The competition has helped countries such as the U.S. and Australia replace some nurses who quit in record numbers during the height of the Covid-19 pandemic. But it is also leaving hospitals in developing countries and some wealthier nations such as the U.K. worse off, as they lose staff to countries offering bigger paychecks.

Australia has been one of the most aggressive poachers, with offers of special bonuses and fast-tracked visas. An Australian advertising campaign in the British Isles this past winter featured workers with sunshine streaming through windows behind them. The campaign coincided with British nurses going on strike over pay, long hours and other concerns.

“You can surf in the early mornings, go fly fishing on weekends, take photography classes, write novels, or sell preserves at the farmers’ markets,” stated an ad in the British Medical Journal, an industry magazine, for an emergency-medicine registrar job.

The health department in Australia’s Tasmania state, which placed the ad, said that like other local authorities it is looking to many countries including the U.K. for overseas workers.

The battle is part of a global resurgence in migration that is reshaping the world economy this year. As borders have reopened since the worst of the pandemic, countries have been welcoming foreign workers in selected industries to address labor shortfalls, helping push migration to record levels.

Douglas Chikobvu, a nurse at Gweru Provincial Hospital in Zimbabwe, said he has watched about a dozen nurses from his surgical ward move to take jobs abroad in recent years.

Chikobvu, who is secretary-general of the Zimbabwe Professional Nurses Union, said that in some hospitals one nurse sometimes ends up looking after 25 or 30 patients during a shift, instead of a more reasonable level of 10. Doctors are being forced to cancel procedures because they don’t have enough staff.

Zimbabwe’s vice president, Constantino Chiwenga, who is also the health minister, in April threatened that his country would pass a new law that would criminalize the active recruitment of Zimbabwe’s healthcare workers.

Data released by the U.K. government this year showed that the U.K. alone issued 17,421 health- and care-worker visas to Zimbabwe nationals in the 12 months to March 31—almost six times as many as in the previous 12 months.

Speaking at an event on human trafficking in April, Chiwenga referred to the recruitment of developing-world medical staff as a “crime against humanity.”

“If people die in hospitals because there are no nurses and doctors—and somebody who has been so irresponsible for not training their own nationals, but wanting poor countries to train for them—it’s a crime that must be taken seriously,” he said.

The World Health Organization in March this year published a list of 55 countries—37 of them in Africa—with the most pressing health-workforce challenges. These countries on average have just 15 health workers per 10,000 people, compared with 148 per 10,000 in high-income countries.

The WHO has asked its members not to actively recruit doctors and nurses from these 55 nations without first sealing bilateral agreements to support the countries where they are recruiting. Such support could include financing the training of new staff or plans for health workers to return to their country of origin after a number of years.

For wealthier countries, luring medical staff from abroad is attractive because it can take years to train nurses and doctors. Between 2020 and 2021, the U.S. lost more than 100,000 nurses, the largest decline on record, a study in the journal Health Affairs showed.

Since the height of the pandemic, hospitals have struggled to rebuild normal staffing levels and morale. Improved salaries and working conditions have since drawn some workers back, but shortages remain.

In Australia, the number of advertised vacancies for health professionals more than doubled from early 2020 to August 2022 and remained close to that historic peak nine months later, according to the most recent data from the Australian Bureau of Statistics.

The country granted 4,950 visas to healthcare workers over the nine months through March 2023, according to data from the Australian Department of Home Affairs. That number is up 48% from a year earlier—yet the country is still facing nursing shortages, officials say.

Ramsay Health Care, which owns more than 500 hospitals and clinics in Australia and 10 other countries, recently said a lack of skilled workers continues to limit its ability to treat patients. It is looking overseas for staff, it said.

Dr. Hardeep Kang, a sexual-health physician, was working in northern Britain when she was approached by a recruitment agency to see whether she would be interested in a move to Australia. She now works in Cairns, a city in northern Australia known as a gateway to the Great Barrier Reef, after migrating in November.

Kang said she now earns about $56,000 more a year than in the U.K., in part because of a supplement offered by the state government to sweeten roles outside major cities. Her daily commute involves riding a bicycle along the oceanfront.

Rebekah Daly, a radiologist who moved to Australia in January from Ireland, said that almost a quarter of her co-workers back home had quit to travel or work overseas now that Covid-related travel restrictions had been lifted, adding to the workload of those left behind.

The U.K. has introduced a new visa for healthcare workers with less onerous provisions than those for other skilled workers. It issued 101,570 visas to health and care workers in the 12 months ended March 31, nearly three times as many as during the previous year, with most recruits coming from India, Nigeria and Zimbabwe, according to government data.

After the publication of the WHO list, the U.K. government said health and social care organizations wouldn’t actively recruit from nations flagged by the agency, but there is nothing that stops health workers from these countries from applying for open posts.

Ireland—which depended heavily on overseas health workers before the pandemic—last year relaxed employment restrictions for non-European doctors already in the country as part of an effort to keep them.

More than 70 countries have introduced laws in recent years to make it easier to hire health workers from abroad, according to the WHO. Other rich countries like Germany have made the recruitment of healthcare workers part of high-level trips to countries such as Ghana, Brazil and Albania.

In the U.S., recruiting nurses from abroad effectively stopped because the type of green card that healthcare institutions use to hire nurses became so oversubscribed that the State Department stopped processing applications. Visa-screening requests from overseas healthcare workers, including registered and vocational nurses, rose more than 40% in each of the past two fiscal years, which run through September.

Some developing countries are pushing back by making it more difficult for health workers to emigrate.

The Philippines, which has long lost many of its healthcare workers to the U.S., imposed a temporary ban on more leaving during the pandemic. It continues to cap the number who can work overseas, even though doing so deprives the country of much-needed income from remittances.

Nigerian lawmakers are considering a bill that would require doctors to work at home for at least five years before they are allowed to emigrate.

Zimbabwe’s Health Service Commission, which oversees staffing there, says it needs 81,517 healthcare workers to meet population needs, but as of last September it had only 74,298.

Chikobvu, the nurse at Gweru Provincial Hospital in Zimbabwe, said he and his colleagues share ads for jobs in countries such as the U.S. and the U.K. in dedicated WhatsApp groups.

Despite seeing the effects of the medical brain drain in his country, Chikobvu is currently applying for nursing jobs in the U.S. and opposes restrictions on rich countries hiring nurses from poor ones.

He said his monthly income of about $425 isn’t enough to pay for his family’s food and healthcare and cover school fees for his four children.