The ongoing Iran–Israel conflict, and the Indian government’s efforts to evacuate its citizens — especially medical students — from the region, has once again thrown the spotlight on a recurring question: Why do so many Indian students go abroad to study medicine?

According to the MEA’s estimated data of Indian students studying abroad, in 2022, about 2,050 students were enrolled in Iran, mostly for medical studies, at institutions like the Tehran University of Medical Sciences, Shahid Beheshti University and Islamic Azad University. A significant number of the students are from Kashmir.

This is not the first time a geopolitical crisis has exposed the scale of India’s outbound medical education. In 2022, during the Russia – Ukraine war, the Indian government had to evacuate thousands of medical students under ‘Operation Ganga’.

A growing trend

Story continues below this ad

Despite a significant rise in the number of medical seats in India—from around 51,000 MBBS seats in 2014 to 1.18 lakh in 2024 —tens of thousands of students continue to pursue medical education abroad. The trend is visible in the rising number of candidates appearing for the Foreign Medical Graduate Examination (FMGE), which is mandatory for practising medicine in India after studying abroad. About 79,000 students appeared for the FMGE in 2024, up from 61,616 in 2023 and just over 52,000 in 2022.

This outward movement is driven by two main factors: competitiveness and cost.

Story continues below this ad

“While the number of MBBS seats have increased in the country, the field continues to remain competitive. Students have to get a very good rank to get into government colleges,” said Dr Pawanindra Lal, former executive director of the National Board of Examinations in Medical Sciences, which conducts the FMGE.

More than 22.7 lakh candidates appeared for NEET-UG in 2024 for just over 1 lakh MBBS seats. Only around half of these seats are in government colleges. The rest are in private institutions, where costs can soar.

“A candidate ranked 50,000 can get admission in a good private college but the fees can run into crores. How many people in the country can afford that? It is just simple economics that pushes students towards pursuing medical education in other countries. They can get the degree at one-tenth the cost in some of the countries,” said Dr Lal.

Story continues below this ad

Why do so many Kashmiri students go to Iran?

While affordability draws many Indian students abroad, Iran holds a unique appeal for those from the Kashmir Valley. For them, the choice is shaped not just by economics, but by cultural and historical ties.

“Kashmir for a very long time has been called Iran-e-Sagheer or Iran Minor,” said Professor Syed Akhtar Hussain, a Persian scholar at Jawaharlal Nehru University. “The topography of Kashmir and the culture of Kashmir are similar to that of Iran. In the old times, they always thought Kashmir was a part of Iran in a way. In the 13th century, Meer Sayyed Ahmed Ali Hamadani came to Kashmir from Iran. He brought about 200 Syeds along with him, and those people brought crafts and industry from Iran to Kashmir. They brought carpet, papier-mâché, dry fruits and saffron too. Historically, this is the link”

Religious affinity is another driver. “Because there is a Shia element in Kashmir, and Shia presence in Iran, there is that affinity. Iran also feels happy that it has that special space in the heart of Kashmir,” he said.

Story continues below this ad

Most Kashmiri students pursue medical education in Tehran, while others study Islamic theology in the holy cities of Qom and Mashhad. According to Prof. Hussain, Iran has even created admission pathways tailored for Kashmiri students. “Iran gives some concessions to Kashmiri students to study there. By virtue of being Shia, they get admission very quickly and easily… for Kashmiris in Iran, it’s less expensive.”

This is often referred to as the “pargees quota”.

What are the risks?

Though admission is relatively easier and cheaper abroad, experts warn of important caveats in medical studies abroad.

“There are not a lot of eligibility requirements. If the student can pay, they usually get admission. Some universities run two batches for each year to accommodate more students,” said Dr Lal. However, he warned that some foreign universities operate two tiers of medical education: one designed to produce local doctors, and another primarily to award degrees to foreigners. “In fact, after completing some of the courses meant for foreigners, the students may not be eligible to practice in the host country,” he said.

Story continues below this ad

To address this, India’s National Medical Commission (NMC) has introduced a rule stating that students will be eligible to practise in India only if they are also eligible to practise in the country where they studied. The NMC also mandates that the medical course be 54 months long, completed at a single university, followed by a one-year internship at the same institution.

Dr Lal also flagged the lack of transparent information: “There are no foreign colleges or universities listed by the country’s medical education regulator that people can trust… The regulator should either provide a list of approved colleges or select, say, the top 100 colleges from a given country.”

What happens when such students return?

Even after securing their degree, foreign-trained doctors face several hurdles in India. Students from the Philippines, for instance, faced recognition issues because their courses were only 48 months long, short of the required 54.

Story continues below this ad

Another bottleneck is the FMGE, which all foreign-trained doctors must clear. The pass rate has historically been low: 25.8% in 2024, 16.65% in 2023, and 23.35% in 2022.

“Even afterwards, they face challenges in getting employed. This is because their training is not as robust. Sometimes there is a lack of patients and practical training. The FMGE questions are simple, meant to test the students’ practical knowledge. And, yet, many are unable to pass the examination even after several attempts,” said Dr Lal.