Dr Gul Khan is a 50-something doctor working as a general practitioner at a private hospital in Jeddah. She’s the only caretaker of her parents back home in Pakistan.

Dr Khan and her husband are both Pakistani doctors who have been in Saudi Arabia for over 20 years, with their two children and Dr Khan’s parents, who go back and forth between Saudi and Pakistan a few times a year.

Her parents are not eligible for a resident visa (Iqama) and enter Saudi on a family visit visa instead. Iqama holders can sponsor a family visit visa for their spouses, their children, their parents, and their in-laws.

This arrangement is not unusual – parents and in-laws don’t typically qualify to become dependents. 

“It is obviously not as convenient as them having an Iqama but it works for the most part,” says Dr Khan. “It is only difficult to get the visas around Hajj season, for instance, so we have to time their visits slightly strategically – that is typically the main issue we have had to face over the year and of course the costs of applying for visas repeatedly.” These costs include visa fees, the visa extension fee, the flight tickets, and travel and health insurance several times a year, depending on how many visits the parents make.

Dr Khan’s parents flew back after a three-month stay in Jeddah to Pakistan in mid-February 2020 and were expected to fly to Jeddah again in late March. However, as coronavirus cases spread and countries placed additional restrictions on their borders, they quickly called their parents back to Jeddah just before flights were suspended, so that they could be together during this uncertain time. 

Dr Khan’s parents, and then the entire family, started showing symptoms of COVID-19 just days after reaching Jeddah. “Not sure if they picked it up at the airport or we brought it from work as people at work have been having it of course,” says Dr Khan. “We all got it though – me, my husband, my parents, and my kids who live with us.”

Dr Khan’s father, 72, had the most severe symptoms. He had to spend two weeks on a ventilator.

“The most important thing for us that mattered was my father’s recovery because he was the most critical. Two weeks later, he was well enough to be brought home. I wouldn’t say he was recovering but he was definitely not critical anymore. He still had very short breath all the time and was constantly coughing and sick in all sorts of ways but had tested negative and was off the vent so we brought him home.”

High costs of healthcare

In normal circumstances, Saudi Arabia has a mixed public and private healthcare system that are considered to provide services of similar quality, though the public healthcare system is open only to Saudi citizens and non-Saudi public sector workers. Everyone else is must purchase health insurance to access the private healthcare system. 

However, as of late March 2020, free treatment was to be provided to all coronavirus patients in all government and private health facilities. According to the Kingdom's health minister, free treatment extended to both citizens and residents – even those in violation of residency laws.

So, although Dr Khan’s father had travel medical insurance – mandatory for those on a visit visa – his costs at the hospital were covered by the government because he had tested positive for COVID-19. However, he never fully recovered and, in late April, had to return to the hospital. But because he no longer tested positive for COVID-19, his second treatment was not covered by the government.

Basic travel health insurance costs between SR30 to SR 100 typically – varying based on the age, sex, and medical background of the applicant – and must be issued by one of the seven insurance companies that are currently authorised by the Ministry of Health. The insurance typically claims to cover costs to a maximum of SR100,000  with policy limits set in the contract for hospitalisation, hospital rooms, doctor and nursing services, and life support limited to SR600 per day.

Dr Khan’s father stayed on the ventilator until his death in January 2021. And while the travel health insurance did cover a significant chunk of the costs, Dr Khan was left with a fairly large sum to pay out of pocket.

Although she doesn’t want to reveal how much she had to pay, she does point out that having personal contacts in the medical and insurance fields helped bring the costs down. Without those, the bills would have left her in significant debt.

“Being a doctor myself really helped,” she admits. “If I wasn’t, I wouldn’t have probably even asked them to fly to me. Not everyone can afford to have an elderly parent get sick. Insurance, especially a visitor’s insurance, can only cover so much. I also did consider sending him to Pakistan during the brief window he got better just because I was so worried about the costs.”

Saad, a 37-year-old employee at a finance company, says that he sent his father back to India because he was worried about the possibility of them getting sick and the potential bills – as was the case with one of his colleagues whose mother-in-law had to fly back after recovering from COVID-19, in needed additional health support that would not be covered by the government. Insurance was not a realistic option because it is overcomplicated and does not always cover what’s needed, he says. 

“My father lives with me for as long as I can keep him which is already pretty costly,” says Saad. “I am not sure how easy insurance companies are to work with here but I have an understanding that the coverage of someone on an Iqama and someone on travel insurance is not the same. God forbid if something were to happen to him here, I’d not be more worried about the costs than of his health.”

Saad typically flies his father out at least twice a year and his wife spends a few months a year with him back home just so the elder doesn’t have to be alone for long periods of time.

Saudi Arabia does allow family visit visas to be converted into a permanent residency permit for a close family member of an expatriate worker “under special conditions”.

Typically, a widowed mother or mother-in-law who is older than 60 has a higher chance of getting a permanent residency than an elderly father or father-in-law or when both parents are alive. There is, however, no set policy or guarantee on whether a request will be approved. Only spouses and children (except sons older than 18 and married daughters) are typically eligible to become dependents.

A spokesperson for the Ministry of Interior stated that expats who don’t have anyone to look after parents who have reached the age of 60 can approach the Passport Department and make a case. According to officials, the Passport Department goes through every request and makes a case-by-case decision based on the genuineness of the request.

Relatively higher salaries typically also make it more likely for an Iqama request to be approved. 

Dr Khan notes that at least a few of her colleagues have, in fact, been able to sponsor their mothers or in-laws.

“I know it takes some work and wasta but is probably doable – especially for me as both my husband and I are doctors and living comfortably but I guess I never thought about trying,” she says. “The multiple-visits on a visit visa arrangement seemed to be working fairly alright. It was an exceptional situation such as the pandemic that made me regret not having tried my sources to get my parents on an Iqama earlier.”

Dr Khan intends to apply for her widowed mother’s Iqama soon. 

Saad had tried to get an Iqama issued for his late mother-in-law once but the request was rejected.

“I don’t have any ‘inside contacts’ in the Jawazat [the General Directorate of Passports,” he says. “I applied and just hoped for the best but the request was rejected. I don’t know why. I think my salary is alright. I’m sure I could have supported one more dependent.”