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Cablegate: The Syrian-American Medical Connection

VZCZCXRO7600
RR RUEHTRO
DE RUEHDM #1162/01 3441010
ZNR UUUUU ZZH
R 101010Z DEC 07
FM AMEMBASSY DAMASCUS
TO RUEHC/SECSTATE WASHDC 4434
INFO RUEHAM/AMEMBASSY AMMAN 7164
RUEHEG/AMEMBASSY CAIRO 3501
RUEHLB/AMEMBASSY BEIRUT 4813
RUEHGB/AMEMBASSY BAGHDAD 0618
RUEHYN/AMEMBASSY SANAA 0308
RUEHKU/AMEMBASSY KUWAIT 1285
RUEHAK/AMEMBASSY ANKARA 5396
RUEHIT/AMCONSUL ISTANBUL 0301
RUEHTV/AMEMBASSY TEL AVIV 2046
RUEHJM/AMCONSUL JERUSALEM 1533
RUEHMS/AMEMBASSY MUSCAT 0089
RUEHMK/AMEMBASSY MANAMA 0635
RUEHAD/AMEMBASSY ABU DHABI 1355
RUEHDI/AMCONSUL DUBAI 0152
RUEHDO/AMEMBASSY DOHA 0456
RUEHTU/AMEMBASSY TUNIS 2918
RUEHAS/AMEMBASSY ALGIERS 0421
RUEHRB/AMEMBASSY RABAT 0608
RUEHCL/AMCONSUL CASABLANCA 0890
RUEHTRO/AMEMBASSY TRIPOLI 0032
RUEHRH/AMEMBASSY RIYADH 7915
RUEHJI/AMCONSUL JEDDAH 2692
RUEHTH/AMEMBASSY ATHENS 0316
RUEHPNH/NVC PORTSMOUTH 6418
RUEAHLC/HOMELAND SECURITY CENTER WASHINGTON DC
RUEAIIA/CIA WASHDC
RUCNFB/DIR FBI WASHDC

UNCLAS SECTION 01 OF 03 DAMASCUS 001162

SIPDIS

SENSITIVE
SIPDIS

E.O. 12958
TAGS: CVIS CASC OEXC SCUL KFRD SY
SUBJECT: THE SYRIAN-AMERICAN MEDICAL CONNECTION


1. (SBU) Summary: Doctors receive the vast majority of the H1-B
visas and nearly half of the J-1 visas issued at Embassy Damascus.
They are likewise responsible for a substantial portion of the
B-1/B-2 visas issued at Post. Syrian doctors typically remain in
the U.S. at least until they naturalize, spending part of that time
working in underserved areas. In addition to contributing their
talents to the U.S. medical field, many have donated their time and
money to improving healthcare in Syria. This aspect of the
U.S.-Syrian bilateral relationship has been supported by the SARG,
and Post has worked to ensure that this important conduit remains
free from fraud. End summary.

--------------------------------------------- -
DOCTORS: THE BREAD AND BUTTER OF THE NIV UNIT
--------------------------------------------- -

2. (SBU) Syria is not well-known in the United States as a bountiful
repository of top-notch medical talent, but that reputation would be
well-deserved. A common claim heard in Damascus is that Syria is
second only to India as a source of foreign-born doctors working in
the US. While this statistic is apocryphal, the numbers from the
NIV database clearly demonstrate that doctors are a valuable Syrian
export. Of the 74 H1-B visas issued to Syrian citizens worldwide in
2006 (66 of them in Damascus), 54 of them were issued to doctors or
dentists (nearly 73 percent of the total). Likewise, they
constitute a substantial portion of J-1 visa holders. Doctors
performing their residencies and medical students taking clinical
observerships accounted for 79 of the 180 (or 43.9 percent) J-1
visas issued to Syrians in 2006. (Most of the rest were
participants in the DOS International Visitor Program.)

3. (SBU) These numbers may seem small compared to the 4,232 NIVs
issued to Syrians in Damascus in 2006, but they have powerful
multiplier effects. Doctors' spouses and children comprise a
similar proportion of the H-4 and J-2 derivatives issued at post,
and several B-1/B-2 applicants per day are their parents and
siblings. More importantly, the H1-B or J-1 visas are seldom the
first U.S. visas these doctors have held. Often, doctors in their
early 20s will apply for a B-1/B-2 visa, either to take a medical
elective or the Step 2 Clinical Skills (CS) Exam of the U.S. Medical
Licensing Exam (USMLE), which must be taken in the U.S., or to
participate in the National Residency Matching Program (NRMP).

--------------------------------
A LEGAL PATH TO U.S. CITIZENSHIP
--------------------------------

4. (SBU) Syrian doctors commonly parlay their first B-1/B-2 into a
J-1 residency, followed by a period as an H1-B doctor. (Internists,
hospitalists, obstetricians, and oncologists seem to be the most
common specializations.) Later, they adjust status to Legal
Permanent Residency, and finally naturalize as U.S. citizens.

5. (SBU) In addition to enhancing the talent pool of the United
States, Syrian doctors also contribute to its diversity. In order
to remain in the U.S. after the end of their residencies as J-1 visa
holders, doctors must receive a waiver of Section 212(e) of the INA.
The easiest way to receive a waiver is to serve as an H1-B doctor
in an underserved area, which is usually rural and remote. As a
result, Syrian doctors bring their families and their culture to
places far removed from the handful of urban enclaves favored by
Syrian immigrants on family-based petitions.


DAMASCUS 00001162 002 OF 003


6. (SBU) Because of the security and opportunities citizenship
affords them and their children, these doctors are loath to violate
their status. Being very family-oriented, Syrian doctors often
return to visit their relatives in Syria, and the relatively short
validity of visas for Syrians (multiple-entry, two-year for J-1s and
one-entry, three-month H1-Bs) means that they have to maintain their
legal status scrupulously. They are therefore more likely to
overcome 214(b) than the broader Syrian applicant pool.

---------------------------
FRAUD ISOLATED, NOT ENDEMIC
---------------------------

7. (SBU) With young and often single Syrian doctors applying for
their first visas shortly after their graduation from medical
school, the best way to determine their commitment to adhere to
immigration law is often to judge the quality of their scholarship.
Therefore, the discovery in late October of this year that a B-1/B-2
applicant had presented a fraudulent Step 2 CS exam score was a
troubling development. (Thus far, Post has discovered only one
fraudulent USMLE document.)

8. (SBU) Until mid-August of this year, USMLE results were
distributed by regular mail and printed on paper with strong
security features. Since then, the ECFMG (the body that sanctions
the USMLE) has been distributing the results in PDF format on its
website. While USMLE results are never the sole factor in
determining visa eligibility, the ability of applicants to forge
these important documents more easily raises concerns. Post has
found ECFMG officials willing to confirm the authenticity of these
documents after the fraud was brought to their attention.

------------------------------------------
DUAL CITIZEN DOCTORS GIVE BACK THROUGH NGO
------------------------------------------

9. (SBU) One "offspring" of the Syrian-U.S. medical relationship is
the Syrian-American Medical Society (SAMS). SAMS is an apolitical,
non-profit organization founded by American medical professionals of
Syrian descent in 1998. With several hundred US-based members and
regional/state chapters, the organization's objectives encompass a
range of professional, educational, humanitarian and cultural
activities. Each July, with the Syrian government's full support,
SAMS holds an annual conference in Syria. Many members spend
several weeks in Syria around this conference teaching best
practices at local hospitals and medical schools, and donating pro
bono medical care to needy Syrians. In Syria, since local law will
not allow SAMS to establish a Syrian chapter, there is a separate,
independent association known as the Syrian American Medical
Association (SAMA).

10. (SBU) Establishing a more permanent footprint in Syria, two
SAMS members recently broke ground on the Syrian-American Medical
City, a private diagnostic hospital being constructed in suburban
Damascus, tentatively set to open in the summer of 2008. A separate
group of Syrian-American doctors, 26 in all, plans to begin
construction of a second hospital called, confusingly, the
Syrian-American Medical Center. Slated for completion sometime in
mid-2010, it will feature a cancer ward, a transplant center, and a
neonatal intensive care unit.

11. (SBU) Comment: Despite ongoing tensions between the two
countries, the Syrian-American medical relationship has faced little

DAMASCUS 00001162 003 OF 003


apparent opposition from the SARG. While visitors identified
through PD exchange programs have been directly discouraged by the
SARG from using or even receiving their visas, Post has no
indication that doctors have faced similar intimidation. Likewise,
there have been no reports of harassment of U.S.-trained doctors
when they return to Syria. Although many Syrian doctors choose to
remain in the U.S., the relationships they maintain with the Syrian
medical establishment, and the contributions made by those who
return, appear to have convinced the SARG to support this aspect of
our bilateral relationship.

CORBIN
DRAFT - 11/25/07

DRAFT - 11/25/07

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