German retirement homes are having trouble finding geriatric nurses. To resolve the problem, they're looking for help from abroad, recently expanding that search to Africa. Is it a good strategy? And for whom?


Mohamed Ali Nefzi, 23, wants to live in a country where he can wear floral-print shirts without being stared at. A place where his mother won't ask him every week when he is finally going to get married and how many children he plans to have. For Nefzi, who goes by Dali, Germany is that place.

A tall man in suit-pants and suspenders, Dali Nefzi squints over the frames of his sunglasses into the glaring light on the beach of La Goulette in Tunisia. He's a registered nurse in his home country and until recently he worked as a paramedic for Pireco, the pipeline contractor.

Now, he's been chosen to participate in the German program Triple Win. He and 17 other people from Tunisia are to help alleviate the extreme shortage of geriatric caregivers in Germany.

Waves are breaking behind Nefzi on the beach of his hometown of La Goulette. Children are shouting as they play on the beach, calls drift over from the nearby basketball court, music pumps out of the cafés and the noise of TVs can likewise be heard from the marble sidewalks. He will miss his family and friends, Nefzi says.

"My goal is for all people to live with a smile on their faces."

Some 250 kilometers (155 miles) to the south, boats full of Africans from myriad different countries, all dreaming of reaching Italy, set out to sea from near the Tunisian port city of Sfax. They are all full of hope for a better life in Europe and are willing to risk their lives to get there.

But the new geriatric nurses heading for Germany will take the plane. Nefzi refers to the offer to move to Germany for work as a "Schnäppchen," or "bargain" – an important German word he has already learned. He is excited about the freedom that Germany offers to young men and women. He wants to learn, to travel and to meet new people. And he wants to get to know the German culture.

He is unaware of the racism that also exists in Germany, of the right-wing populist, Islamophobic party that has 92 seats in Germany parliament which they use as a platform for their hate. That wasn't a topic of conversation in his one-week crash course on cultural differences and the German work ethic. But Nefzi isn't worried.


Nefzi took German lessons at the Goethe Institute in Tunis, paid for by his future employer, the Bavarian Red Cross (BRK). He only received his airline ticket after passing the test at the end of the course.

It costs the BRK at least 6,500 euros to recruit new caregivers from Tunisia. Their residency permit in Germany is directly linked to their job and candidates must first sign a contract with the German Society for International Cooperation (GIZ), a development organization that works directly with the German government. The employer in Germany, in this case the Bavarian Red Cross, only takes over responsibility for the candidate once he or she receives additional training, completes another German language class and passes two state exams for geriatric care.

In total, each Tunisian recruited with GIZ help costs participating companies more than 100,000 euros. It's a lot of money, but the investment could pay off. After all, there are very few geriatric nurses in Germany who don't already have a job – and the situation has remained unchanged for years. Currently, an open geriatric nursing position remains unfilled for an average of 171 days, the worst average among all professions. At the same time, the number of people requiring old-age care continues to rise in a trend that is expected to last until 2060. The share of geriatric nurses from abroad has likewise been rising for years and is currently at 11 percent.

There is, succinctly put, an extreme shortage of people who want to become geriatric nurses – and especially not in rural Germany, where caregivers earn a gross salary of just 2,600 euros per month. That's what the social services division of the Bavarian Red Cross pays nurses who care for the elderly, which means Nefzi's salary is below the average for nurses in Bavaria. Furthermore, there is a significant gap between the pay received by home health nurses, the job Nefzi trained to do in Tunisia, and geriatric caregivers.

It's hardly surprising, then, that retirement homes are eager to keep their workers, and offer them all kinds of perks to convince them to stay.

Nefzi will be working in a retirement home in Olching, a bedroom community just northwest of Munich with 30,000 residents along with an old town center and a Catholic church.

If a caregiver falls ill, a replacement is immediately sent by a temporary work agency. Home management regularly invites caregivers to a free meal as a sign of gratitude. And instead of a simple meal in the Christmas season, the workforce most recently went to the theater and to a concert together.

"I find it so sad in Germany that the elderly have to live like this."

One of Nefti's future coworkers has something to say that sounds rather astounding coming from a practitioner of the geriatric nursing profession: "The work here won't crush you. You can't really complain."

It is, in other words, a triple win – a situation in which all sides benefit. Tunisia wins because it means there are fewer young people who need jobs, given the country's youth unemployment rate of 35 percent. Germany wins because the influx provides a bit of a respite given the shortage of care workers. And the geriatric nurse-in-training from North Africa wins because he can migrate legally to the EU and has a job in the German labor market. It is a dream that millions of others will never be able to fulfill.

But there is a significant shortcoming in the system. Germany is not spending money to transform otherwise untrained school graduates into geriatric care specialists. Rather, the Triple Win program removes already trained nurses that Tunisia needs as well.

Officials at GIZ say they adhere to the World Health Organization's declaration of intent, which holds that the needs of the country supplying migrant labor be considered as well. GIZ also says they are working closely together with the Tunisian labor office.


"When everyone wins." That's the motto GIZ has chosen for its program aimed at recruiting foreign care nurses. But the truth is that Europe wins and Africa loses – at least if you ask those who are directly affected by the Triple Win pilot project in Tunisia.

Mounir Daghfous, a doctor and professor, leads the state-run emergency medical service in Tunis and was responsible for training Nefzi in emergency medicine, just as he has done for hundreds of others before him.

"We train them, and then they are lured away."

The four doctors and two caregivers who have already headed to Germany this year will soon be joined by others. A friend of Nefzi's – who is in the same GIZ program and who worked for Daghfous as an emergency caregiver – will be the next one to go.

Nefzi and the others are not part of the army of unskilled workers in Tunisia who have little hope of ever getting a job. On the contrary: Since quitting his job at Pireco one year ago, Nefzi has received four job offers. But, he says, he rejected all of them so he could fully dedicate himself to his German classes.

The rest of the 35 percent of young men and women who are unemployed will not receive any job training from Germany. They remain hopeless. In rural Tunisia, Islamists seek to attract the frustrated – and have historically had some success. Islamic State, which has now lost most of its territory in Syria, managed to attract an extremely high number of fighters from Tunisia and now the country is growing concerned about their return. Meanwhile, the UN's International Organization for Migration has catalogued a rapidly rising number of Tunisians seeking to make the dangerous Mediterranean crossing to Italy. In early June, more than 100 people lost their lives when their boat capsized not far from the port city of Sfax.


On April 12, a sliding door in Terminal C of the Munich airport opens up and the geriatric nurse-in-training Dali pulls his huge suitcase through. Along with his personal belongings, the suitcase also contains Tunisian olive oil and cookies baked by his mother.

Nefzi's new boss Monika Wochnik and two of her employees are there to greet him. From the airport, they drive Nefzi to his new apartment and then to the supermarket Aldi, and they also help him with his official paperwork and to open a bank account. They give him a new bicycle, as well.

Nefzi simply smiles and says "danke!" before repeating the word a few more times. Danke, danke, danke. And then he is alone in his 45-square-meter (485-square-foot) apartment – freshly renovated and furnished. Everything is quite new, and the walls are even decorated with framed pictures bought at the furniture store.

On the drive back and forth through Olching, Nefzi gazed in wonderment at his new surroundings. All the cars, all the big houses, and everything so orderly. Now, he steps out onto his balcony on a warm spring afternoon and asks:

"Where are all the people?"

It's early May and things are going well for Dali Nefzi. His boss raves about his empathy and the warmth he shows to patients. He is so friendly with the elderly, she says, patiently lifting, washing and feeding them.

In Tunisia, caregivers must train for three years and ultimately receive about half the education of medical doctors. But before flying to Germany to take up jobs as geriatric nurses, Nefzi and the others were warned that the job is not highly valued in the country, that they are merely there to wash and feed the patients. Only after a year, once their qualifications have been recognized, would they be allowed to administer injections such as insulin. Furthermore, they were told, they would likely be working for female bosses – a warning that program directors felt was necessary for caregivers from Tunisia, a Muslim country.

Nefzi says that the basics of elderly care – washing patients, changing their diapers, turning them in their beds – are taken care of by families in Tunisia. "I find it so sad in Germany that the elderly have to live like this," he says. So he tries to compensate for the German coldness, doing things like taking the fragile Ms. Maier by the hand and saying: "Come along, Ms. Maier, let's go to the garden." "Well," says Ms. Maier in response, "what a good idea."

Nefzi quickly became friends with Andi, a wiry young man who was Nefzi's shift partner at the beginning. Andi enjoys dancing to heavy metal and has taken Nefzi into Munich a few times, including a visit to the Hirschgarten, the city's largest beer garden.

Over a snack and a wheat beer, Nefzi talks about his views on god and life in general. He refers to his outlook on religion as "Islam light." He keeps a copy of the Koran on his bedside table, to be sure, but he doesn't pray five times a day. Alcohol is a sin – but just a small one, he believes. Hard drugs, on the other hand, are haram – strictly forbidden. The same holds true for talking bad about someone behind their back.

Andi listens intently. "I liked you from the very beginning, but on that, we see things exactly the same way, you and me. And the fact that you can also enjoy a beer, that makes me really happy."

Nefzi's training isn't going quite as planned. He learned the basics of geriatric care a few years ago and has been helping out for the last four weeks at a station. But much of what is done in practice is new to him. His immediate superior says he'll have to continue his observation period for four additional weeks. That wasn't the plan at the beginning, his superior says, but it's also not a big problem.

Nefzi himself is ecstatic. "I enjoy my work," he says. "And everyone here is so nice, it's like my new family." A female coworker who hears the comment smiles warmly.

But then, in late May, there is a setback. Ramadan, the Muslim month of fasting, has been underway since the 16th and Nefzi fasts the whole day through, for 18 hours at a stretch. And apparently, one of the 24 caregivers in the Olching team, a member of Nefzi's "new family," has a problem with that.

"Mr. Nefzi is facing a conflict."

Nefzi is accused of no longer washing women patients during Ramadan and of not responding to a resident's bell when he is breaking his fast in the evening.

The rumor makes the rounds for five days and Nefzi, because he has some time off due to a surfeit of overtime hours, cannot respond. "Mr. Nefzi is facing a conflict," says the woman who was so full of praise a few weeks before. "There is a need for consideration – on all sides." But not everyone in the team sees it that way.

"It's a lie," says Nefzi on the day he returns to work, defending himself during a team meeting. Yes, he is fasting, he says, but he is doing his job and jumping in when he is needed, just as he has always done. And, of course, he's still washing women because there aren't any men at his station at all.

Nefzi's superiors are embarrassed and the rumor cannot be confirmed. Just talk, apparently. Nothing to it.

But all the optimism that Nefzi brought with him from Tunisia has vanished. "Why do people do things like that? Nobody said anything to me directly, they're all so nice all the time." One of his coworkers, he says, even gave him dates at the beginning of Ramadan.

It is sinful to talk about others behind their backs, Nefzi believes. Apparently, at least one of his coworkers has a bit of repentance to do.

Shortly after the team meeting, Nafzi receives some good news. Adel, who he took German lessons with in Tunisia and who has now finally managed to pass his oral exams, will also be coming to Olching in June. The two will share the apartment at the edge of town.

That means that Mounir Daghfous' emergency care service in Tunis will once again be losing a paramedic. And the German geriatric care system will have another Tunisian employee.

If the two make good progress, Adel and Nefzi will advance to full geriatric nurse status instead of their current rank as assistants. That means they will earn full salaries, state recognition and, ultimately, permission to settle permanently in Germany.
Only then will it truly become clear who the winner is of Germany's search for nurses oversees.


Author: Christoph Titz
Photos and video: Christian Werner
Programming: Chris Kurt
Video editing: Roman Höfner, Bernhard Riedmann
Fact checking: Klaus Falkenberg
Graphics: Patrick Stotz
Design: Elsa Hundertmark
Motion Design: Lorenz Kiefer
Editing: Johannes Korge, Jens Radü