Colombo, Sri Lanka – The harassment from a higher-up in the health sector was a burden. Feeling abandoned by the government during COVID-19 deepened the wound. But it was the economic downturn that followed the pandemic that drove Lahiru Prabodha Gamage over the edge.

The 35-year-old doctor from Sri Lanka left for the United Kingdom in January 2023, after spending six years in a government hospital in the remote town of Hatton, located 120km (75 miles) from Colombo. He is now a senior house officer with Britain’s National Health Service (NHS).

Leaving wasn’t an easy choice. “I have a deep love for my country. That will never change,” Gamage told Al Jazeera. “However, despite earning money, I was trapped under massive loans.” With the economy in shambles and inflation skyrocketing to a record 73 percent in late 2022, he saw no other option but to leave.

Gamage is part of a mass exodus. The Government Medical Officers Association (GMOA), Sri Lanka’s largest union of government doctors, reports that over 1,700 doctors have left in the past two years, primarily due to economic factors. This accounts for nearly 10 percent of the island's medical practitioners.

The already fragile healthcare infrastructure is suffering severely. In April of last year, all emergency surgeries were halted for weeks at the District General Hospital in Embilipitiya, approximately 200km (120 miles) from Colombo, due to the departure of two anaesthesiologists. Although another was temporarily relocated from a nearby hospital, she too eventually left for overseas training.

The paediatric ward at Anuradhapura Teaching Hospital, located about 200km (120 miles) northeast of Colombo, has also been temporarily shut down after its three paediatricians migrated. The GMOA has cautioned Health Minister Ramesh Pathirana that nearly 100 rural hospitals are on the brink of closure due to the doctor shortage.

Physicians argue this crisis could have been prevented.

Missing: money and respect

Gamage's primary salary was 64,000 Sri Lankan rupees ($213). Including overtime, it totaled about 220,000 rupees ($730).

“I had to maintain my car, cover food and housing costs, repay loans and support my parents,” he explained. “After all that, I was left with just 20,000 rupees [$67]. One party, and that money is gone.”

Adding to his woes was a profound sense of disrespect from government bodies.

During his stint as a junior doctor in a remote village, Gamage managed health camps after work hours. Together with another doctor, he developed a contact tracing app amid the COVID-19 outbreak. Rather than rewarding them for their initiative, the regime under then-President Gotabaya Rajapaksa commissioned a private firm to develop a similar app.

“We presented our app to the COVID-19 Presidential Task Force. They took notes but later awarded the project to a private firm,” Gamage lamented.

Cardiologist Eranda Ranasinghe Arachchi cited three reasons for his emigration. Now working in Northern Ireland, he spoke to Al Jazeera.

“Top reason: financial constraints. Second: improved working conditions. Third: a brighter future,” the 35-year-old stated.

He too felt undervalued by society, especially after the pandemic struggle.

“During COVID-19, we were stretched thin but strived to save lives,” Ranasinghe Arachchi said. “Much like other doctors, I avoided going home for days to prevent infecting my elderly parents.”

As Sri Lanka's economic situation worsened post-pandemic, citizens had to queue for hours for essentials like food, medicine, and fuel. Doctors were not immune to these hardships.

When the GMOA requested a special fuel quota for doctors, it met with public backlash. “I too had to wait in long lines, but that time could have been better used treating patients. Yet, public sentiment was against us,” he said.

A better future

The sky-high inflation, insurmountable foreign debt, and shortages brought about nationwide protests, culminating in Gotabaya Rajapaksa’s ouster in July 2022. The Rajapaksa brothers were later held accountable for the financial mismanagement by Sri Lanka’s Supreme Court in November 2023.

Ranasinghe Arachchi, the eldest of three siblings with retired parents, couldn’t afford to stick around.

He left in August 2022.

“As a middle-grade doctor in Sri Lanka, I earned about 400 pounds [$508] a month. In the UK, a similar role earns around 3,000 pounds [$3,800] a month,” said Ranasinghe Arachchi. And due to the soaring inflation, living costs in both countries were almost comparable.

Meanwhile, Gamage has been able to pay off some of his debts.

“In just a year, I cleared a 1.5 million rupee [$4,630] loan – a feat impossible if I had stayed in Sri Lanka,” he said.

As patients and hospitals reel from the shortage, the GMOA has proposed several recommendations to the government to stem the exodus.

“Doctors feel their salaries and services are highly undervalued in Sri Lanka. This is our main finding,” Hansamal Weerasooriya, GMOA executive committee member, told Al Jazeera.

He added that the absence of a comprehensive career development system and the lack of incentives for doctors in remote areas compound the disillusionment.

Deep-rooted social hierarchies also play a role. “In Sri Lanka, it's common for doctors to look down on or refuse to sit with nurses. This ego-driven system is hurtful,” Gamage noted. “In the UK, everyone is treated equally. This judgmental attitude back home was demoralizing.”

“I became fed up with the system.”

However, if conditions improve sufficiently – inflation has notably dropped – some doctors are open to returning.

“Despite traveling to many countries, I see none like Sri Lanka,” Ranasinghe Arachchi said. “I would gladly return if the working conditions and pay improve.”

Yet for now, he does not see that happening soon. Northern Ireland remains his home for the foreseeable future.