always acted in a certain way, or if it was just towards them as foreigners: [I]n the first month when I lived in Sweden, I go to a shop. I need to buy a telephone. So, I ask [imitating the conversation], I can’t talk Swedish, can we speak English, of course! I see one iPhone, so, please can you tell me some details. There is another man coming inside at the same time, I don’t know, but I think he is Swedish, blond, big blue eyes [laughing], yeah, that’s classical stereotype, and he leaves me and go to that person and starts to speak with him. I don’t know why he did that. But maybe he […] I don’t know if it’s personal to me, or if it’s normal. Just considerations. 6. BEING A DOCTOR 6.1. Motivation When asked why they chose to become doctors, the interviewees gave two types of answers. On the one hand, for many being a medical doctor meant achieving a certain social status and occupational security in life. Rashid expressed this in the following story: I liked [my father’s] profession. It felt that it had good, I don’t want to say high, but it has a good status. And concrete, safe future possibilities. My grandfather used to say, there are three people who will never become unemployed. The first are those who sell food – people will continue to eat. Then those who are doctors – people will continue to get ill. And the third are those who sell clothes for women [laughing].The advantages of social status were rarely coupled with the benefits of a high salary, since they did not necessarily come hand in hand, especially in Iraq. Only Yi Hui observed that in Malaysia people also decide to become doctors because of the salary. On the other hand, for many becoming a doctor meant working with people, helping them, and improving their well-being. In Mohammed’s words: “I wanted to be a doctor […] to help people who are sick in the hospital. It’s a great feeling when you help somebody to be free of pain, to be healthy again. It’s a great feeling. Nobody can feel this feeling if they are not doctors”. Also, Hayder painted a vivid picture of what inspired him to become a doctor: Because I think, at the same time it’s a job, I am working with human beings. With the body of human beings, with their souls. And that’s. I am like you. I feel happy when I listen to the stories of the others. Usually they are the story of suffering. Really. But at the same time, on the other side of the coin, it is human stories. Because it’s not only a patient when you become a doctor, the patient will not tell you only stories of their disease. No, at the same time he will tell you part of the story of his life.For the doctors, the two groups of reasons were not necessarily opposing, but rather went hand in hand. What is more, in most of the cases, practicing medicine was already in the family and the interviewees were either encouraged or simply inspired by their parents, uncles, or grandparents to enter the profession. 6.2. Being a doctor The above section also points to how the interviewed doctors understood their societal roles. By being able to help people, the interviewees perceived themselves as “providers” of care, as giving something back to society. In the interviews, they often juxtaposed this role to that of “recipient” (e.g. of social benefits). One of Hayder’s hopes for the future was as follows: I hope I can continue in Sweden. […] To work, and for myself, so that I can be producer, not just receiver. I feel I must produce something, so that I can work, I can pay taxes, I can help others and not just wait for someone to help me. Because that’s sort of a transformation between the roles. I am a receiver, but within some years, I think, I will become a producer in that society. Not just a producer as a doctor, but I can also give many ideas for the improvement of my surroundings.Another aspect that featured prominently in the interviewees’ narratives is that medicine is a practical profession. On numerous occasions, the interviewees expressed their efforts to practice medicine – e.g. during their initial time in Sweden when they were still in the licensing process – in order to retain their medical skills and to stay in touch with developments in the medical field. As Mohammed said: “I need to be in tune, to be in the hospital, to keep my information. Now and three months ago, I feel that I am not a doctor. […] Because I am not using my knowledge at all”. As the next section will show in more detail, all of the interviewees expressed having had extreme difficulties when they were not able to work as doctors during their initial time in Sweden. 6.3. Professional re-establishment in Sweden The process of acquiring a Swedish medical license featured as a prominent topic in all of the interviews. The interviewees were either still in the process of obtaining a Swedish medical license or were already working as doctors in Sweden. In order to work as a doctor in Sweden, they had to pass several Swedish language courses, which usually took them about 2 years, then the TULE exam, and then do their residency. Only Fatin enrolled in the supplementary course at the Karolinska Institutet in Stockholm and Khalid also tried to get a place there. Once in Sweden, all interviewees wanted to continue practicing medicine. Their decision was based not only on their dedication to medicine, but also on the realisation that they were unequipped to practice any other profession, except some low-skilled jobs in, e.g. the food service industry or transportation sector. Nevertheless, once they embarked on the process of obtaining a Swedish medical license, many of the interviewees felt extremely frustrated. They were riddled with doubts about whether they would ever be able to practice medicine again and, at points, lost all interest in doing so. As Noor recalled: “I was depressed. It was nothing to do. I couldn’t work, like anything. And that’s when I got the feeling that maybe I cannot be a doctor in Sweden anymore. Or anymore at all. I don’t know what can I say more, but I was really unsure”. The sense of frustration stemmed mainly from the tediousness of the licensing process. On numerous occasions, the interviewees’ frustration referred to the number of years they invested in being able to work in Sweden. Mohammed “saw black” when thinking of it: I was suffering with the [Swedish language] school. Suffering and just seeing black in front of me. You put yourself in my situation. Like, you already study six years and worked one year and then left here and then one year doing nothing, just waiting, and then come to the school and then know from your teachers that you have to wait. Can you imagine that they tell me, you have to be in SFI 38 weeks, then you can go to higher level.The frustration also arose from the feeling that much of the complementary training was a repetition of what they had already done. The interviewees felt that their previous medical skills and knowledge did not count. As Hayder said: “After two years of the working and the supervision, they will legitimate me just as a doctor. I am specialist. […] I have been working as a doctor for 15 years. But when I contact the National Board, they say, no, that means nothing for us”. Also during the Swedish language courses, the interviewees felt that their abilities and educational level were not recognised. They disapproved of having to attend courses with people with lower levels of education, which slowed them down. Noor remembered her course: So, what if you are a doctor from your homeland? You don’t have a certificate here in Sweden. You know, even teachers in the Swedish language, they treat us as if we are kids. […] I mean, me and other kind of people who is not highly educated or not educated at all, we sit in the same place, the same start of the language level. And that’s why […] People who has high education, they could advance quickly. And that’s why I’ve been and my colleagues have been frustrated.The interviewees continuously underlined their disapproval of the existing regulations pertaining to non-EU doctors by referring to the fact that Sweden is in need of doctors. They also rarely refrained from mentioning the lax regulations concerning EU doctors and the more reasonable rules that exist in many other EU countries. Even though the licensing regulations do not leave much leeway for the doctors, the interviewees tried to make as much out of the circumstances as possible. All interviewees did internships – often unpaid – for several months while they were studying the Swedish language or preparing for the TULE exam. This increased their chances of excelling at the test, improved their language skills, and enabled them to practice medicine and get to know the Swedish medical system. As Fatin said about her internship: “I was treated very well there, it was a very good time. I learned much about the language, about the health system”. Also, some of the interviewees described occasions when they challenged the regular process for acquiring a license. Rashid, for instance, explained how he was able to make an arrangement with his social worker where he and his wife would not have to go to a regular Swedish language course in order to continue receiving social benefits. Instead of going to school every day, they would study at home and at the same time prepare for their TULE exams and do internships. As he said: “So, it is no waste of time, pang, pang, pang, pang [makes a hand gesture to show how fast it all went]. Systematically, orderly, we had a study plan”. 6.4. Working as a doctor in Sweden When talking about their working experiences in Sweden, the interviewees expressed great satisfaction at being able to practice medicine again. Nevertheless, they felt that they remained in a disadvantaged position. In comparison to their Swedish colleagues, they felt that they had less job opportunities. When talking about their AT, specialisation, and internship positions, the interviewees often mentioned that they had to be prepared to commute over great distances or even to move in order to find employment. Yi Hui, for instance, changed her mind about her specialisation because she would never be able to get a position as a gynaecologist, a very popular specialisation among Swedish medical students. Though they would not speak of discrimination, the interviewees furthermore felt that they had to work harder, and that they were treated differently compared to their Swedish colleagues. Fatin felt that foreign doctors have to exert themselves twice as much because they “are under a microscope”: For example, if my colleague does something wrong, that is from one to ten, no one would notice it. But if I do something wrong, there will be two out of ten that will notice it. It will be noticed because I am an immigrant or a foreign doctor. There is prejudice. But at the same time, I don’t feel that I was discriminated in any way.Furthermore, many felt that the knowledge they acquired before coming to Sweden did not matter. Granted, previous experiences made them better physicians, but the fact that they had to repeat a part of their medical training meant they had to work with, and for, considerably younger and less experienced doctors. Noor (in her early 40s) recalled a recent event: If I am sitting here and a Swedish doctor who is more […] blond, sitting [points to the chair next to her] and come another doctor from outside and want to talk to us with some patient. They don’t talk to me, they talk to the Swedish girl, because always, oh, she is foreigner, she don’t understand, maybe she is new, beginner. It has happened actually yesterday! Meanwhile, my colleague, she is a very young physician. But no matter, they look at her, talking with her, not with me.Swedish not being their native language was, as Noor said, a further “handicap” and they also felt disadvantaged because they were less aware of their rights and, even if they were aware, did not dare to demand them. Yi Hui said: “I don’t dare to demand the same rights. Because there is also always a fear that I might be punished if I demand too much”. 6.5. Gaining strength from one’s profession Though a lot of what has been outlined to this point speaks of the limitations and disappointments that the interviewees have encountered during their Swedish careers, it also became clear that professional successes were not rare and that they meant the world to the interviewees. It was with pride that they talked about the jobs they obtained and exams they successfully passed, and they spoke with joy when they remembered how they had helped a patient. Noor described how she felt about an internship offer: “She asked me if I want to work, I was so happy! I worked for three months, without any vacation, just working hard, then they gave me flowers! Oh, it was so […] Flowers aren’t a lot, but it just approved that I succeeded. That I did something that I want”. It was, however, not only they that had gained something out of their work. The interviewees contributed to society not only through their daily work as medical practitioners, but also by actively engaging with the societal system. Fatin, for instance, together with another physician, created a social media group for other non-EU physicians, which enables them to share information about the licensing process in Sweden. In addition, several of the interviewees claimed that they are treated differently if they mention their profession. Yi Hui said that “when I go anywhere and you introduce yourself, you are a doctor, people do respect you more”. More importantly, they felt that their profession lifted them out of their migrant role and enabled them to occupy a worthier social position. To substantiate this point, I present at length a story narrated by Rashid: Well, there exists, generally speaking, that foreigners in this country are unemployed. You know that for sure. So, if one looks like me [points to his skin], then you’re of course a foreigner. […] There was something some weeks ago. So, I went to the BMW store and I was looking at a car that costs about 300 000 [SEK]. So, I went to the salesman, can I test-drive this one. Aha, do you have a driver’s license? Yes, I have that, I showed my driver’s license. Aha. How were you thinking to pay for it, he asks me. I will pay 20 or 25 per cent. And the rest I would pay in instalments. Aha, is it settled with the bank? He didn’t do that with the others. I saw that, he had many customers, but he didn’t do that with them. If they wanted to test-drive, they got the keys immediately. They give the driver’s license, he looks at it, makes a copy and then they get the keys. Two minutes. But he made a frigging long examination with me. And then I got the keys to the car. I got annoyed and to be honest, I wanted to say to him, you, I earn per month as much as you earn in six months [his voice grows louder]. I can even pay in cash for this car immediately, so I have no problem to pay for it with my own money and buy even two BMWs. I got very annoyed, I didn’t say it, but I would have wanted to. I regret it every time I think of it. So, it’s like, sometimes one gets judged by skin, background. And it helps […] Now I show, if they ask after my ID, then I show this ID [points to his doctor ID from Region Skåne]. It says there that I am a doctor. Like this it gets much smoother. I have noticed that it goes better. […] I thought of replacing the driver’s license and instead show this ID [again pointing to his doctor’s ID], it says doctor on it so they know, and it says Region Skåne on it, so they know I have a job and that I work as a doctor when they read it.Noor, however, took a different stance and predicted, perhaps rather resignedly, that her foreignness will continue to be her defining characteristic: But I had one occasion, I was a doctor, I was in [the name of the hospital] with my friend, she was operated. So, she was in the hospital, in the operation department and I was in the restaurant eating lunch, like everybody eating lunch. And there comes an old man and he sits beside me and there are a lot of tables nearby. And he starts talking, oh, who are you, you are not Swedish, where are you from, I thought he is kind to talk to me. So, I said, I am from Iraq. Yes! You, you come to Sweden [for] our money, just taking Swedish [social] benefits. And he starts shouting. And I am a doctor! So, I just leave my food and the restaurant, I was […] Really, I want to cry, I want to shout, I just want to say I [stressing] am a doctor, but I thought it was silly to talk to him, he maybe addict or psychologically ill, I don’t know so. But whatever you are, even with that clothes [points to her medical white coat], even if they say […] You look foreigner, it’s another feeling actually. I don’t think it will get better, because it was like that the whole time. 7. DISCUSSION By making use of the conceptual framework combining Brubaker and Cooper’s distinction between “identification and categorization”, and “self-understanding and social location”, as well as Jenkins’s theory on social identity and Anthias’s notion of translocational positionality (see Section 2), this section interprets the presented material. Three main findings are drawn about how the highly skilled refugees who were interviewed perceived themselves and their social locations. The chosen conceptual framework proves to be a valuable heuristic tool as it permits one to make sense of the highly complex identity-formation processes without losing sight of their agents and objects, as well as the contexts in which they take place and the interactions surrounding them. 7.1. Self-understanding: “provider” versus “recipient” The interviewees’ narratives show that being a doctor incorporates two important aspects. On the one hand, the interviewees see their profession as a matter of practice: being a medical doctor means making diagnoses, curing diseases, fixing problems, and saving lives. It is not about “sitting around”. While this points to a particular kind of self-understanding, it also hints at an important aspect of the identification process. Though the interviewees identified themselves with their profession, their professional identity was deeply shaken when they could not practise medicine upon arrival in Sweden. On the other hand, though the interviewees see medicine as a profession that gives economic security and steady employment, it is also understood as a means of helping people. Taken together, the two aspects indicate that the interviewees understand themselves as “providers”. For them, being a physician entails an active contribution to patients’, and thus also wider society’s, well-being. Concurrently, the interviewees had a hard time identifying themselves with the often constrained and inactive role of a refugee, i.e. a “recipient” of social benefits: a person who “sits around” while waiting to get the asylum application approved. 7.2. Identification and categorisation: the limited significance of profession The interviewees identified themselves as refugees only in relation to their entry to Sweden and the particular circumstances that framed their lives during their initial time in Sweden. When talking about the time after the asylum process, they referred to themselves as foreigners or, occasionally, migrants. Thereby, they were not shy in using expressions such as “we foreigners”, which is something they never used in relation to the term “refugee”. As suggested by Jenkins,44 these self-identification processes can only be understood when taking into account how the interviewees were categorised at the institutional level. At that level, the interviewees were categorised as refugees. The interviewees understood themselves as refugees because the legal framework labelled them as such and, at the same time, made them into refugees. The very formal category that is used in political and bureaucratic contexts placed the interviewees within a certain frame of regulations and thus imposed upon them a lifestyle that shaped them into refugees (e.g. waiting for the approval of their asylum application while living in a detention centre and relying on social benefits). The identity of refugee emerged mainly through the external processes that defined them as such, whereas the migrant identity also stemmed from the interviewees’ own self-perceptions. Rashid’s remark about refugees hints at a possible explanation. By thinking of themselves as “being placed” into the refugee identity rather than essentially “having it”, the interviewees disputed any possession of – often negative – characteristics that are attached to the refugee category, such as passivity and poverty. Instead, the interviewees saw themselves as foreigners, a term that carries far less drastic and charged images of desolation, yet still reflects the disadvantaged social location in which they found themselves. Pertaining to their professional re-establishment, the interviewees were also categorised as immigrants at the institutional level. In the licensing process, physicians are grouped according to their country of education: there is a differentiation made between those trained in Sweden, within the EU, and those who obtained their medical qualifications outside of the EU. When it comes to Swedish language courses, the interviewees were obviously categorised according to their immigrant background, yet no further categorisation took place according to their educational or professional background. In sum, during their initial time in Sweden, the interviewees were rarely categorised as medical doctors. Their professional identification took place mainly through their self-identification as doctors and their own drive to embark on and continue along the path that would also establish them as doctors at the institutional level. The institutional guidelines for non-EU doctors in Sweden indeed framed this process, but the actual design of the process impeded, rather than supported, the interviewees’ professional identification. 7.3. Translocational positionality: being a migrant and a doctor Through migration, the interviewees’ social location changed from that of native into migrant. The geographical relocation from their home countries did not dislocate the interviewees in terms of their profession, but did change it. This section accounts for the positionality of the interviewees once they acquired a Swedish medical license and were thus placed within the institutional category of doctors. Depending on the context, the intersection of their social locations as migrants and doctors put the interviewees in sometimes dominant and sometimes subordinate positions. Once the interviewees started working as doctors, they felt they were in a disadvantaged position compared to Swedish doctors. They de facto occupied the same or even a lower position than their much younger and less experienced Swedish colleagues. More importantly, it was through their daily workplace interactions that the interviewees were reminded of their disadvantaged position within the otherwise privileged social location of physician. Thereby, the interviewees’ self-identification with being foreign was further reinforced by the external identification of the interviewees as immigrants, something that was perceived largely as inhibiting. They understood that being a migrant put them in a disadvantaged social location in comparison to Swedes and – due to their outward appearance – sometimes even in comparison to EU and some other migrants. On the other hand, outside of their professional context, the interviewees felt that their profession could sometimes put them in an advantaged social position. If someone became aware that they were a doctor, their position was not only made more advantageous than before, it sometimes even became superior to their counterpart (recall Rashid’s encounter with the car dealer). 8. CONCLUDING REMARKS The aim of this article was to account for the refugee and professional identities of a group of non-EU doctors who came to Sweden as refugees and to better understand how these self-perceptions are interwoven. In sum, the interviewees’ understanding of what it means to be a doctor and what it means to be a refugee can be seen as contrasting elements. For them, being a physician entails not only possessing a medical license, but actually practising medicine. Their profession is positively connoted and seen as a source of strength. It means providing for oneself while at the same time actively contributing to society. Being a refugee is, on the other hand, burdened with negativity. It is therefore a term that they reluctantly use in relation to themselves. Instead, “refugee” is a label that is appointed to them. The interviewees instead perceive themselves as foreigners – a term that is less negatively loaded, yet still captures the inhibiting elements of these individuals’ existence. Thereby, the migrant and professional selves are in a constant interplay with each other and shape the interviewees’ existence and self-perceptions. Whereas their profession may better their social position, the external labelling of the interviewees as immigrants and refugees rattles their doctor-identity. This is not only the case during the licensing process: the migrant identity gives even licensed physicians the feeling that they occupy a somewhat outsider position within the medical field.45 By accounting for individuals’ refugee and professional selves, and how these are interwoven, this article emphasises the social and irredeemably processual nature of identity formation. In Liisa Malkki’s words: “[I]dentity is always mobile and processual, partly self-construction, partly categorization by others, partly a condition, a status, a label, a weapon, a shield, a fund of memories, et cetera. It is a creolized aggregate composed through bricolage.”46 The article hence cautions against over-generalisation and argues against the essentialisation of migrants’ identities. Whereas the terms “refugee” and “highly skilled migrant” might have analytical usefulness as legal or descriptive rubrics, it is important to bear in mind that these categories should not be employed as labels for a particular type of person. Instead, they should accommodate a diversity of individuals along with their multifaceted histories, self-perceptions, and contextualities. It is only in this way that we can move away from the often one-sided depictions of the different categories of migrants, and acknowledge the value that each individual possesses. Footnotes 1 L. Bleasdale, “Under Attack: The Metaphoric Threat of Asylum Seekers in Public-Political Discourses”, Web Journal of Current Legal Issues, 1, 2008; L. Chouliaraki, “Between Pity and Irony: Paradigms of Refugee Representation in Humanitarian Discourse”, in K. Moore, B. Gross & T. Threadgold (eds.), Migrations and the Media, New York, Peter Lang Publishing, 2012, 13–31; M. Eastmond, “Egalitarian Ambitions, Constructions of Difference: The Paradoxes of Refugee Integration in Sweden”, Journal of Ethnic and Migration Studies, 37(2), 2011, 277–295; K. Moore, “Introduction to Migrations and the Media”, in Moore, Gross & Threadgold (eds.), Migrations and the Media, 1–9; T. Wright, Refugees on Screen, Oxford, University of Oxford, Refugees Study Centre Working Paper No. 5, 2000. 2 J. Chaloff & G. Lemaître, Managing Highly-Skilled Labour Migration: A Comparative Analysis of Migration Policies and Challenges in OECD Countries, Paris, OECD Publishing, OECD Social, Employment and Migration Working Paper No. 79, 2009, available at: http://www.oecd-ilibrary.org/content/workingpaper/225505346577 (last visited 7 Dec. 2016); R. Iredale, “The Migration of Professionals: Theories and Typologies”, International Migration, 39(5), 2001, 7–26. 3 Iredale, “Migration of Professionals”, 8. 4 For an exception, see e.g. A. Liversage, “Finding a Path: Investigating the Labour Market Trajectories of High-Skilled Immigrants in Denmark”, Journal of Ethnic and Migration Studies, 35(2), 2009, 203–226. 5 See e.g. P. Bevelander, “The Employment Integration of Resettled Refugees, Asylum Claimants, and Family Reunion Migrants in Sweden”, Refugee Survey Quarterly, 30(1), 2011, 22–43; V. Colic-Peisker, “‘At Least You’re the Right Colour’: Identity and Social Inclusion of Bosnian Refugees in Australia”, Journal of Ethnic and Migration Studies, 31(4), 2005, 615–638; M. Collyer, “When Do Social Networks Fail to Explain Migration? Accounting for the Movement of Algerian Asylum Seekers to the UK”, Journal of Ethnic and Migration Studies, 31(4), 2005, 699–718; M. Hajdukowski-Ahmed, N. Khanlou & H. Moussa, Not Born a Refugee Woman: Contesting Identities, Rethinking Practices, New York, Berghahn, 2013; S. Khosravi, “Illegal” Traveller: An Auto-Ethnography of Borders, London, Palgrave Macmillan, 2010; L.H. Malkki, “Speechless Emissaries: Refugees, Humanitarianism, and Dehistoricization”, Cultural Anthropology, 11(3), 1996, 377–404; M. Povrzanović Frykman, “Struggle for Recognition: Bosnian Refugees’ Employment Experiences in Sweden”, Refugee Survey Quarterly, 31(1), 2012, 54–79; S.S. Willen, “Toward a Critical Phenomenology of ‘Illegality’: State Power, Criminalization, and Abjectivity among Undocumented Migrant Workers in Tel Aviv, Israel”, International Migration, 45(3), 2007, 8–38. 6 See e.g. Bevelander, “The Employment Integration of Resettled Refugees”; P. Bevelander & R. Pendakur, “The Labour Market Integration of Refugee and Family Reunion Immigrants: A Comparison of Outcomes in Canada and Sweden”, Journal of Ethnic and Migration Studies, 40(5), 2014, 689–709; Colic-Peisker, “‘At Least You’re the Right Colour’”; V. Colic-Peisker & F. Tilbury, “‘Active’ and ‘Passive’ Resettlement: The Influence of Support Services and Refugees’ Own Resources on Resettlement Style”, International Migration, 41(5), 2003, 61–92; Povrzanović Frykman, “Struggle for Recognition”; D.-O. Rooth & J. Ekberg, “Occupational Mobility for Immigrants in Sweden”, International Migration, 44(2), 2006, 57–77. 7 G. Smyth & H. Kum, “‘When They Don’t Use It They Will Lose It’: Professionals, Deprofessionalization and Reprofessionalization: The Case of Refugee Teachers in Scotland”, Journal of Refugee Studies, 23(4), 2010, 503–522. 8 J. Willott & J. Stevenson, “Attitudes to Employment of Professionally Qualified Refugees in the United Kingdom”, International Migration, 51(5), 2013, 120–132. 9 See e.g. E. Piętka-Nykaza, “‘I Want to Do Anything Which Is Decent and Relates to My Profession’: Refugee Doctors’ and Teachers’ Strategies of Re-Entering. Their Professions in the UK”, Journal of Refugee Studies, 28(4), 2015, 523–543; M. Psoinos, “Exploring Highly Educated Refugees’ Potential as Knowledge Workers in Contemporary Britain”, Equal Opportunities International, 26(8), 2007, 834–852. 10 A brief note on terminology: since all interviewees originally came from and obtained their medical training on the Asian continent, the terms “non-EU” (here, EU refers to European Union) and “non-European” are used interchangeably, designating both their national origin as well as their country of education. Furthermore, I use the term “refugee” to refer to all interviewees though some of them might have, legally speaking, been granted asylum not on the basis of the 1951 United Nations Refugee Convention but on the basis of another type of protection. As I focus not on the legal regulations that frame individuals’ admission to Sweden, but on the analytical and social category their entry to Sweden puts them in, strict differentiation is not relevant in this article. 11 H. de Haas, Migration Theory: Quo Vadis?, Oxford, University of Oxford, International Migration Institute, Working Paper No. 100, 2014; R. King, Theories and Typologies of Migration: An Overview and a Primer, Malmö, Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM), Willy Brandt Series of Working Papers in International Migration and Ethnic Relations, No. 3/12, 2012; D. Turton, Conceptualising Forced Migration, Oxford, University of Oxford, Refugee Studies Centre, RSC Working Paper Series, No. 12, 2003. 12 N. Van Hear, New Diasporas: The Mass Exodus, Dispersal and Regrouping of Migrant Communities, London, University College London Press, 1998; N. Van Hear, Mixed Migration: Policy Challenges, Oxford, Centre on Migration, Policy and Society (COMPAS), The Migration Observatory, 2011; N. Van Hear, “Mixed Migration”, in B. Anderson & M. Keith (eds.), Migration: The COMPAS Anthology, Oxford, Centre on Migration, Policy and Society (COMPAS), 2014; N. Van Hear, R. Brubaker & T. Bessa, Managing Mobility for Human Development: The Growing Salience of Mixed Migration, United Nations Development Programme, Human Development Research Paper No. 2009/20, 2009. 13 See e.g. D.A. Boehm, “US-Mexico Mixed Migration in an Age of Deportation: An Inquiry into the Transnational Circulation of Violence”, Refugee Survey Quarterly, 30(1), 2011, 1–21; E. Serra Mingot & J. de Arimatéia da Cruz, “The Asylum-Migration Nexus: Can Motivations Shape the Concept of Coercion? The Sudanese Transit Example”, Journal of Third World Studies, 30(2), 2013, 175–190. 14 R. Brubaker & F. Cooper, “Beyond ‘Identity’”, Theory and Society, 29(1), 2000, 1–47. 15 R. Jenkins, “Categorization: Identity, Social Process and Epistemology”, Current Sociology, 48(3), 2000, 7–25; R. Jenkins, Social Identity, 3rd ed., Abingdon, Routledge, 2008. 16 F. Anthias, “Where Do I Belong? Narrating Collective Identity and Translocational Positionality”, Ethnicities, 2(4), 2002, 491–514; F. Anthias, “Thinking Through the Lens of Translocational Positionality: An Intersectionality Frame for Understanding Identity and Belonging”, Translocations: Migration and Social Change, 4(1), 2008, 5–19; F. Anthias, “Transnational Mobilities, Migration Research and Intersectionality”, Nordic Journal of Migration Research, 2(2), 2012, 102–110. 17 de Haas, Migration Theory, 13. 18 Jenkins, Social Identity, 17. 19 Jenkins, “Categorization”, 10; Jenkins, Social Identity, 39–48. 20 Jenkins, “Categorization”, 7–8; Jenkins, Social Identity, 40–45. 21 Jenkins, Social Identity, 8, 12. 22 Brubaker & Cooper, “Beyond ‘Identity’”, 15. 23 Ibid. 24 Ibid., 16. 25 Ibid., 17–19. 26 Anthias, “Where Do I Belong?”; Anthias, “Thinking Through the Lens of Translocational Positionality”; Anthias, “Transnational Mobilities, Migration Research and Intersectionality”. 27 Anthias, “Transnational Mobilities, Migration Research and Intersectionality”, 108. 28 Anthias, “Thinking through the Lens of Translocational Positionality”, 15; Anthias, “Transnational Mobilities, Migration Research and Intersectionality”, 108. 29 Anthias, “Thinking through the Lens of Translocational Positionality”, 15. 30 Anthias, “Where Do I Belong?”, 501–502; Anthias, “Transnational Mobilities, Migration Research and Intersectionality”, 108. 31 Socialstyrelsen, Nationella planeringsstödet 2017: Tillgång och efterfrågan på vissa personalgrupper inom hälso- och sjukvård samt tandvård, Stockholm, Socialstyrelsen, 2017, 18. 32 Socialstyrelsen, Nationella planeringsstödet: Tillgång och efterfrågan på vissa personalgrupper inom hälso- och sjukvård samt tandvård, Stockholm, Socialstyrelsen, 2013; 2014; 2015; 2016; 2017. The numbers on foreign physicians in the quoted reports by the National Board of Health and Welfare (NBHW, or as it is called in Swedish: Socialstyrelsen) refer to those who were trained abroad (läkare med utländsk utbildning), which may also include Swedish nationals with foreign education. Despite this fact, I am using these statistics because they represent the official and closest approximation of the number of foreign physicians in Sweden. 33 See e.g. O. Öst, “Läkare från Syrien kan hjälpa lanstinget”, Sundsvalls Tidning, 4 Nov. 2014, available at: http://www.st.nu/medelpad/sundsvall/lakare-fran-syrien-kan-hjalpa-lanstinget (last visited 27 Nov. 2017). 34 OECD, International Migration Outlook 2016, 2016, 304, available at: http://dx.doi.org/10.1787/migr_outlook-2015-en (last visited 27 Nov. 2017). 35 Migrationsverket, Asylsökande till Sverige under 2000-2016, 2017, available at: https://www.migrationsverket.se/download/18.585fa5be158ee6bf362fd2/1485556063045/Asyls%C3%B6kande+till+Sverige+2000-2016.pdf (last visited 27 Nov. 2017). 36 The rules concerning those who obtained their medical training outside of the EU/EEA changed partly on 1 Jul. 2016. 37 The institute refers to itself with its official Swedish name also in English texts and does not offer any official English translation. 38 B. Flyvbjerg, “Five Misunderstandings about Case-Study Research”, Qualitative Inquiry, 12(2), 2006, 219–245. 39 L. Salmonsson, The ‘Other’ Doctor: Boundary Work Within the Swedish Medical Profession. PhD Dissertation, Uppsala, Uppsala University, 2014, 11. 40 Flyvbjerg, “Five Misunderstandings about Case-Study Research”. 41 Ibid.; C. Squire, M. Davis, C. Esin, M. Andrews, B. Harrison, L.-C. Hydén & M. Hydén, What Is Narrative Research? (The “What Is?” Research Methods Series), New York, Bloomsbury, 2014. 42 Names and further identifying information have been changed or omitted in order to assure the anonymity of the research participants. 43 Yi Hui is a female specialist who lives in middle Sweden together with her family. She comes from Malaysia and moved to Sweden 25 years ago together with her husband who is from a Middle Eastern country. Legally speaking, she did not come to Sweden as a refugee, but rather as a family migrant. However, her migratory trajectory made her, as she claims, into a refugee, which is why I am including her in the sample. Because the Middle Eastern country where her husband comes from was at war in the 1980s, Yi Hui and her husband sought asylum in Sweden. For about a year, they lived in different detention camps where she gave birth to their daughter, yet due to her Malaysian citizenship, they rejected their asylum application. Because of that, she decided to return to Malaysia and leave her husband and their daughter in Sweden. After she left, her husband got his asylum application approved, which enabled her to reunite with them after living in Malaysia for almost 2 years. 44 Jenkins, Social Identity, 40–48. 45 Salmonsson, The ‘Other’ Doctor. 46 L.H. Malkki, “National Geographic: The Rooting of Peoples and the Territorialization of National Identity among Scholars and Refugees”, Cultural Anthropology, 7(1), 1992, 24–44 (37). © Author(s) [2018]. All rights reserved. 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Being Highly Skilled and a Refugee: Self-Perceptions of Non-European Physicians in Sweden

Refugee Survey Quarterly , Volume Advance Article (2) – Mar 19, 2018

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Abstract

ABSTRACT Both in popular imaginings as well as in migration scholarship, migrants are generally placed into different categories. We know, for instance, of refugees, family migrants, international students, and highly skilled migrants. This article seeks to document the narratives of people standing at the junction of the usually separated categories of “refugee” and “highly skilled migrant”, and to account for the complex criss-crossings of their professional and refugee identities. The article is based on semi-structured interviews with non-European medical doctors who came to Sweden as refugees. In order to make sense of how these highly skilled refugees understand themselves, what they identify with, and what social locations they occupy in the destination country, the article employs Rogers Brubaker and Frederick Cooper’s distinction between “identification and categorization” and “self-understanding and social location”. These concepts have further been developed by Richard Jenkins’s theory on social identity and Floya Anthias’s work on translocational positionality. The article points to the processual nature of identity, which is always partly self-constructed and partly determined by external categorisations, and hence makes the case against the essentialisation of migrants’ identities, be they “refugee” or “highly skilled migrant”. 1. INTRODUCTION This article takes its point of departure as the predominance of a grid-like understanding of migrants in which individuals are neatly placed into the categories of “refugee”, “highly skilled migrant”, etc. As such, these are often attributed characteristics that are not only disparate, but even contrasting, taking into account how refugees and highly skilled migrants are portrayed in popular discourse, for instance. Whereas refugees are prevalently depicted as passive victims and as a threat to the economic, social, and security welfare of the host countries;1 highly skilled migrants are often cherished for their contribution to the host societies and seen as an indispensable asset.2 Within the field of migration studies, definitions of refugees and highly skilled migrants barely allow for tangency and almost completely disconnected fields of research have been fostered. Refugees are predominantly bundled under the term “forced migrants”. This implies that their migratory move was initiated by external circumstances, such as war and persecution, rather than their own wish to follow, for instance, economic or other incentives. By comparison, highly skilled migrants are usually defined as those in possession of a university degree and/or extensive professional experiences who move abroad in order to find more rewarding employment. They are thus mainly categorised as a subdivision of labour migrants.3 Correspondingly, refugees and other involuntary migrants who did not migrate due to economic reasons are largely exempted from studies on highly skilled migrants.4 In the same vein, studies on refugees are rarely demarcated according to an individual’s professional affiliation. They most commonly delimit the examined group according to the refugees’ legal status, type of entry, nationality, ethnicity, and increasingly also gender.5 Granted, profession does play an essential role when discussing topics such as refugees’ labour market performance and integration, as well as their social inclusion and identity construction.6 However, even when such studies include highly skilled refugees, they do so without focusing on them. Exceptions do exist. For instance, Smyth and Kum7 explore refugee teachers’ professional re-emplacement in Scotland, and Willott and Stevenson8 analyse employment experiences and work attitudes among refugee professionals in Leeds. However, apart from these and a couple of other studies on highly educated refugees in the UK,9 research focusing on highly skilled refugees has been close to non-existent in other European countries. This article seeks to document the narratives of people standing at the junction of the categories of “refugee” and “highly skilled migrant”. In order to do so, the article focuses on highly skilled refugees’ understandings of their professional and refugee identities and how these are intertwined. More particularly, the article looks at how non-European medical doctors who came to Sweden as refugees10 understand themselves, what they identify with, and what social locations they occupy in the destination country. By exploring the realities of people standing at the intersection of “being a refugee” and “being a highly skilled migrant”, the article hopes to contribute to the empirical knowledge of this under-researched topic of highly skilled refugees. The article furthermore seeks to refine our understanding of who is a refugee and who is a highly skilled migrant. Thereby, the article contributes to the growing body of literature within migration studies that points to the fact that the refugee-(economic) migrant dichotomy represents an ideal type that rarely reflects the reality in all its multiple layers.11 The concept of “mixed migration” – a term coined by the United Nations High Commissioner for Refugees (UNHCR), yet analytically developed primarily by migration scholar Nicholas Van Hear12 – represents an example of an analytical tool that has been employed to highlight the continuum between forced and voluntary migration. The concept aims to capture the complexities of migration dynamics, i.e. the blending of motivations that drive people into moving, as well as the mixing associated with other stages in the migration process.13 Though this article is not concerned with highly skilled refugees’ motivations for migration or their migratory trajectories, the in-depth exploration of the self-perceptions held by non-European physicians who came to Sweden as refugees similarly refines our understanding of the “refugee” and “highly skilled migrant” categories. Namely, it underscores the blurriness of these categories’ demarcations and points to the continuity between the two. The next section of the article maps out the conceptual framework that enables us to grasp the intricate interplay between the refugee and professional selves as perceived by the non-European physicians who came to Sweden as refugees. The third section lays out the contextual setting of the empirical part of the study by outlining the regulations that frame the licensing process of non-European doctors in Sweden. The fourth section briefly presents the empirical study that this article is based on, i.e. it outlines the sample, how the employed material was generated, and the methods used in the analysis. The subsequent two sections are dedicated to the presentation of the material that was obtained through interviews with non-EU medical doctors: the first illustrates their perceptions and experiences as refugees in Sweden, and the second focuses on their realities as doctors. In order to capture the intricacies of the interviewees’ professional and refugee identities, as well as the context in which they transpire, the obtained material is presented at length. With the help of the theoretical framework, the presented material is discussed in the seventh section. The final section gives some concluding remarks. 2. CONCEPTUAL FRAMEWORK Many authors claim that the concept of “identity” has simultaneously come to mean both too much and too little. It is used to address too many elements at once: its application ranges from, for instance, portraying an individual’s core self to group identification processes. Concurrently, the concept often captures too little as it does not address the questions of identity production within specific contextual frameworks. In order to avoid this trap and to develop a heuristic tool that will enable us to engage with the multidimensionality of an individual’s self, this article conceptualises identity following Rogers Brubaker and Frederick Cooper’s14 distinction between “identification and categorization” and “self-understanding and social location”. The two categories are further developed by Richard Jenkins’s theory on social identity15 and Floya Anthias’s work on social location, which is captured in the notion of “translocational positionality”.16 The proposed conceptual eclecticism simultaneously incorporates structures that frame people’s lives and the agency these same individuals possess within given spaces. What is more, the proposed theoretical framework enables the portrayal of multifaceted identity-formation processes while at the same time depicting the underlying regularities. As de Haas points out: “Social theory formation is precisely about striking a delicate balance between the desire to acknowledge the intricate complexities and the richness of social life on the one hand and the scientific need to discern underlying regularities, patterns and trends on the other”.17 2.1. Identification and categorisation Speaking of “identification” shifts our attention away from the idea of identity as a static state of mind and being, i.e. as something that one has. Instead, the processual nature of the term emphasises the importance of analysing the dynamics of identity construction by looking at what we do. As Jenkins points out: identity is not simply out there, instead it must always be established. It is a process of being and becoming.18 The second major claim that Jenkins makes about the processes of identification is that both individual as well as collective identifications follow one basic model of internal–external dialectics. In order to better understand this mechanism, we have to make a short detour into Jenkins’s understanding of the human world. Leaning on Erving Goffman and Anthony Giddens, Jenkins distinguishes between three distinct orders of the world as constructed and experienced by humans: 1) the individual order, which consists of individual human beings and their perceptions of the world; 2) the interaction order, which is the world that is constituted of relationships between individuals; and 3) the institutional order, which is the world of organisation(s) and established ways of conduct.19 When it comes to the individual order, it is important to note that individual identification is always socially constructed, i.e. it emerges through the ongoing and simultaneous synthesis of self-identification (the internal element) and definitions of oneself by others (the external element). This dialectical interplay brings us to the interaction order: identification is not just what we think about ourselves; our self-understanding is also validated against what others think of us. What is more, not only do we identify ourselves according to the internal–external dialectical logic, but we also identify others through the same process. The institutional order represents a vehicle of categorisation that frames and shapes the identifications that occur at the other two levels, while simultaneously being influenced by them.20 This explains how identification and categorisation are interconnected. According to Jenkins, “categorization” is the external aspect of identification, i.e. the process by which people categorise others.21 Yet, categorisation does not need to be produced by a specific actor, as it can occur anonymously by means of, for instance, public discourses. While categorisation takes place at all three levels of the human world, it is important to single out the categorisation processes that occur at the institutional level – “the formalized, codified, objectified systems of categorization developed by powerful, authoritative institutions”.22 The modern State hence represents one of the most important agents of categorisation, since it has “the power to name, to identify, to categorize, to state what is what and who is who”.23 Yet, as pointed out above, even though the State may be powerful in its ability to construct social categories for people and other non-State actors as well as impose them, the State is not the only producer of identifications and categories, and its categories can be contested.24 2.2. Self-understanding and social location Whereas identification and categorisation are active terms that denote the processes enacted by specific actors or through specific means, “self-understanding” is a dispositional term that designates one’s sense of who one is, where one is located in a particular social setting, and thus how one is to act. In this way, self-understanding and social location are tightly connected with one another. Though self-identification is closely related to self-understanding, it is important to draw a clear distinction between the two. Self-identification is tied to an explicit discursive articulation, whereas self-understanding may be tacit. In relation to the process of identification (which is often affective), self-understanding is of a more cognitive nature and can only refer to one’s own understanding of who one is; it does not capture other people’s understandings.25 The dispositional character of these terms does not mean, however, that self-understanding and social location are unitary, never-changing entities. As shown in Floya Anthias’s understanding of social location, these positions change according to the different contexts we inhabit, as well as with time and space. As developed by sociologist Floya Anthias,26 the concept of “translocational positionality” is particularly useful within the field of migration studies because it takes into account geographical moves as well as transnational spaces. The concept aims to capture people’s identities in terms of social locations. Similar to Jenkins, Anthias rejects the idea of given identities and stresses the importance of understanding social locations as a dynamic practice that is dependent on context and can hence involve shifts and contradictions. The “translocational” part of the concept emphasises two things. First, the term highlights the multiplicity of the social locations – “social spaces defined by boundaries on the one hand and hierarchies on the other hand”27 – that we inhabit. Although Anthias uses the term “social location” specifically in relation to ethnicity, gender, and class, I also consider it applicable to migrant and professional positions. Both national and professional belongings are defined by boundaries and hierarchies: being a migrant means not being a native, which can be, on different occasions, both advantageous as well as disadvantageous. Also, being a physician means something else than being a nurse, for instance, and can be thought of as being “ranked higher” due to its better financial position and higher social status. We thus need to think of social locations in relation to each other since they are interrelated and produced relationally. Thereby, social locations are not only relative to one another, but are also situational, temporal, and subject to different meanings.28 Secondly, the term “translocational” points to the idea that even though migratory movement might entail geographical dis- and relocation, it does not mean that one becomes dislocated in social terms. Anthias emphasises that our social locations are not only multiple, but that they span across temporal and spatial terrains. She gives an example: “To be dislocated at the level of nation is not necessarily a dislocation in other terms, if we find we still exist within the boundaries of our social class and our gender”.29 She does concede, however, that the movement will transform our social locations and the way we experience them. The “positionality” part of the concept encompasses a reference both to social position (an outcome) and social positioning (a process), and thereby points to the intersection of structure and agency. Taken together, the notion of translocational positionality captures an individual’s position (structure) and positioning (agency) within the interplay of different social locations (such as ethnicity, gender, race, etc.) that are relative to specific temporal and spatial contexts. To illustrate her point, Anthias gives an example of a working class husband and wife from a minority background: the woman’s locations related to class, gender, and ethnicity put her in multiple, subordinated positions, whereas the man may be in subordination, for example, in relation to his employer, but be in a dominating position in relation to his wife.30 3. NON-EUROPEAN PHYSICIANS IN SWEDEN Nowadays, it is not uncommon to be treated by a foreign physician within the Swedish medical system. The percentage of practicing physicians who were trained abroad has grown steadily during the past decade and amounted to 27 per cent in 2014.31 The statistics furthermore consistently show that among these, approximately two-thirds received their education within the European Union/European Economic Area (EU/EEA) and the rest came from countries outside of the EU/EEA, migrating to Sweden mainly as refugees and family migrants. Among other reasons, the internationalisation of the Swedish medical sector is due to the insufficient number of domestic doctors, which has resulted in the need to recruit foreign professionals.32 Whereas recruitment had, until now, been mostly limited to the EU, the combination of the need for physicians with the realisation that a significant number of refugees possess these medical skills made some Swedish county councils (landsting) consider recruitment among refugees as well.33 If nothing else, this seems reasonable in light of the high admission numbers of refugees to Sweden. In 2015, Sweden received, in proportion to its population size, the highest number of asylum-seekers among the member countries of the Organization for Economic Co-operation and Development (OECD).34 Sweden received 162,877 asylum applications in 2015, in comparison to 81,301 applications in 2014 and 54,259 in 2013. The trend changed in 2016, when Sweden received 28,939 asylum applications.35 In 2015, when this study was conducted,36 medical doctors who were educated outside of an EU/EEA Member State or Switzerland had to provide official proof of Swedish language proficiency and were required to complement their training if they wanted to obtain a Swedish medical license. The scope of the supplementary training was based on an assessment of the doctors’ previous medical training. Specialists who had previously practiced medicine for at least 5 years had to complete a probation period (provtjänstgöring) of 6 months at a Swedish medical institution. During this time, the specialist worked under the supervision of the local head of the unit (verksamhetschefen), who provided a final assessment of the doctor’s competence and suggested, if necessary, possible additional training. Doctors with no completed specialisation had to first pass a medical knowledge test (the so-called TULE exam, or, in Swedish tentamensgruppen för utländska läkares examination), which was organised twice a year by the Karolinska Institutet37 in Stockholm and is comparable to the Swedish medical exam. During the 3-day exam, the doctors underwent one theoretical and two practical examinations. The doctors had to answer approximately 100 questions related to surgery, medicine, obstetrics and gynaecology, paediatrics, and psychiatry. The practical examination consisted of one surgical and one medical examination of a patient in which the doctor diagnosed an illness and suggested a treatment. As an alternative to the TULE exam, the doctors could also take part in a supplementary course (kompletterande utbildning för läkare, tandläkare och sjuksköterskor från länder utanför EU), which took place over two terms and was organised by the universities in Gothenburg or Linköping, or at the Karolinska Institutet in Stockholm. After the doctors had complemented their theoretical training, they had to complete an 18-month period of rotation (allmäntjänstgöring, or as it is called in short: AT), which provided them with practical experience in all parts of a hospital’s setting and medical disciplines. In the final step, all doctors had to pass a course on Swedish medical legislation and could then, finally, apply for a Swedish medical license. After the doctors receive the license, they can start their specialisation, which usually takes 5 years. 4. METHOD AND MATERIAL The analysis in this article is based on narrative material collected through semi-structured interviews with seven non-EU doctors who came to Sweden as refugees. The delimitation of the sample to one profession is grounded in the aspiration to tease out the profession-related considerations and factors that shape these refugees’ experiences. The focus on physicians is grounded in the idea that refugee doctors represent an extreme case38 of the contradictory social positions in which highly skilled refugees find themselves. These individuals belong to the esteemed occupation of medical doctor while simultaneously being connected to the category of “refugee” with its less favourable social imaginings.39 The focus on non-European medical doctors is based on the distinct regulations pertaining to EU/EEA and non-EU physicians wanting to work in Sweden (and the fact that refugees in Sweden come from non-EU countries). All individuals interviewed for this study completed their medical training in their home country or another non-EU country and some of them already had work experience before leaving for Sweden. Since the purpose of the study is to probe the nexus between individuals’ professional and refugee experiences, the rest of the sample characteristics, such as national background, time since migration, place of residence, and stage in professional career are considerably diverse. Though they are important, the differences between these prove to be insignificant for the conclusions of this research. The present article is based on interviews with four Iraqi doctors, two Syrian doctors, and one Malaysian doctor, three of whom are female and four male. The interviewees were between 26 and 57 years old and had been in Sweden between 1 and 25 years. At the time of the interviews, four of the interviewees worked as doctors, whereas three were still in the process of obtaining Swedish medical licenses. As the purpose of the study was to gather thick subjective accounts of the studied group rather than aiming towards generalisation across cases, the sample size is adequate.40 What is more, the reoccurrence of certain narrative elements suggests that the sample made it possible to reach an adequate level of data saturation. Contact with the interviewees was established through personal connections, various institutions and projects that are involved in the licensing process for non-EU physicians, social media, and the individuals’ workplaces. Four interviews were conducted in person, whereas the rest took place over Skype. The interviews lasted between 54 and 94 minutes. With the permission of the interviewees, all interviews were recorded and later transcribed. All of the interviews were conducted in English, except on one occasion when the interviewee switched to Swedish at the beginning of the interview. The explorative, in-depth interviews had traits of life-story and narrative interviews: the interviewees were invited to talk about their professional experiences before and after coming to Sweden, as well as about their asylum-seeking process in Sweden and the path to obtaining a Swedish medical license. By trying to capture the individuals’ perspectives, it was hoped that the interviews would grasp the nuanced and positioned nature of these refugee-professionals’ perceptions, feelings, and understandings and provide a close-up of the experiences this little-explored group has lived.41 The second step of the analysis consisted of scrutinising the obtained narratives. This was done through coding by which the material was categorised, which facilitated its interpretation. 5. BEING A REFUGEE 5.1. Insecurity, dependence, and passivity A prominent feature in the interviewees’ narratives was a sense of insecurity in relation to how things would turn out in Sweden. According to many of them, their initial period in Sweden was full of uncertainties. Would they receive asylum and, if so, when? Where would they live? Would they be able to work as doctors? Rashid42 said: “Before we got the residence permit, we didn’t know what was going to happen. Anxiety maybe. We were scared. We didn’t know what will happen, everything was strange”. Those who had lived in Sweden for some years and had already obtained their Swedish medical license were happy that their situations and futures were clearer. As Fatin said: “[W]hen one first came here, one has to see. One doesn’t know what one should do, how life will look like. But now, now I know what I want to be, how life is going to be. Economically, psychologically, everything is clear, one knows how it will be.” The topic of insecurity is tightly connected to the feeling that the interviewees’ lives were not in their own hands. Their emplacement in Sweden depended very much on regulations, external circumstances, and even luck. This feeling of dependence and powerlessness was especially present with regard to obtaining a residence permit and – as will be shown in Section 6.3 – the process of obtaining a Swedish medical license. Furthermore, the narratives concerning the refugees’ initial time in Sweden point to long periods of waiting and passivity. Khalid recounted how he waited for the decision concerning his asylum application: And you cannot do anything in that waiting time. Just sit in those apartments of the Migration Board, or in a camp […] I was so sad and depressed, to sit there just eating and sleeping without do[ing] anything. And I tried to get books from the library to study Swedish or do something. But I couldn’t. Also, people living with me in the apartment, so, like, just people apply for asylum and do nothing. Just drinking and taking hash, so, it was so bad for me. It was so bad for me.Here it is important to note that the expression “to sit [around]” had an explicitly negative connotation for the interviewees. In particular, Rashid used the phrase often in order to express something negative. When I asked him if he remembered a period in which he was unable to work as a doctor, he replied: “If you count that [initial] period [in Sweden]. But I had something to do. I was learning Swedish. I validated my grades and went to courses. So, I wasn’t like […] I didn’t just sit at home and do nothing”. 5.2. Being a refugee, being a foreigner The interviewees understood themselves as refugees in two ways. On the one hand, they knew they were refugees in legal terms, i.e. because they had applied for asylum in Sweden. On the other hand, they understood themselves as refugees because of particular life circumstances, i.e. the way they had travelled to Sweden, their unfamiliarity with the language, their dependence on the Swedish welfare system, and their experience of how others treated them. Fatin explained why she felt like a refugee during her initial time in Sweden: “Because you come as a refugee. I know myself that I applied as a refugee. I don’t know language, language is very important. We go shopping and we speak in English. It didn’t feel like home”. Even if Yi Hui was, legally speaking, not a refugee,43 she claimed that her life situation in Sweden made her into one: Because when we were studying Swedish and studying for the exams, we were not financially secure, we were much financially dependent on the government to give us, to pay us the benefits and when we were waiting for our residence permit, I lived together with the refugees too. So, we were treated as refugees.Rashid, however, who came to Sweden with the assistance of smugglers, had applied for asylum and lived in a detention centre, but refused to apply that term to himself: When one says “refugees”, there is a big difference if one is in a refugee camp like all those from Syria who have no water, no medicine, they are tired, it rains on them, snows on them. Or a refugee here in Sweden who lives in an apartment, who can take a walk to [the supermarket] and buy himself food, cook at home, watch television, or google on the Internet. So, that is a good life. So, I cannot say that I felt like […] The word refugee or asylum-seeker, it means something bad, or worse than it was. I didn’t feel like this. […] I always felt like a stranger.Rashid was not the only one who spoke of himself as a foreigner. Take Noor, for example: “But I think that we, foreigners, are always afraid, we are little bit sensitive, we are little bit […] You know what is ömtålig [fragile]? We can be injured, insulted easily. Because we feel like we belong not to this place”. The interviewees talked of themselves as foreigners mostly in relation to the situations that occurred after their asylum application process had finished. As Sections 6.3–6.5 show, they felt like foreigners because of how they were treated in work-related and private situations. Thereby, it is important to note that even though many had the feeling that they were treated as foreigners, they all expressed the same insecurity as to whether or not their interpretations of other people’s actions were correct. As the recollection from Hayder below shows, many were uncertain whether the Swedes always acted in a certain way, or if it was just towards them as foreigners: [I]n the first month when I lived in Sweden, I go to a shop. I need to buy a telephone. So, I ask [imitating the conversation], I can’t talk Swedish, can we speak English, of course! I see one iPhone, so, please can you tell me some details. There is another man coming inside at the same time, I don’t know, but I think he is Swedish, blond, big blue eyes [laughing], yeah, that’s classical stereotype, and he leaves me and go to that person and starts to speak with him. I don’t know why he did that. But maybe he […] I don’t know if it’s personal to me, or if it’s normal. Just considerations. 6. BEING A DOCTOR 6.1. Motivation When asked why they chose to become doctors, the interviewees gave two types of answers. On the one hand, for many being a medical doctor meant achieving a certain social status and occupational security in life. Rashid expressed this in the following story: I liked [my father’s] profession. It felt that it had good, I don’t want to say high, but it has a good status. And concrete, safe future possibilities. My grandfather used to say, there are three people who will never become unemployed. The first are those who sell food – people will continue to eat. Then those who are doctors – people will continue to get ill. And the third are those who sell clothes for women [laughing].The advantages of social status were rarely coupled with the benefits of a high salary, since they did not necessarily come hand in hand, especially in Iraq. Only Yi Hui observed that in Malaysia people also decide to become doctors because of the salary. On the other hand, for many becoming a doctor meant working with people, helping them, and improving their well-being. In Mohammed’s words: “I wanted to be a doctor […] to help people who are sick in the hospital. It’s a great feeling when you help somebody to be free of pain, to be healthy again. It’s a great feeling. Nobody can feel this feeling if they are not doctors”. Also, Hayder painted a vivid picture of what inspired him to become a doctor: Because I think, at the same time it’s a job, I am working with human beings. With the body of human beings, with their souls. And that’s. I am like you. I feel happy when I listen to the stories of the others. Usually they are the story of suffering. Really. But at the same time, on the other side of the coin, it is human stories. Because it’s not only a patient when you become a doctor, the patient will not tell you only stories of their disease. No, at the same time he will tell you part of the story of his life.For the doctors, the two groups of reasons were not necessarily opposing, but rather went hand in hand. What is more, in most of the cases, practicing medicine was already in the family and the interviewees were either encouraged or simply inspired by their parents, uncles, or grandparents to enter the profession. 6.2. Being a doctor The above section also points to how the interviewed doctors understood their societal roles. By being able to help people, the interviewees perceived themselves as “providers” of care, as giving something back to society. In the interviews, they often juxtaposed this role to that of “recipient” (e.g. of social benefits). One of Hayder’s hopes for the future was as follows: I hope I can continue in Sweden. […] To work, and for myself, so that I can be producer, not just receiver. I feel I must produce something, so that I can work, I can pay taxes, I can help others and not just wait for someone to help me. Because that’s sort of a transformation between the roles. I am a receiver, but within some years, I think, I will become a producer in that society. Not just a producer as a doctor, but I can also give many ideas for the improvement of my surroundings.Another aspect that featured prominently in the interviewees’ narratives is that medicine is a practical profession. On numerous occasions, the interviewees expressed their efforts to practice medicine – e.g. during their initial time in Sweden when they were still in the licensing process – in order to retain their medical skills and to stay in touch with developments in the medical field. As Mohammed said: “I need to be in tune, to be in the hospital, to keep my information. Now and three months ago, I feel that I am not a doctor. […] Because I am not using my knowledge at all”. As the next section will show in more detail, all of the interviewees expressed having had extreme difficulties when they were not able to work as doctors during their initial time in Sweden. 6.3. Professional re-establishment in Sweden The process of acquiring a Swedish medical license featured as a prominent topic in all of the interviews. The interviewees were either still in the process of obtaining a Swedish medical license or were already working as doctors in Sweden. In order to work as a doctor in Sweden, they had to pass several Swedish language courses, which usually took them about 2 years, then the TULE exam, and then do their residency. Only Fatin enrolled in the supplementary course at the Karolinska Institutet in Stockholm and Khalid also tried to get a place there. Once in Sweden, all interviewees wanted to continue practicing medicine. Their decision was based not only on their dedication to medicine, but also on the realisation that they were unequipped to practice any other profession, except some low-skilled jobs in, e.g. the food service industry or transportation sector. Nevertheless, once they embarked on the process of obtaining a Swedish medical license, many of the interviewees felt extremely frustrated. They were riddled with doubts about whether they would ever be able to practice medicine again and, at points, lost all interest in doing so. As Noor recalled: “I was depressed. It was nothing to do. I couldn’t work, like anything. And that’s when I got the feeling that maybe I cannot be a doctor in Sweden anymore. Or anymore at all. I don’t know what can I say more, but I was really unsure”. The sense of frustration stemmed mainly from the tediousness of the licensing process. On numerous occasions, the interviewees’ frustration referred to the number of years they invested in being able to work in Sweden. Mohammed “saw black” when thinking of it: I was suffering with the [Swedish language] school. Suffering and just seeing black in front of me. You put yourself in my situation. Like, you already study six years and worked one year and then left here and then one year doing nothing, just waiting, and then come to the school and then know from your teachers that you have to wait. Can you imagine that they tell me, you have to be in SFI 38 weeks, then you can go to higher level.The frustration also arose from the feeling that much of the complementary training was a repetition of what they had already done. The interviewees felt that their previous medical skills and knowledge did not count. As Hayder said: “After two years of the working and the supervision, they will legitimate me just as a doctor. I am specialist. […] I have been working as a doctor for 15 years. But when I contact the National Board, they say, no, that means nothing for us”. Also during the Swedish language courses, the interviewees felt that their abilities and educational level were not recognised. They disapproved of having to attend courses with people with lower levels of education, which slowed them down. Noor remembered her course: So, what if you are a doctor from your homeland? You don’t have a certificate here in Sweden. You know, even teachers in the Swedish language, they treat us as if we are kids. […] I mean, me and other kind of people who is not highly educated or not educated at all, we sit in the same place, the same start of the language level. And that’s why […] People who has high education, they could advance quickly. And that’s why I’ve been and my colleagues have been frustrated.The interviewees continuously underlined their disapproval of the existing regulations pertaining to non-EU doctors by referring to the fact that Sweden is in need of doctors. They also rarely refrained from mentioning the lax regulations concerning EU doctors and the more reasonable rules that exist in many other EU countries. Even though the licensing regulations do not leave much leeway for the doctors, the interviewees tried to make as much out of the circumstances as possible. All interviewees did internships – often unpaid – for several months while they were studying the Swedish language or preparing for the TULE exam. This increased their chances of excelling at the test, improved their language skills, and enabled them to practice medicine and get to know the Swedish medical system. As Fatin said about her internship: “I was treated very well there, it was a very good time. I learned much about the language, about the health system”. Also, some of the interviewees described occasions when they challenged the regular process for acquiring a license. Rashid, for instance, explained how he was able to make an arrangement with his social worker where he and his wife would not have to go to a regular Swedish language course in order to continue receiving social benefits. Instead of going to school every day, they would study at home and at the same time prepare for their TULE exams and do internships. As he said: “So, it is no waste of time, pang, pang, pang, pang [makes a hand gesture to show how fast it all went]. Systematically, orderly, we had a study plan”. 6.4. Working as a doctor in Sweden When talking about their working experiences in Sweden, the interviewees expressed great satisfaction at being able to practice medicine again. Nevertheless, they felt that they remained in a disadvantaged position. In comparison to their Swedish colleagues, they felt that they had less job opportunities. When talking about their AT, specialisation, and internship positions, the interviewees often mentioned that they had to be prepared to commute over great distances or even to move in order to find employment. Yi Hui, for instance, changed her mind about her specialisation because she would never be able to get a position as a gynaecologist, a very popular specialisation among Swedish medical students. Though they would not speak of discrimination, the interviewees furthermore felt that they had to work harder, and that they were treated differently compared to their Swedish colleagues. Fatin felt that foreign doctors have to exert themselves twice as much because they “are under a microscope”: For example, if my colleague does something wrong, that is from one to ten, no one would notice it. But if I do something wrong, there will be two out of ten that will notice it. It will be noticed because I am an immigrant or a foreign doctor. There is prejudice. But at the same time, I don’t feel that I was discriminated in any way.Furthermore, many felt that the knowledge they acquired before coming to Sweden did not matter. Granted, previous experiences made them better physicians, but the fact that they had to repeat a part of their medical training meant they had to work with, and for, considerably younger and less experienced doctors. Noor (in her early 40s) recalled a recent event: If I am sitting here and a Swedish doctor who is more […] blond, sitting [points to the chair next to her] and come another doctor from outside and want to talk to us with some patient. They don’t talk to me, they talk to the Swedish girl, because always, oh, she is foreigner, she don’t understand, maybe she is new, beginner. It has happened actually yesterday! Meanwhile, my colleague, she is a very young physician. But no matter, they look at her, talking with her, not with me.Swedish not being their native language was, as Noor said, a further “handicap” and they also felt disadvantaged because they were less aware of their rights and, even if they were aware, did not dare to demand them. Yi Hui said: “I don’t dare to demand the same rights. Because there is also always a fear that I might be punished if I demand too much”. 6.5. Gaining strength from one’s profession Though a lot of what has been outlined to this point speaks of the limitations and disappointments that the interviewees have encountered during their Swedish careers, it also became clear that professional successes were not rare and that they meant the world to the interviewees. It was with pride that they talked about the jobs they obtained and exams they successfully passed, and they spoke with joy when they remembered how they had helped a patient. Noor described how she felt about an internship offer: “She asked me if I want to work, I was so happy! I worked for three months, without any vacation, just working hard, then they gave me flowers! Oh, it was so […] Flowers aren’t a lot, but it just approved that I succeeded. That I did something that I want”. It was, however, not only they that had gained something out of their work. The interviewees contributed to society not only through their daily work as medical practitioners, but also by actively engaging with the societal system. Fatin, for instance, together with another physician, created a social media group for other non-EU physicians, which enables them to share information about the licensing process in Sweden. In addition, several of the interviewees claimed that they are treated differently if they mention their profession. Yi Hui said that “when I go anywhere and you introduce yourself, you are a doctor, people do respect you more”. More importantly, they felt that their profession lifted them out of their migrant role and enabled them to occupy a worthier social position. To substantiate this point, I present at length a story narrated by Rashid: Well, there exists, generally speaking, that foreigners in this country are unemployed. You know that for sure. So, if one looks like me [points to his skin], then you’re of course a foreigner. […] There was something some weeks ago. So, I went to the BMW store and I was looking at a car that costs about 300 000 [SEK]. So, I went to the salesman, can I test-drive this one. Aha, do you have a driver’s license? Yes, I have that, I showed my driver’s license. Aha. How were you thinking to pay for it, he asks me. I will pay 20 or 25 per cent. And the rest I would pay in instalments. Aha, is it settled with the bank? He didn’t do that with the others. I saw that, he had many customers, but he didn’t do that with them. If they wanted to test-drive, they got the keys immediately. They give the driver’s license, he looks at it, makes a copy and then they get the keys. Two minutes. But he made a frigging long examination with me. And then I got the keys to the car. I got annoyed and to be honest, I wanted to say to him, you, I earn per month as much as you earn in six months [his voice grows louder]. I can even pay in cash for this car immediately, so I have no problem to pay for it with my own money and buy even two BMWs. I got very annoyed, I didn’t say it, but I would have wanted to. I regret it every time I think of it. So, it’s like, sometimes one gets judged by skin, background. And it helps […] Now I show, if they ask after my ID, then I show this ID [points to his doctor ID from Region Skåne]. It says there that I am a doctor. Like this it gets much smoother. I have noticed that it goes better. […] I thought of replacing the driver’s license and instead show this ID [again pointing to his doctor’s ID], it says doctor on it so they know, and it says Region Skåne on it, so they know I have a job and that I work as a doctor when they read it.Noor, however, took a different stance and predicted, perhaps rather resignedly, that her foreignness will continue to be her defining characteristic: But I had one occasion, I was a doctor, I was in [the name of the hospital] with my friend, she was operated. So, she was in the hospital, in the operation department and I was in the restaurant eating lunch, like everybody eating lunch. And there comes an old man and he sits beside me and there are a lot of tables nearby. And he starts talking, oh, who are you, you are not Swedish, where are you from, I thought he is kind to talk to me. So, I said, I am from Iraq. Yes! You, you come to Sweden [for] our money, just taking Swedish [social] benefits. And he starts shouting. And I am a doctor! So, I just leave my food and the restaurant, I was […] Really, I want to cry, I want to shout, I just want to say I [stressing] am a doctor, but I thought it was silly to talk to him, he maybe addict or psychologically ill, I don’t know so. But whatever you are, even with that clothes [points to her medical white coat], even if they say […] You look foreigner, it’s another feeling actually. I don’t think it will get better, because it was like that the whole time. 7. DISCUSSION By making use of the conceptual framework combining Brubaker and Cooper’s distinction between “identification and categorization”, and “self-understanding and social location”, as well as Jenkins’s theory on social identity and Anthias’s notion of translocational positionality (see Section 2), this section interprets the presented material. Three main findings are drawn about how the highly skilled refugees who were interviewed perceived themselves and their social locations. The chosen conceptual framework proves to be a valuable heuristic tool as it permits one to make sense of the highly complex identity-formation processes without losing sight of their agents and objects, as well as the contexts in which they take place and the interactions surrounding them. 7.1. Self-understanding: “provider” versus “recipient” The interviewees’ narratives show that being a doctor incorporates two important aspects. On the one hand, the interviewees see their profession as a matter of practice: being a medical doctor means making diagnoses, curing diseases, fixing problems, and saving lives. It is not about “sitting around”. While this points to a particular kind of self-understanding, it also hints at an important aspect of the identification process. Though the interviewees identified themselves with their profession, their professional identity was deeply shaken when they could not practise medicine upon arrival in Sweden. On the other hand, though the interviewees see medicine as a profession that gives economic security and steady employment, it is also understood as a means of helping people. Taken together, the two aspects indicate that the interviewees understand themselves as “providers”. For them, being a physician entails an active contribution to patients’, and thus also wider society’s, well-being. Concurrently, the interviewees had a hard time identifying themselves with the often constrained and inactive role of a refugee, i.e. a “recipient” of social benefits: a person who “sits around” while waiting to get the asylum application approved. 7.2. Identification and categorisation: the limited significance of profession The interviewees identified themselves as refugees only in relation to their entry to Sweden and the particular circumstances that framed their lives during their initial time in Sweden. When talking about the time after the asylum process, they referred to themselves as foreigners or, occasionally, migrants. Thereby, they were not shy in using expressions such as “we foreigners”, which is something they never used in relation to the term “refugee”. As suggested by Jenkins,44 these self-identification processes can only be understood when taking into account how the interviewees were categorised at the institutional level. At that level, the interviewees were categorised as refugees. The interviewees understood themselves as refugees because the legal framework labelled them as such and, at the same time, made them into refugees. The very formal category that is used in political and bureaucratic contexts placed the interviewees within a certain frame of regulations and thus imposed upon them a lifestyle that shaped them into refugees (e.g. waiting for the approval of their asylum application while living in a detention centre and relying on social benefits). The identity of refugee emerged mainly through the external processes that defined them as such, whereas the migrant identity also stemmed from the interviewees’ own self-perceptions. Rashid’s remark about refugees hints at a possible explanation. By thinking of themselves as “being placed” into the refugee identity rather than essentially “having it”, the interviewees disputed any possession of – often negative – characteristics that are attached to the refugee category, such as passivity and poverty. Instead, the interviewees saw themselves as foreigners, a term that carries far less drastic and charged images of desolation, yet still reflects the disadvantaged social location in which they found themselves. Pertaining to their professional re-establishment, the interviewees were also categorised as immigrants at the institutional level. In the licensing process, physicians are grouped according to their country of education: there is a differentiation made between those trained in Sweden, within the EU, and those who obtained their medical qualifications outside of the EU. When it comes to Swedish language courses, the interviewees were obviously categorised according to their immigrant background, yet no further categorisation took place according to their educational or professional background. In sum, during their initial time in Sweden, the interviewees were rarely categorised as medical doctors. Their professional identification took place mainly through their self-identification as doctors and their own drive to embark on and continue along the path that would also establish them as doctors at the institutional level. The institutional guidelines for non-EU doctors in Sweden indeed framed this process, but the actual design of the process impeded, rather than supported, the interviewees’ professional identification. 7.3. Translocational positionality: being a migrant and a doctor Through migration, the interviewees’ social location changed from that of native into migrant. The geographical relocation from their home countries did not dislocate the interviewees in terms of their profession, but did change it. This section accounts for the positionality of the interviewees once they acquired a Swedish medical license and were thus placed within the institutional category of doctors. Depending on the context, the intersection of their social locations as migrants and doctors put the interviewees in sometimes dominant and sometimes subordinate positions. Once the interviewees started working as doctors, they felt they were in a disadvantaged position compared to Swedish doctors. They de facto occupied the same or even a lower position than their much younger and less experienced Swedish colleagues. More importantly, it was through their daily workplace interactions that the interviewees were reminded of their disadvantaged position within the otherwise privileged social location of physician. Thereby, the interviewees’ self-identification with being foreign was further reinforced by the external identification of the interviewees as immigrants, something that was perceived largely as inhibiting. They understood that being a migrant put them in a disadvantaged social location in comparison to Swedes and – due to their outward appearance – sometimes even in comparison to EU and some other migrants. On the other hand, outside of their professional context, the interviewees felt that their profession could sometimes put them in an advantaged social position. If someone became aware that they were a doctor, their position was not only made more advantageous than before, it sometimes even became superior to their counterpart (recall Rashid’s encounter with the car dealer). 8. CONCLUDING REMARKS The aim of this article was to account for the refugee and professional identities of a group of non-EU doctors who came to Sweden as refugees and to better understand how these self-perceptions are interwoven. In sum, the interviewees’ understanding of what it means to be a doctor and what it means to be a refugee can be seen as contrasting elements. For them, being a physician entails not only possessing a medical license, but actually practising medicine. Their profession is positively connoted and seen as a source of strength. It means providing for oneself while at the same time actively contributing to society. Being a refugee is, on the other hand, burdened with negativity. It is therefore a term that they reluctantly use in relation to themselves. Instead, “refugee” is a label that is appointed to them. The interviewees instead perceive themselves as foreigners – a term that is less negatively loaded, yet still captures the inhibiting elements of these individuals’ existence. Thereby, the migrant and professional selves are in a constant interplay with each other and shape the interviewees’ existence and self-perceptions. Whereas their profession may better their social position, the external labelling of the interviewees as immigrants and refugees rattles their doctor-identity. This is not only the case during the licensing process: the migrant identity gives even licensed physicians the feeling that they occupy a somewhat outsider position within the medical field.45 By accounting for individuals’ refugee and professional selves, and how these are interwoven, this article emphasises the social and irredeemably processual nature of identity formation. In Liisa Malkki’s words: “[I]dentity is always mobile and processual, partly self-construction, partly categorization by others, partly a condition, a status, a label, a weapon, a shield, a fund of memories, et cetera. It is a creolized aggregate composed through bricolage.”46 The article hence cautions against over-generalisation and argues against the essentialisation of migrants’ identities. Whereas the terms “refugee” and “highly skilled migrant” might have analytical usefulness as legal or descriptive rubrics, it is important to bear in mind that these categories should not be employed as labels for a particular type of person. Instead, they should accommodate a diversity of individuals along with their multifaceted histories, self-perceptions, and contextualities. It is only in this way that we can move away from the often one-sided depictions of the different categories of migrants, and acknowledge the value that each individual possesses. Footnotes 1 L. Bleasdale, “Under Attack: The Metaphoric Threat of Asylum Seekers in Public-Political Discourses”, Web Journal of Current Legal Issues, 1, 2008; L. Chouliaraki, “Between Pity and Irony: Paradigms of Refugee Representation in Humanitarian Discourse”, in K. Moore, B. Gross & T. Threadgold (eds.), Migrations and the Media, New York, Peter Lang Publishing, 2012, 13–31; M. Eastmond, “Egalitarian Ambitions, Constructions of Difference: The Paradoxes of Refugee Integration in Sweden”, Journal of Ethnic and Migration Studies, 37(2), 2011, 277–295; K. Moore, “Introduction to Migrations and the Media”, in Moore, Gross & Threadgold (eds.), Migrations and the Media, 1–9; T. Wright, Refugees on Screen, Oxford, University of Oxford, Refugees Study Centre Working Paper No. 5, 2000. 2 J. Chaloff & G. Lemaître, Managing Highly-Skilled Labour Migration: A Comparative Analysis of Migration Policies and Challenges in OECD Countries, Paris, OECD Publishing, OECD Social, Employment and Migration Working Paper No. 79, 2009, available at: http://www.oecd-ilibrary.org/content/workingpaper/225505346577 (last visited 7 Dec. 2016); R. Iredale, “The Migration of Professionals: Theories and Typologies”, International Migration, 39(5), 2001, 7–26. 3 Iredale, “Migration of Professionals”, 8. 4 For an exception, see e.g. A. Liversage, “Finding a Path: Investigating the Labour Market Trajectories of High-Skilled Immigrants in Denmark”, Journal of Ethnic and Migration Studies, 35(2), 2009, 203–226. 5 See e.g. P. Bevelander, “The Employment Integration of Resettled Refugees, Asylum Claimants, and Family Reunion Migrants in Sweden”, Refugee Survey Quarterly, 30(1), 2011, 22–43; V. Colic-Peisker, “‘At Least You’re the Right Colour’: Identity and Social Inclusion of Bosnian Refugees in Australia”, Journal of Ethnic and Migration Studies, 31(4), 2005, 615–638; M. Collyer, “When Do Social Networks Fail to Explain Migration? Accounting for the Movement of Algerian Asylum Seekers to the UK”, Journal of Ethnic and Migration Studies, 31(4), 2005, 699–718; M. Hajdukowski-Ahmed, N. Khanlou & H. Moussa, Not Born a Refugee Woman: Contesting Identities, Rethinking Practices, New York, Berghahn, 2013; S. Khosravi, “Illegal” Traveller: An Auto-Ethnography of Borders, London, Palgrave Macmillan, 2010; L.H. Malkki, “Speechless Emissaries: Refugees, Humanitarianism, and Dehistoricization”, Cultural Anthropology, 11(3), 1996, 377–404; M. Povrzanović Frykman, “Struggle for Recognition: Bosnian Refugees’ Employment Experiences in Sweden”, Refugee Survey Quarterly, 31(1), 2012, 54–79; S.S. Willen, “Toward a Critical Phenomenology of ‘Illegality’: State Power, Criminalization, and Abjectivity among Undocumented Migrant Workers in Tel Aviv, Israel”, International Migration, 45(3), 2007, 8–38. 6 See e.g. Bevelander, “The Employment Integration of Resettled Refugees”; P. Bevelander & R. Pendakur, “The Labour Market Integration of Refugee and Family Reunion Immigrants: A Comparison of Outcomes in Canada and Sweden”, Journal of Ethnic and Migration Studies, 40(5), 2014, 689–709; Colic-Peisker, “‘At Least You’re the Right Colour’”; V. Colic-Peisker & F. Tilbury, “‘Active’ and ‘Passive’ Resettlement: The Influence of Support Services and Refugees’ Own Resources on Resettlement Style”, International Migration, 41(5), 2003, 61–92; Povrzanović Frykman, “Struggle for Recognition”; D.-O. Rooth & J. Ekberg, “Occupational Mobility for Immigrants in Sweden”, International Migration, 44(2), 2006, 57–77. 7 G. Smyth & H. Kum, “‘When They Don’t Use It They Will Lose It’: Professionals, Deprofessionalization and Reprofessionalization: The Case of Refugee Teachers in Scotland”, Journal of Refugee Studies, 23(4), 2010, 503–522. 8 J. Willott & J. Stevenson, “Attitudes to Employment of Professionally Qualified Refugees in the United Kingdom”, International Migration, 51(5), 2013, 120–132. 9 See e.g. E. Piętka-Nykaza, “‘I Want to Do Anything Which Is Decent and Relates to My Profession’: Refugee Doctors’ and Teachers’ Strategies of Re-Entering. Their Professions in the UK”, Journal of Refugee Studies, 28(4), 2015, 523–543; M. Psoinos, “Exploring Highly Educated Refugees’ Potential as Knowledge Workers in Contemporary Britain”, Equal Opportunities International, 26(8), 2007, 834–852. 10 A brief note on terminology: since all interviewees originally came from and obtained their medical training on the Asian continent, the terms “non-EU” (here, EU refers to European Union) and “non-European” are used interchangeably, designating both their national origin as well as their country of education. Furthermore, I use the term “refugee” to refer to all interviewees though some of them might have, legally speaking, been granted asylum not on the basis of the 1951 United Nations Refugee Convention but on the basis of another type of protection. As I focus not on the legal regulations that frame individuals’ admission to Sweden, but on the analytical and social category their entry to Sweden puts them in, strict differentiation is not relevant in this article. 11 H. de Haas, Migration Theory: Quo Vadis?, Oxford, University of Oxford, International Migration Institute, Working Paper No. 100, 2014; R. King, Theories and Typologies of Migration: An Overview and a Primer, Malmö, Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM), Willy Brandt Series of Working Papers in International Migration and Ethnic Relations, No. 3/12, 2012; D. Turton, Conceptualising Forced Migration, Oxford, University of Oxford, Refugee Studies Centre, RSC Working Paper Series, No. 12, 2003. 12 N. Van Hear, New Diasporas: The Mass Exodus, Dispersal and Regrouping of Migrant Communities, London, University College London Press, 1998; N. Van Hear, Mixed Migration: Policy Challenges, Oxford, Centre on Migration, Policy and Society (COMPAS), The Migration Observatory, 2011; N. Van Hear, “Mixed Migration”, in B. Anderson & M. Keith (eds.), Migration: The COMPAS Anthology, Oxford, Centre on Migration, Policy and Society (COMPAS), 2014; N. Van Hear, R. Brubaker & T. Bessa, Managing Mobility for Human Development: The Growing Salience of Mixed Migration, United Nations Development Programme, Human Development Research Paper No. 2009/20, 2009. 13 See e.g. D.A. Boehm, “US-Mexico Mixed Migration in an Age of Deportation: An Inquiry into the Transnational Circulation of Violence”, Refugee Survey Quarterly, 30(1), 2011, 1–21; E. Serra Mingot & J. de Arimatéia da Cruz, “The Asylum-Migration Nexus: Can Motivations Shape the Concept of Coercion? The Sudanese Transit Example”, Journal of Third World Studies, 30(2), 2013, 175–190. 14 R. Brubaker & F. Cooper, “Beyond ‘Identity’”, Theory and Society, 29(1), 2000, 1–47. 15 R. Jenkins, “Categorization: Identity, Social Process and Epistemology”, Current Sociology, 48(3), 2000, 7–25; R. Jenkins, Social Identity, 3rd ed., Abingdon, Routledge, 2008. 16 F. Anthias, “Where Do I Belong? Narrating Collective Identity and Translocational Positionality”, Ethnicities, 2(4), 2002, 491–514; F. Anthias, “Thinking Through the Lens of Translocational Positionality: An Intersectionality Frame for Understanding Identity and Belonging”, Translocations: Migration and Social Change, 4(1), 2008, 5–19; F. Anthias, “Transnational Mobilities, Migration Research and Intersectionality”, Nordic Journal of Migration Research, 2(2), 2012, 102–110. 17 de Haas, Migration Theory, 13. 18 Jenkins, Social Identity, 17. 19 Jenkins, “Categorization”, 10; Jenkins, Social Identity, 39–48. 20 Jenkins, “Categorization”, 7–8; Jenkins, Social Identity, 40–45. 21 Jenkins, Social Identity, 8, 12. 22 Brubaker & Cooper, “Beyond ‘Identity’”, 15. 23 Ibid. 24 Ibid., 16. 25 Ibid., 17–19. 26 Anthias, “Where Do I Belong?”; Anthias, “Thinking Through the Lens of Translocational Positionality”; Anthias, “Transnational Mobilities, Migration Research and Intersectionality”. 27 Anthias, “Transnational Mobilities, Migration Research and Intersectionality”, 108. 28 Anthias, “Thinking through the Lens of Translocational Positionality”, 15; Anthias, “Transnational Mobilities, Migration Research and Intersectionality”, 108. 29 Anthias, “Thinking through the Lens of Translocational Positionality”, 15. 30 Anthias, “Where Do I Belong?”, 501–502; Anthias, “Transnational Mobilities, Migration Research and Intersectionality”, 108. 31 Socialstyrelsen, Nationella planeringsstödet 2017: Tillgång och efterfrågan på vissa personalgrupper inom hälso- och sjukvård samt tandvård, Stockholm, Socialstyrelsen, 2017, 18. 32 Socialstyrelsen, Nationella planeringsstödet: Tillgång och efterfrågan på vissa personalgrupper inom hälso- och sjukvård samt tandvård, Stockholm, Socialstyrelsen, 2013; 2014; 2015; 2016; 2017. The numbers on foreign physicians in the quoted reports by the National Board of Health and Welfare (NBHW, or as it is called in Swedish: Socialstyrelsen) refer to those who were trained abroad (läkare med utländsk utbildning), which may also include Swedish nationals with foreign education. Despite this fact, I am using these statistics because they represent the official and closest approximation of the number of foreign physicians in Sweden. 33 See e.g. O. Öst, “Läkare från Syrien kan hjälpa lanstinget”, Sundsvalls Tidning, 4 Nov. 2014, available at: http://www.st.nu/medelpad/sundsvall/lakare-fran-syrien-kan-hjalpa-lanstinget (last visited 27 Nov. 2017). 34 OECD, International Migration Outlook 2016, 2016, 304, available at: http://dx.doi.org/10.1787/migr_outlook-2015-en (last visited 27 Nov. 2017). 35 Migrationsverket, Asylsökande till Sverige under 2000-2016, 2017, available at: https://www.migrationsverket.se/download/18.585fa5be158ee6bf362fd2/1485556063045/Asyls%C3%B6kande+till+Sverige+2000-2016.pdf (last visited 27 Nov. 2017). 36 The rules concerning those who obtained their medical training outside of the EU/EEA changed partly on 1 Jul. 2016. 37 The institute refers to itself with its official Swedish name also in English texts and does not offer any official English translation. 38 B. Flyvbjerg, “Five Misunderstandings about Case-Study Research”, Qualitative Inquiry, 12(2), 2006, 219–245. 39 L. Salmonsson, The ‘Other’ Doctor: Boundary Work Within the Swedish Medical Profession. PhD Dissertation, Uppsala, Uppsala University, 2014, 11. 40 Flyvbjerg, “Five Misunderstandings about Case-Study Research”. 41 Ibid.; C. Squire, M. Davis, C. Esin, M. Andrews, B. Harrison, L.-C. Hydén & M. Hydén, What Is Narrative Research? (The “What Is?” Research Methods Series), New York, Bloomsbury, 2014. 42 Names and further identifying information have been changed or omitted in order to assure the anonymity of the research participants. 43 Yi Hui is a female specialist who lives in middle Sweden together with her family. She comes from Malaysia and moved to Sweden 25 years ago together with her husband who is from a Middle Eastern country. Legally speaking, she did not come to Sweden as a refugee, but rather as a family migrant. However, her migratory trajectory made her, as she claims, into a refugee, which is why I am including her in the sample. Because the Middle Eastern country where her husband comes from was at war in the 1980s, Yi Hui and her husband sought asylum in Sweden. For about a year, they lived in different detention camps where she gave birth to their daughter, yet due to her Malaysian citizenship, they rejected their asylum application. Because of that, she decided to return to Malaysia and leave her husband and their daughter in Sweden. After she left, her husband got his asylum application approved, which enabled her to reunite with them after living in Malaysia for almost 2 years. 44 Jenkins, Social Identity, 40–48. 45 Salmonsson, The ‘Other’ Doctor. 46 L.H. Malkki, “National Geographic: The Rooting of Peoples and the Territorialization of National Identity among Scholars and Refugees”, Cultural Anthropology, 7(1), 1992, 24–44 (37). © Author(s) [2018]. All rights reserved. For permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

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Refugee Survey QuarterlyOxford University Press

Published: Mar 19, 2018

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