How the Ukraine war exposed education inequity in India

On Feb. 24, Divyanshu Gahlot woke up to a frantic video call. Overnight, Russia had invaded Ukraine, where he was attending his sixth and final year of medical school, and on the phone, Mr. Gahlot’s friend was pointing out his window at the plumes of smoke where Russian bombs were making landfall.

It would take nearly a week for Mr. Gahlot to make it home to India, and he wasn’t alone. About 22,000 Indians, mostly medical students, have fled Ukraine since the war began. Their ordeal – dodging bombs, walking for miles in freezing temperatures, long waits without food or water at border checkpoints – prompted wall-to-wall news coverage in India. It also begged a question: Why were so many Indians studying in Ukraine in the first place?

Every year, roughly 1.5 million students take the National Eligibility cum Entrance Test, or NEET, to compete for some 90,000 seats in medical schools across India. About half of those are at private universities where tuition and other fees easily exceed $100,000. As a result, tens of thousands of Indian students opt to study medicine in countries like China, Russia, and Ukraine, where education is cheaper.

Opposition to NEET has been brewing since the government introduced the exam in 2013. Critics say that NEET favors students from elite backgrounds who can afford specialized coaching – echoing arguments against the SAT and ACT in the United States – or who can attend expensive private colleges where the bar for admission is lower. “The system is not fair; there cannot be any doubt on that,” says Dr. Anand Krishnan, a professor of community medicine at the All India Institute of Medical Sciences in New Delhi. “Medical profession is not just pure knowledge. You have to be more humane. There are a lot of other characteristics which are important to look for.”

High competition, high cost

When Mr. Gahlot was in 11th grade, he left his hometown of Siryawali in northwest Uttar Pradesh to go to Kota, Rajasthan, the academic coaching capital of India. There, he says, he followed a grueling regimen of studying six to seven hours a day, but fell about 50 points short of what was required to get into a government-run college.

“It was totally depressing. I would think I’m not smart enough to be a doctor, I can’t do this,” he says. Several of his friends in similar situations chose different career paths. But Mr. Gahlot had made up his mind to become a doctor in eighth grade, and turned to his last resort – going abroad. He says he was too ashamed to tell his peers he was leaving India, because many see foreign medical students as “quitters” who weren’t able to crack NEET.

The fierce competition for Indian medical school seats cost another student his life. Naveen Gyanagoudar had gone outside to buy food when he was killed by Russian shelling in Kharkiv, Ukraine. Speaking to local reporters, his distraught father lamented that despite scoring 97% on high school exams, his son couldn’t get admission to a medical school in his own country.

The double blow of high competition and high cost means India’s new generation of doctors lacks diversity. “They are predominantly urban-centric kids, from well-entrenched, reasonably well-off middle-class families,” says Dr. Sita Naik, a former member of the Medical Council of India, which used to oversee medical education. Dr. Naik says these graduates are unlikely to move to rural areas, where the demand for doctors is the greatest. Rural India is home to two-thirds of the country’s population but only 20% of its doctors, according to a 2016 report.

In search of a fairer system

Some of the harshest opposition to NEET comes from the southern state of Tamil Nadu, where social justice movements have historically centered on access to education. In February, the state’s chief minister, Muthuvel Karunanidhi Stalin, called the exam “knowledge untouchability of the 21st century,” comparing its bias to that faced by India’s most oppressed castes.

Krishna Baskaran, a former Tamil Nadu schoolteacher who writes on education issues, agrees that a multiple-choice test covering physics, chemistry, and biology is a poor way to determine college admissions. 

“You don’t need merit to enroll yourself in college,” he says. “It is supposed to give you merit.” 

Before NEET, medical hopefuls would take up to a dozen entrance tests administered by different state governments and elite institutions. That was too stressful, says Dr. Krishnan, adding that a single, common test is a better idea. 

“NEET should be there, but don’t make it the only criteria. We have to find a sort of hybrid model,” says Dr. Krishnan. That could mean giving colleges the freedom to choose their own candidates through a series of interviews. Prior to NEET, that’s how admissions worked at Vellore’s Christian Medical College, whose graduates typically go on to work in underserved communities.

A 2021 report commissioned by the Tamil Nadu government echoes this call for a holistic approach. It found that admission requirements in India were “diametrically opposite” to other countries, most of which relied on a mix of factors – national entrance exams, interviews, high school GPA, etc. – to decide who gets admission into medical school, and granted more decision-making power to local governments or individual institutions.

Some states have also tried to stem systemic bias by reserving a proportion of medical school seats for underrepresented groups, including public high school graduates. Whatever the solution, the guiding principle, Mr. Krishna says, should be to “keep the entry point as democratic and as accessible as possible.” 

Back home, Mr. Gahlot is following the war in Ukraine closely, hoping he’ll somehow be able to finish his degree. Afterward, he plans to set up a practice in his village. There weren’t many doctors in Uttar Pradesh’s rural Bijnor district when he was growing up, and he wants to change that.