The rough road from carer to killer

Although raised in Australia, as a hospital registrar of Bangladeshi and Muslim background I am often approached by overseas-trained doctors with tales of woe and misery. They feel I can offer a sympathetic ear. From colleagues berating their clinical skills to patients abusing them for poor English, many feel hard done by. I remember a Pakistani doctor taking me aside on a ward round to bemoan how the nurses had complained about the smell of his curry lunches. This was surely an example of racism, or so he felt.

While technology gurus, management consultants and investment bankers rule the modern economies, doctors remain the quintessential high-status professional, especially in the developing world. While the best and brightest here go on to a variety of occupations, in the Third World a greater proportion go on to study medicine.

It is also reflected locally when you consider children of Asian migrants form a high proportion of students in Australian medical schools. In their lust to make a difference, many are later attracted to positions in the clergy or politics. Intervening in human life becomes inseparable from dabbling in human meaning.

Part of the attraction of studying medicine for foreigners is the possibility of migrating to the West, a trend magnified in the past decade when Western governments have produced fewer doctors per capita. The shortfall has been filled by a steady supply of overseas-trained doctors, primarily from Asia and the Middle East. The Australian Medical Association estimates about 25 per cent of the medical workforce is overseas-trained. This figure rises to almost 50 per cent in areas of greater shortage such as rural communities and in states such as Queensland and South Australia.

As a result, a visit to the public hospital these days will have similarities to catching a taxi or going to a convenience store. While the skill sets for the jobs are very different, the interaction is likely to involve a recent immigrant from the developing world, and very often a Muslim. These are the spaces where the south meets the north, right in our own backyards.

While all immigrants from non-English-speaking backgrounds suffer a loss in status, overseas doctors suffer a loss greater than most. Extended periods of examinations, racism and discrimination from health staff and an obligation to do the least desirable jobs often produce a sense of humiliation, a trait central to would-be terrorists.

Doctors are said to be at the centre of the latest attacks in Britain. This would appear inexplicable, especially to those who believe terrorism is attractive only to those who are poor or alienated.

But doctors from the developing world have long been at the centre of terrorist operations or affiliated with radical groups. It is in line with professional, highly educated operators undertaking leadership roles in many Islamic extremist groups.

The most notable is Ayman al-Zawahiri, the Egyptian-born pediatrician who rose to be Osama bin Laden's closest aide. He is widely credited to be the major thinker behind al-Qaida and credited with its shift from targeting apostates in the Middle East to attacking the West in its own backyard.

Many of the senior figures in Hamas are doctors, from the founder Mahmoud Zahar, who was a surgeon, to the notorious Abdel Rantisi, a pediatrician killed three years ago in a precision Israeli assassination.

An Australian parallel can be seen in the forthcoming trial of the medical student Izhar ul-Haque. He stands accused of joining a banned terrorist group dedicated to Kashmiri liberation. He said he was "fed up with Westerners" before he left on a trip to Pakistan.

Like al-Haque, the Jordanian doctor at the centre of the current British investigations was also very suspicious of Westerners when he moved to Britain. Mohammed Asha was worried about racism. In the Midlands where he lived, The New York Times has reported, he was forthright in asking neighbours about racist attacks in the area. Asha was described as a brilliant man by his peers in Jordan.

For those with a sense of victimhood and alienation, Islamism offers a potent identity to express alienation and connect their personal story to a larger, global struggle, fuelled by television images of conflicts such as those in Palestine, Chechnya or Iraq. In this way Islam has become a symbol of protest - political or social - attracting many who feel disenfranchised or wronged by the society in which they live.

This gains greater weight when you consider that not only are a great proportion of the world's poor Muslim, the places of social exclusion in the West also have a strong ethno-religious flavour, from North Africans in Paris to South Asians in Britain and to a lesser extent, Lebanese in south-western Sydney. These groups often perceive themselves as marginalised or undervalued in their society and thereby feel a connection with the "real" poor and dispossessed Muslims in other parts of the world.

These imagined feelings of connection with the poor and dispossessed are the reasons why the middle classes of the developing world have so often been the leaders in radical groups, including terrorist operations. This is heightened when they feel a sudden drop in status on migrating to the West or are excluded from its liberal social mores.

Overseas doctors as a group are not a terrorist threat. Most make a wonderful contribution to our society. It is a quirk of immigration patterns and Western skill shortages that they have formed the bulk of the latest terrorism detainees. But the event illustrates the kind of groups that may be vulnerable to the lure of terrorism. In this case, sadly, those who were dedicated to preserving human life were transformed into the exact opposite.