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
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RUEAHLC/HOMELAND SECURITY CENTER WASHINGTON DC
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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