Ethical International Healthcare Recruitment: How Can Countries Recruit Nurses Without Causing Harm?
International healthcare recruitment has become an increasingly important part of the global healthcare workforce.
Hospitals in many high-income countries are struggling to recruit and retain enough nurses, doctors, and other healthcare professionals, while qualified professionals in other countries are seeking better career opportunities, higher salaries, professional development, and the chance to build a different future for themselves and their families.This creates a genuine opportunity. International recruitment can help hospitals fill critical vacancies while giving healthcare professionals access to opportunities that may not exist in their home countries.
But it also creates a difficult question: how can countries recruit the healthcare professionals they need without weakening the healthcare systems of the countries they leave behind?
This is the central challenge of ethical international healthcare recruitment.The issue has become even more important in 2026. In May, WHO Member States approved amendments to the WHO Global Code of Practice on the International Recruitment of Health Personnel, strengthening the international framework for managing health-worker migration. WHO has also announced that an updated Health Workforce Support and Safeguards List will be published later in 2026. For healthcare employers and recruitment organizations, ethical recruitment is therefore no longer simply a matter of corporate responsibility. It is becoming an essential part of how international healthcare recruitment should operate.
Why International Healthcare Recruitment Is Growing
Healthcare workforce shortages are not limited to one country.Across OECD countries, international migration has become an increasingly important source of doctors and nurses. The OECD's 2025 analysis, produced in collaboration with WHO, describes growing workforce shortages and increasing global competition for healthcare professionals. (OECD)Foreign-trained doctors represented an average of 20% of the medical workforce across OECD countries in 2023, compared with 16% in 2010. In some countries, the proportion was considerably higher, exceeding 40% in Switzerland, New Zealand, Ireland and Norway, and reaching 59% in Israel. (OECD) Nurses are similarly mobile. Countries such as the Philippines, India, Poland and Nigeria are among the major sources of internationally mobile nurses working in OECD countries. This movement of healthcare professionals can be beneficial.A nurse who moves from one country to another may gain:
A higher income
Better career opportunities.
Access to specialist training
Improved working conditions
International experience
Greater financial security for their family
Opportunities for permanent migration
The destination country benefits too.
A hospital can fill a vacancy without waiting several years for a newly trained nurse to enter the workforce. Patients can receive care, hospitals can maintain services, and existing staff can face less pressure from persistent vacancies.The problem arises when international recruitment becomes concentrated in countries that cannot afford to lose healthcare workers themselves.
The Risk of Brain Drain
The term "brain drain" describes the loss of skilled professionals when they leave their country to work elsewhere. In healthcare, the consequences can be particularly serious. Training a doctor or nurse requires years of education, clinical training, and significant investment. When that professional leaves, the source country loses not only an employee but also part of its investment in its healthcare workforce.
Imagine a rural hospital in a lower-income country with ten nurses. If five nurses leave to work overseas and the hospital cannot replace them, the remaining five nurses may have to care for the same number of patients. Waiting times can increase, workloads can rise, and healthcare access can deteriorate.If this happens across hundreds of hospitals, international migration can contribute to a national workforce problem.
This is why WHO has established the Health Workforce Support and Safeguards List. The list identifies countries facing the most pressing health workforce challenges, and WHO discourages active international recruitment from these countries because further recruitment could worsen existing shortages. The previous 2023 list included 55 countries facing particularly serious health workforce challenges. The important point is that ethical recruitment does not mean international healthcare workers should never leave their home countries.It means recruitment should consider the circumstances of the healthcare system they are leaving.
Healthcare Professionals Have the Right to Move
Ethical recruitment needs to balance two legitimate interests. First, countries have an interest in protecting their healthcare systems. Second, healthcare professionals have a right to make decisions about their own careers and lives. A nurse who has spent years studying and working in healthcare should not be treated as if they are permanently owned by the healthcare system in which they trained.Healthcare professionals should be able to seek better employment, move internationally, and pursue opportunities elsewhere.
The goal of ethical recruitment is therefore not to prevent migration.
Instead, it is to manage migration responsibly.
WHO's Global Code of Practice was created precisely to address this challenge. It seeks to minimize the negative consequences of healthcare-worker migration while promoting sustainable health workforces. This distinction is important.The question is not:
"Should nurses be allowed to leave?"
The better question is: "How can international recruitment provide opportunities for healthcare professionals while protecting vulnerable healthcare systems and ensuring that migration produces benefits for more than one side?"
Recruitment Should Be Based on Transparency
One of the foundations of ethical recruitment is transparency.Healthcare professionals considering international employment should understand exactly what they are agreeing to. Recruiters and employers should provide clear information about:
Salary
Working hours
OvertimeContract length
Benefits
Accommodation
Relocation costs
Registration requirements
Licensing requirements
Language requirements
Visa conditions
Recruitment fees
Repayment clauses
Probation periods
Working location
Expected duties
A nurse should never arrive in another country only to discover that the job is substantially different from what they were promised.This may sound obvious, but international recruitment involves a particularly large information imbalance.A candidate may be moving thousands of kilometres away and entering an unfamiliar healthcare system. They may have limited knowledge of local employment law or professional regulations.That makes honesty especially important.An ethical recruitment company should therefore make sure candidates understand the opportunity before they commit to it.
Candidates Should Not Be Exploited
International healthcare workers can be particularly vulnerable to exploitation because of their immigration status. A nurse who has moved to another country under a work visa may worry that leaving an employer could jeopardize their ability to remain in the country. This can create an unhealthy power imbalance. Recruiters and employers should therefore avoid arrangements that make healthcare professionals excessively dependent on a single employer.
Contracts should be clear and lawful.
Workers should know their employment rights.
They should have access to appropriate grievance procedures.
They should be able to understand their employment agreement before signing it.
Recruitment should also never depend on misleading candidates about their future earnings or working conditions.
Ethical recruitment ultimately means treating the healthcare professional as a professional and a person, rather than simply as a vacancy that needs to be filled.
Recruitment Fees Matter
Another important issue is who pays for recruitment.Healthcare workers seeking international employment can sometimes face substantial costs related to recruitment, travel, documentation, professional registration, language testing and immigration.Excessive recruitment charges can leave workers heavily indebted before they have even started their new job.This is particularly problematic if a worker has borrowed money to secure employment overseas.Ethical recruitment should therefore seek to minimize unnecessary financial burdens on candidates and make every fee transparent.Where possible, employers or recruitment organizations can absorb appropriate recruitment costs rather than transferring them onto individual workers.The precise rules vary by country, profession and recruitment arrangement, so organizations should always comply with applicable local laws and regulations.
But the underlying principle is simple: A healthcare professional should know exactly what they will pay, why they are paying it, and what they are receiving in return.
Avoiding Recruitment From Vulnerable Health Systems
One of the most important safeguards is deciding where recruitment should take place.Not every country represents the same ethical risk.A country with a large healthcare workforce, strong training capacity, and more qualified professionals than available positions may be very different from a country experiencing severe shortages.This is why WHO's Health Workforce Support and Safeguards List is so important.WHO discourages active international recruitment from countries on the safeguards list because doing so could further weaken already vulnerable healthcare systems. Recruiters therefore need to understand more than just where qualified nurses are located.They need to understand the workforce situation in the countries from which they recruit.A large pool of nurses does not automatically mean it is ethical to recruit aggressively from that market.
Ethical Recruitment Can Create Shared Benefits
International recruitment does not have to be a zero-sum situation.A nurse leaving one country can benefit another country while also benefiting herself.The challenge is creating systems in which the source country can also benefit.There are several ways this can happen.One approach is investment in healthcare education.Destination countries and employers that benefit from international recruitment can contribute to training programs in source countries.
Another approach is structured migration agreements. WHO, the OECD and the International Labour Organization have developed guidance on bilateral agreements on health-worker migration and mobility, with the aim of creating arrangements that can produce benefits for both source and destination countries. These agreements can establish expectations around recruitment, training, workforce planning, worker protections and cooperation between countries.This is potentially much better than an unstructured competition in which wealthy healthcare systems simply recruit from whichever country has qualified professionals available.
Investing in the Countries That Train Healthcare Workers
There is a strong argument that destination countries benefiting from international recruitment should help strengthen the healthcare workforce pipeline globally.Suppose Country A recruits 1,000 nurses from Country B.
Instead of viewing the relationship simply as:
Country B → nurses → Country A
the relationship could become:
Country B → training + nurses → Country A → investment + training support → Country B
This creates the possibility of a more sustainable cycle.Investment could support:
Nursing schools
Medical schools
Scholarships
Clinical training
Continuing professional education
Healthcare facilities
Faculty development
Simulation centres
Professional development programs
The objective would not necessarily be to stop migration.Instead, it would be to ensure that healthcare-worker mobility is accompanied by investment in future healthcare capacity.That is consistent with the broader direction of the updated WHO Code, which encourages destination countries benefiting from international recruitment to establish mutually agreed, structured arrangements and strengthen cooperation with source countries. (WHO Apps)
Education Is One of the Most Powerful Solutions
One of the strongest long-term responses to healthcare shortages is simply to train more healthcare professionals. International recruitment can help fill immediate vacancies.Education helps increase the global supply of healthcare professionals over time. This is why ethical recruitment should not exist in isolation from healthcare education.Governments, healthcare organizations, universities, charities and recruitment companies can all contribute to developing the next generation of healthcare professionals.
Scholarships can help students who otherwise could not afford medical or nursing education.
Training partnerships can help strengthen healthcare institutions.
Continuing education can help existing professionals develop specialist skills.
And international partnerships can allow healthcare professionals to exchange knowledge across borders.
The result can be a system where migration and education work together rather than competing against each other.
Recruitment Should Complement Domestic Training
International recruitment should also not become an excuse for destination countries to stop training their own healthcare professionals.A country facing a nursing shortage has several options.It can:Train more nurses.Improve retention.Improve working conditions.Encourage former healthcare workers to return.Recruit internationally.Use a combination of all of the above.The OECD identifies these kinds of approaches as part of the broader policy options available to countries seeking to address healthcare workforce shortages. International recruitment can therefore be part of a workforce strategy without becoming the entire strategy.A sustainable healthcare system should continue investing in domestic education and retention while using international recruitment responsibly to address gaps.
Retention Is Part of Ethical Recruitment
There is another issue that is sometimes overlooked. Recruiting healthcare professionals internationally does not solve a workforce shortage if the destination country immediately loses those workers again. Hospitals need to think about retention. Why does a nurse leave?
Perhaps the workload is too high.
Perhaps pay is uncompetitive.
Perhaps there are insufficient opportunities for advancement.
Perhaps the nurse does not feel supported.
Perhaps the relocation process was poorly managed.
Recruitment and retention are therefore closely connected.An employer that spends money recruiting an international nurse but fails to support that nurse after arrival may simply create another vacancy a year later.Ethical recruitment should include appropriate onboarding and integration.Healthcare professionals moving internationally may need help understanding:The local healthcare systemWorkplace expectationsProfessional regulationsCultural differencesAccommodationTransportBankingLocal servicesProfessional developmentThe better the transition, the greater the chance that the professional will successfully establish a long-term career.
Supporting International Healthcare Workers After Arrival
The recruitment process should not end when the employment contract is signed. For an internationally recruited nurse, the first months in a new country can be challenging. They may be adapting to new clinical terminology, different documentation systems, different technology, different workplace cultures, and different expectations. They may also be adjusting to life far away from family and friends. Employers can help through structured orientation, mentorship, clinical support, cultural integration programs and accessible management. This benefits everyone. The nurse has a better chance of succeeding. The employer has a better chance of retaining the employee. Patients benefit from a stable and supported healthcare workforce. And the international recruitment process develops a stronger reputation.
The Importance of Professional Recognition
Ethical recruitment also means ensuring that internationally trained healthcare professionals are treated fairly during the licensing and recognition process. A nurse may have years of experience but still need to satisfy registration requirements in the destination country. This is reasonable because healthcare regulators must protect patient safety. However, processes should be transparent and efficient. Professionals should know:
Which qualifications are recognized
What examinations are required
Whether language testing is necessary
How long registration is expected to take
What documents they need
Whether additional training is required
Unnecessary uncertainty can discourage qualified professionals and create avoidable costs. Efficient recognition of internationally trained professionals can help healthcare systems use existing talent more effectively while maintaining appropriate professional standards.
The Role of Recruitment Agencies
Recruitment companies sit at an important point between healthcare professionals and employers. That gives them significant responsibility. A recruitment company can either make international migration safer and more transparent—or contribute to problems. An ethical recruiter should therefore:
Verify candidates' qualifications
Verify employer requirements
Provide accurate job information
Explain fees clearly
Avoid misleading claims
Respect professional regulations
Follow relevant immigration laws
Consider source-country workforce conditions
Protect candidate informationAvoid discriminatory practices
Support candidates through the recruitment process
Maintain appropriate standards after placement
Recruiters should also know when not to recruit.If a recruitment opportunity could clearly undermine an already vulnerable healthcare system, the responsible decision may be to reconsider the recruitment strategy.This is one reason international healthcare recruitment requires considerably more expertise than ordinary labour recruitment.
The 2026 WHO Code Update
The issue of ethical recruitment has received renewed attention this year.In May 2026, WHO Member States approved a resolution amending the WHO Global Code of Practice on the International Recruitment of Health Personnel. WHO described the amendment as an important step toward strengthening implementation of the Code and supporting sustainable healthcare workforces globally. (World Health Organization)The development is significant because international healthcare recruitment is no longer a niche issue.Healthcare-worker mobility is now an important component of workforce planning in many countries.The OECD and WHO have documented the increasing international mobility of doctors and nurses and the growing competition among countries for healthcare talent. (OECD)At the same time, WHO continues to emphasize the importance of protecting countries experiencing serious healthcare workforce shortages. (World Health Organization)The result is a growing expectation that international recruitment should be structured, transparent and sustainable.
What Ethical Recruitment Could Look Like in Practice
A genuinely ethical international recruitment model could look something like this:A hospital identifies a long-term shortage of nurses. Instead of relying entirely on expensive temporary staffing, it works with an international recruitment organization to identify qualified professionals. The recruitment organization assesses the hospital's needs and identifies suitable markets. Before recruiting, it considers whether the source countries have serious workforce shortages and whether additional safeguards are required. Candidates receive complete information about the position. Their qualifications are verified. They understand their salary, contract, registration requirements and immigration process.Recruitment costs are transparent. The candidate is not misled about the job. The hospital provides appropriate onboarding and support. The healthcare professional receives assistance with relocation and integration. The hospital invests in retention. And, where appropriate, the destination country or employer contributes to healthcare workforce development and education in source countries. This approach does more than fill a vacancy. It creates a responsible international workforce partnership.
The Future of International Healthcare Recruitment
The demand for healthcare professionals is unlikely to disappear. Population ageing, increasing healthcare demand, retirement among existing healthcare workers, and workforce shortages will continue to create recruitment pressure. At the same time, healthcare professionals will continue to seek international opportunities. International migration is therefore likely to remain an important part of global healthcare workforce planning.
The challenge is making that migration sustainable.Countries should not compete simply by offering higher salaries and recruiting increasingly aggressively from the same limited pool of healthcare workers. Instead, the future should involve greater cooperation. Destination countries can invest in training. Source countries can develop stronger healthcare education systems. Recruiters can adopt responsible recruitment standards. Hospitals can improve retention. Governments can develop bilateral agreements. Healthcare professionals can make informed decisions about their careers, and international organizations can provide frameworks to help coordinate these efforts.
A Better Model for Global Healthcare Recruitment
Ethical international healthcare recruitment is ultimately about balance. Healthcare systems in destination countries genuinely need nurses.Healthcare professionals genuinely want international opportunities. And source countries genuinely need functioning healthcare systems. All three realities can exist at the same time.The answer is not to stop healthcare professionals from moving. Nor is it to allow wealthy healthcare systems to recruit without considering the consequences. The better approach is to build a system in which healthcare-worker mobility creates opportunities while strengthening, rather than undermining, global healthcare capacity.
For recruitment organizations, this means looking beyond the immediate placement. The goal should be to create successful, sustainable relationships between candidates and employers while respecting the healthcare systems and communities involved.
For employers, it means viewing international recruitment as part of a broader workforce strategy that includes domestic training, retention and professional development. For governments, it means creating policies that allow healthcare professionals to move while protecting vulnerable health systems. And for the healthcare professionals themselves, it means having access to transparent opportunities that allow them to make informed decisions about their own careers.
Huz Health's Perspective
At Huz Health, we believe international healthcare recruitment should create opportunities for both healthcare professionals and the organizations that need them. Recruitment should never be about treating healthcare workers as commodities. It should be about connecting qualified professionals with legitimate opportunities while supporting them throughout the international placement process. As the global demand for healthcare professionals continues to grow, we believe the recruitment industry has an important role to play in building a more connected and sustainable healthcare workforce.International recruitment can help fill critical vacancies today. Ethical recruitment should also help build a stronger healthcare workforce for tomorrow.
Sources
World Health Organization — WHO Global Code of Practice on the International Recruitment of Health Personnel (World Health Organization)
World Health Organization — WHO Global Code amended, May 2026 (World Health Organization)
World Health Organization — Health Workforce Support and Safeguards List (World Health Organization)
World Health Organization / OECD / ILO — Bilateral Agreements on Health Worker Migration and Mobility (World Health Organization)
OECD — International Migration Outlook 2025: International Migration of Health Professionals to OECD Countries (OECD)
OECD — Health at a Glance 2025: International Migration of Doctors (OECD)
OECD — Health at a Glance 2025: International Migration of Nurses (OECD)
OECD — Migration of Health Workers (OECD)
WHO — Health Workforce (World Health Organization)
WHO — Health Workforce Migration (World Health Organization)