What it’s like to be visibly Muslim in the NHS

However, while efforts have been taken in recent years to tackle racism and boost inclusivity in the health service, clinicians from one minority group told Nursing Times that they often still faced discrimination, especially when speaking up or asserting themselves.

“As soon as [the patient] saw me, he said he didn’t want the hijabi girl to take care of him”

Fatima Al Ali

The 2021 census suggested around 6.5% of the UK population (3.9 million people) identify as Muslim and, like other religious minorities in the country and around the world, many have faced discrimination on the grounds of their religion.

But discrimination is often even worse when they are ‘visibly’ of a religion, according to nurses and midwives who are Muslims.

They told Nursing Times that false assumptions, additional scrutiny and even patients refusing to accept treatment were just some of the challenges they faced.

This was particularly true of Muslim clinicians who wear hijabs, or other head coverings, as a way of expressing their faith or modesty.

Wearing the hijab is voluntary and is generally only be taken off in the presence of men in their immediate family. Most hijabi women also cover up their arms with long-sleeved tops.

Fatima Al Ali, a nurse from Birmingham, told Nursing Times that she had experienced discrimination from patients while at work due to her choice to wear a hijab.

Midlands-based nurse Fatima Al Ali

Ms Ali, who moved from Dubai to the UK in 2021 for work, said she has been asked to remove her hijab countless times and had felt bombarded with questions and misplaced worry about her welfare due to incorrect assumptions about Islam.

She said that, mostly, the discrimination she has faced has come from a place of ignorance rather than malice: “I wouldn’t say staff were [discriminatory], but they were not aware about what is a hijab or why I’m wearing it; the reasons, is it fine for me to remove it.

“[They ask] why you’re wearing it, is it necessary, that was the feeling I got from them at first. Staff would ask, OK, can you remove your hijab? Can you show us your hair?”

She continued: “I had multiple questions from patients asking if I should wear it in summer when it’s hot, they asked me if I was allowed to remove it, telling me it’s too hot, like I was suffering. I’m not suffering.

“They don’t understand that Islam is not something you are forced to do. It’s your choice, like if you want to read a magazine, read a book, go to church.”

During Ramadan, this year 10 March to 9 April, Ms Ali said her visibility as a Muslim in the NHS was heightened. The religious month sees Muslims fast during hours when the sun is up, culminating with Eid, a celebratory day of feasting.

Ms Ali said she would spend her days at work fielding questions about why she was doing it and if she was OK, with some people even questioning if she was “torturing” herself.

She said: “It’s not torture, it’s a lovely month for me. I don’t mind people asking me about Ramadan because I ask a lot of questions about Christmas, Easter, but that feeling that you are being tortured or doing something wrong – it’s different.”

However, while a lot of the comments and questions that Ms Ali receives while working as a nurse are not malicious, she has found some to be far more upsetting.

At one point, she said, a patient refused treatment from her because she wore a hijab.

“As soon as he saw me, he said he didn’t want the hijabi girl to take care of him,” she recalled.

“I just thought, ‘what did I do?’ My hijab doesn’t have anything to do with that I am a nurse, taking care of patients.”

With her practice questioned because of her religion, Ms Ali said this incident left her upset for the rest of the shift and is something she remembers from her first job in the UK.

However, she said that, in the time she has been in the UK, trusts have, in general, been supporting staff from religious minorities better.

“From the NHS itself, the hospitals, they have provided services and facilities,” she said.

Fatimah Mohamied, a midwife based in London

“[There are] places for prayer, our hospital is pretty good,” she noted. “Before Ramadan, the hospital sent an email around.”

But she added: “I would say the Muslim community could do more about publicity [for Ramadan].

“A lot of people understand, whether or not they are Indian, about Diwali, but Muslims could do more with making people understand about Ramadan and hijab.”

The percentage of Muslims working in the health service is less than in the overall population. For example, an estimated 3.3% of the 1.4 million NHS workers in England are from a Muslim background.

However, the number of nurses and midwives who identify as Muslim on the Nursing and Midwifery Council (NMC) register doubled between 2018 and 2023, from 9,323 to 17,389, representing 1.4% and 2.2% of registrants, respectively.

Ofrah Muflahi is one of the founders of the British Arab Nursing and Midwifery Association (BANMA), an organisation set up in 2023 to support the growing number of nurses and midwives of Arab descent, of which there are around 600 on the UK register.

She said wearing a hijab brings “challenges” for Muslim women. “As founder of BANMA, I fully understand how the practice of wearing the hijab relates to their identity,” she said.

Fatimah Mohamied, a midwife of six years based in London, said she had not experienced such a “density” of direct and indirect discrimination due to her religion as she has in her current profession, having previously worked in the NHS for several years in another field.

She told Nursing Times about her experiences of detriment, exclusion and additional scrutiny in her work as a midwife.

According to the NMC, Black, Asian and minority ethnic nurses and midwives are statistically more likely to be the target of a fitness-to-practise referral.

Ms Mohamied said her appearance has led to her experiencing this racial disciplinary gap first hand as a midwife.

She recalled a placement supervisor demanding she roll her sleeves up, threatening to not sign off on paperwork if she did not.

That same supervisor, she said, then put in a series of complaints about her, including falsely claiming she had been involved in a neonatal death.

Ms Mohamied said, due to her hijab, people have “a lot of preconceptions” about her personality when they first meet her.

The midwife said people assume hijabi women are meek, quiet and repressed – and become uncomfortable when she expresses her extroverted, loud and self-advocating personality.

“People think this because of the media and because of our society, and how we are presented to the world,” she said. “I’m pretty much an antithesis to all of that.”

Ms Mohamied continued: “I am a critical thinker, I agitate, I challenge; those are qualities you should have in healthcare… [but] there is greater agitation when I agitate because people don’t expect that.”

She also suggested that some White staff were less happy to take criticism of their practice from colleagues from a minority ethnic background due to unconscious bias.

She said: “It adds insult to injury that it’s from a Muslim woman who is telling you differently and trying to correct you.”

Worse still, Ms Mohamied said first-impression prejudice led people to assume she was a religious radical, or that she could not perform her job properly.

She continued: “Several times, there has been this open-eyed expression, like, ‘Oh my God, I was not expecting you. Can you do your job? Am I going to be safe with you? Are you going to start preaching Islam to me and try to convert me?’”

Ms Mohamied said discrimination was worse when she showed any sign of performing her religion during breaks at work.

Practising Muslims pray multiple times per day and she recalled “hiding away” early in her career. In one workplace, she was told she was not allowed to pray during working hours, even while on a break.

“I will respect them, even if they don’t want me in the room, because that is my duty as a midwife”

Fatimah Mohamied

While today she is more confident, she said many people still feel “threatened” when a Muslim opts to perform their religion in public.

“It makes people uncomfortable, because it makes visible the religious part of being Muslim,” she said.

However, there may be cause for optimism, suggested Ms Mohamied.

“In the past few years, there is more of a discussion in the NHS around cultural safety and anti-racism, there is a willingness to accommodate and there are trusts which accommodate staff fasting,” she said.

“Some have placed prayer mats in the break rooms,” she said. “But we still have a long journey to go.”

Overall, Ms Mohamied said that awareness of race, racism and the need to combat discrimination at a national level had improved, particularly in the last four years.

She pointed to the death of George Floyd and the subsequent Black Lives Matter movement as a turning point.

“We have crossed that line in terms of awkwardness around terms like White privilege and whiteness and race,” she said.

“I feel optimistic that the conversation and the language will be more engaged with… and from what I have seen, in London, there is a greater conversation happening.”

Despite this, she said recent and the ongoing conflict in Gaza and the wider Middle East region have made her, and other Muslims, feel unsafe and fearful as a visible religious minority.

Ms Mohamied added that such assumptions were devastating for Muslim nurses and midwives, and that she experienced feelings of hurt and betrayal from people she assumed would know better.

“I first have to go in with just expressing my full humanity, I’m just human,” she said. “I have to work extra hard to just show that I can be as equal as any White person – that there won’t be any assumptions, that I will be a good midwife.”

Highlighting her commitment to her profession, she added: “I will respect [my patients], even if they don’t want me in the room, because that is my duty as a midwife.”