Refugee Survey Quarterly, 2018, 37, 231–251

doi: 10.1093/rsq/hdy001
Advance Access Publication Date: 19 March 2018
Article

Being Highly Skilled and a Refugee:

Self-Perceptions of Non-European Physicians

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in Sweden
Katarina Mozetic*

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 pro-
cessual nature of identity, which is always partly self-constructed and partly determined
by external categorisations, and hence makes the case against the essentialisation of mi-
grants’ identities, be they “refugee” or “highly skilled migrant”.
K E Y W O R D S : highly skilled refugee, identity, categories, physician, Sweden

1. INTRODUCTION
This article takes its point of departure as the predominance of a grid-like under-
standing of migrants in which individuals are neatly placed into the categories of
“refugee”, “highly skilled migrant”, etc. As such, these are often attributed characteris-
tics that are not only disparate, but even contrasting, taking into account how refu-
gees 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

* Doctoral research fellow, Department of Sociology and Human Geography, University of Oslo, Blindern,
0317 Oslo, Norway. Email: katarina.mozetic@sosgeo.uio.no.
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

C Author(s) [2018]. All rights reserved. For permissions, please email: journals.permissions@oup.com
V

 231
232  Katarina Mozetic j Being Highly Skilled and a Refugee

are often cherished for their contribution to the host societies and seen as an indis-
pensable asset.2
Within the field of migration studies, definitions of refugees and highly skilled mi-
grants barely allow for tangency and almost completely disconnected fields of re-
search have been fostered. Refugees are predominantly bundled under the term

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“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 profes-
sional 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 mi-
grants.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 dis-
cussing topics such as refugees’ labour market performance and integration, as well
as their social inclusion and identity construction.6 However, even when such studies

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. Lemaı̂tre, 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/workingpa
per/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. Povrzanovic 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; Povrzanovic Frykman, “Struggle for Recognition”; D.-O. Rooth & J.
Ekberg, “Occupational Mobility for Immigrants in Sweden”, International Migration, 44(2), 2006, 57–77.
 Refugee Survey Quarterly  233

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 experi-
ences 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

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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 them-
selves, what they identify with, and what social locations they occupy in the destin-
ation 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 further-
more 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 mi-
gration 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 migra-
tion scholar Nicholas Van Hear12 – represents an example of an analytical tool that

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. Pie˛tka-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 train-
ing 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 edu-
cation. 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
234  Katarina Mozetic j Being Highly Skilled and a Refugee

has been employed to highlight the continuum between forced and voluntary migra-
tion. 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-

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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 per-
ceived 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 meth-
ods used in the analysis. The subsequent two sections are dedicated to the presenta-
tion 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 ap-
plication ranges from, for instance, portraying an individual’s core self to group iden-
tification 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 en-
gage 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

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.
 Refugee Survey Quarterly  235

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 individ-
uals possess within given spaces. What is more, the proposed theoretical framework
enables the portrayal of multifaceted identity-formation processes while at the same

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time depicting the underlying regularities. As de Haas points out: “Social theory for-
mation is precisely about striking a delicate balance between the desire to acknow-
ledge 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 na-
ture of the term emphasises the importance of analysing the dynamics of identity con-
struction 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 be-
tween individuals; and 3) the institutional order, which is the world of organisa-
tion(s) and established ways of conduct.19
When it comes to the individual order, it is important to note that individual iden-
tification is always socially constructed, i.e. it emerges through the ongoing and sim-
ultaneous 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

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.
236  Katarina Mozetic j Being Highly Skilled and a Refugee

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 dis-
courses. While categorisation takes place at all three levels of the human world, it is

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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 dispo-
sitional term that designates one’s sense of who one is, where one is located in a par-
ticular 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 be-
tween 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 posi-
tionality” 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 so-
cial locations as a dynamic practice that is dependent on context and can hence in-
volve 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

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”.
 Refugee Survey Quarterly  237

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

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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 re-
lationally. 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 back-
ground: the woman’s locations related to class, gender, and ethnicity put her in mul-
tiple, 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 . N O N - E UR O P E A N P H Y SI C IA N S I N S W ED E N
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, approxi-
mately 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

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.
238  Katarina Mozetic j Being Highly Skilled and a Refugee

reasons, the internationalisation of the Swedish medical sector is due to the insuffi-
cient 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

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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 applica-
tions 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 proba-
tion 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

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 for-
eign 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 stat-
istics 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%B6kandeþtillþSverigeþ2000-
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 offi-
cial English translation.
 Refugee Survey Quarterly  239

an illness and suggested a treatment. As an alternative to the TULE exam, the doc-
tors 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 (allmänt-

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jänstgöring, or as it is called in short: AT), which provided them with practical experi-
ence 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 occupa-
tion 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’ profes-
sional 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 gen-
eralisation across cases, the sample size is adequate.40 What is more, the reoccurrence

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”.
240  Katarina Mozetic j Being Highly Skilled and a Refugee

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, vari-
ous institutions and projects that are involved in the licensing process for non-EU
physicians, social media, and the individuals’ workplaces. Four interviews were con-

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ducted in person, whereas the rest took place over Skype. The interviews lasted be-
tween 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 inter-
views: the interviewees were invited to talk about their professional experiences be-
fore 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 ob-
tained narratives. This was done through coding by which the material was categor-
ised, which facilitated its interpretation.

5 . B E I N G A R E F U G EE
5.1. Insecurity, dependence, and passivity
A prominent feature in the interviewees’ narratives was a sense of insecurity in rela-
tion to how things would turn out in Sweden. According to many of them, their ini-
tial 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 depend-
ence 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.

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 anonym-
ity of the research participants.
 Refugee Survey Quarterly  241

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 de-
cision 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

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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 unfamili-
arity 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, le-
gally 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.

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 deten-
tion 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.
242  Katarina Mozetic j Being Highly Skilled and a Refugee

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

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on them, snows on them. Or a refugee here in Sweden who lives in an apart-
ment, 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 ex-
ample: “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 situ-
ations 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 de-
tails. 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 per-
sonal 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 cer-
tain social status and occupational security in life. Rashid expressed this in the follow-
ing 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.
 Refugee Survey Quarterly  243

My grandfather used to say, there are three people who will never become un-
employed. 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].

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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 al-
ready 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 soci-
etal 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 medi-
cine is a practical profession. On numerous occasions, the interviewees expressed
244  Katarina Mozetic j Being Highly Skilled and a Refugee

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”.

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As the next section will show in more detail, all of the interviewees expressed hav-
ing 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 resi-
dency. 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 de-
cision 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 inter-
viewees 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 previ-
ous 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 spe-
cialist. [. . .] 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”.
 Refugee Survey Quarterly  245

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:

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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 con-
cerning 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 col-
leagues, 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 be-
cause she would never be able to get a position as a gynaecologist, a very popular
specialisation among Swedish medical students.
246  Katarina Mozetic j Being Highly Skilled and a Refugee

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”:

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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 discri-
minated 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 col-
league, 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 de-
mand 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 car-
eers, 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 flow-
ers! 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
 Refugee Survey Quarterly  247

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 intro-

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duce 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 un-
employed. 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 li-
cense. 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 point-
ing 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
248  Katarina Mozetic j Being Highly Skilled and a Refugee

[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

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better, because it was like that the whole time.

7 . D I S C US SI O N
By making use of the conceptual framework combining Brubaker and Cooper’s dis-
tinction between “identification and categorization”, and “self-understanding and so-
cial 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 ma-
terial. Three main findings are drawn about how the highly skilled refugees who
were interviewed perceived themselves and their social locations. The chosen con-
ceptual 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 inter-
actions surrounding them.

7.1. Self-understanding: “provider” versus “recipient”

The interviewees’ narratives show that being a doctor incorporates two important as-
pects. 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 pro-
fession 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 them-
selves as “providers”. For them, being a physician entails an active contribution to pa-
tients’, 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 re-
lation to the term “refugee”.
 Refugee Survey Quarterly  249

As suggested by Jenkins,44 these self-identification processes can only be under-

stood when taking into account how the interviewees were categorised at the institu-
tional 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 cat-

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egory 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 inter-
viewees’ own self-perceptions. Rashid’s remark about refugees hints at a possible ex-
planation. 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 pas-
sivity 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 disadvan-
taged social location in which they found themselves.
Pertaining to their professional re-establishment, the interviewees were also cate-
gorised 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 med-
ical qualifications outside of the EU. When it comes to Swedish language courses,
the interviewees were obviously categorised according to their immigrant back-
ground, 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 categor-
ised 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 pro-
cess, but the actual design of the process impeded, rather than supported, the inter-
viewees’ 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

44 Jenkins, Social Identity, 40–48.

250  Katarina Mozetic j Being Highly Skilled and a Refugee

same or even a lower position than their much younger and less experienced
Swedish colleagues. More importantly, it was through their daily workplace inter-
actions 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

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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 some-
one 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 med-
ical 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 them-
selves. Instead, “refugee” is a label that is appointed to them. The interviewees in-
stead perceive themselves as foreigners – a term that is less negatively loaded, yet
still captures the inhibiting elements of these individuals’ existence. Thereby, the mi-
grant 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 refu-
gees rattles their doctor-identity. This is not only the case during the licensing pro-
cess: 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 proces-
sual, partly self-construction, partly categorization by others, partly a condition, a sta-
tus, 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

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).
 Refugee Survey Quarterly  251

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 acknow-

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ledge the value that each individual possesses.