If India is the world's second-largest source of internationally migrating nurses after the Philippines, Kerala is the reason. A single state — with roughly 2.8% of India's population — has for years accounted for the overwhelming majority of Indian nurses who go abroad. This guide explains why Kerala plays this outsized role, how destination patterns are shifting, current emigration numbers, and the practical pathways available to Kerala nursing graduates today.
Just How Dominant Is Kerala?
| Metric | Figure |
|---|---|
| Share of India's total nurse emigration that was Malayali, 2016–2019 | Roughly 85–95% |
| Malayali nurses who received emigration clearance, 2023 | 9,980 (out of 16,594 nationally) |
| Malayali nurses who received emigration clearance, 2024 | 8,572 (out of 14,584 nationally) |
| Malayali nurses who received emigration clearance, 2025 | 6,393 (out of 11,581 nationally) |
| Estimated Indian nurses (predominantly Malayali) currently in Gulf countries | Approximately 60,000 |
These figures are approximate and drawn from recent reporting (including Onmanorama's July 2026 coverage of clearance data) — treat the exact year-by-year numbers as indicative of scale and trend, not a live count. Emigration clearance statistics are collected by India's Ministry of External Affairs (via the Protector of Emigrants network) and are worth confirming at the source for current figures.
The clear trend since 2023: total numbers are falling. National Indian nurse emigration dropped roughly 30% between 2024 and 2025 alone, and Kerala's numbers fell alongside it — driven mainly by Gulf countries prioritizing their own citizens for hospital jobs, and tighter recruitment rules in some destination countries.
Why Kerala, Specifically?
1. Deep Nursing Education Infrastructure
Kerala has one of India's largest concentrations of nursing colleges relative to its population — commonly cited at 260+ institutions offering GNM (General Nursing and Midwifery), B.Sc Nursing, Post-Basic B.Sc, and M.Sc Nursing programs, spanning government and private colleges regulated by the Kerala Nurses and Midwives Council (KNMC) alongside the Indian Nursing Council (INC). This gives Kerala a large, steady annual output of qualified nursing graduates relative to state population — historically well beyond what Kerala's own health system absorbs at competitive pay.
2. Multi-Generation Diaspora Networks
Malayali nurse migration to the Gulf goes back to the 1970s oil-boom era, meaning there are now multiple generations of established Malayali nursing communities across UAE, Saudi Arabia, Qatar, Oman, Kuwait, and Bahrain. These networks matter practically: job referrals, informal mentorship on navigating a new country's hospital system, shared housing arrangements, and community support all lower the real-world barrier to migrating, especially for early-career nurses.
3. A Cultural Expectation, Not Just an Economic One
In much of Kerala — and Kerala's Christian and coastal communities in particular — nursing followed by overseas work has become a well-worn, socially normalized career track, in a way that's less true in most other Indian states. This cultural familiarity (families who already have a nurse relative abroad, communities that treat it as an established path rather than an unusual choice) reinforces the pattern generation after generation, independent of any single policy or economic push factor.
The Shift: From Gulf-Dominant to a More Mixed Picture
Historically, the Gulf has been the overwhelming primary destination for Kerala nurses — a 2016 report cited roughly 57% of Malayali nurses working abroad as based in Gulf countries, drawn by proximity, no separate licensing-exam requirement in most Gulf hospital-employment routes, and established recruitment channels.
Since COVID-19, the picture has diversified:
- Gulf countries are increasingly prioritizing their own citizens for hospital and clinical roles (a policy trend sometimes referred to broadly as "nationalization" or "Saudization"/"Emiratisation" depending on the country), reducing the number of new openings available to Indian nurses even as demand for healthcare staff generally stays strong.
- UK and US pathways have grown in relative importance, driven by active NHS international recruitment in the UK and persistent US nursing shortages, though both require a formal licensing/registration process the Gulf route generally does not.
- The absolute numbers are down across the board (see the table above), so "shift" should be read as a shift in the mix of destinations among a shrinking total, not a straightforward substitution of one growing pathway for a shrinking one.
Practical Pathways for Kerala Nursing Graduates
Gulf Countries (Historically the Largest Route)
| Step | What It Involves |
|---|---|
| Emigration clearance | Nurses require Emigration Check Required (ECR) clearance from a Protector of Emigrants (POE) office via the government's eMigrate portal before departing for listed ECR countries — this applies to nurses regardless of qualification level, a rule that surprises some graduates |
| Licensing exam | Generally not required to work as a hospital nurse in most Gulf countries — employment is typically employer/hospital-credential-based rather than exam-based, though this can vary by country and role |
| English requirement | Often not a formal test requirement for Gulf hospital employment, though individual employers may still assess English ability during interviews |
| Recruitment | Use only licensed/registered recruitment agencies — verify status via the eMigrate portal and MEA resources before signing any contract |
United Kingdom (via NMC)
Kerala nurses targeting the UK generally follow: B.Sc Nursing or GNM → IELTS or OET → NMC's overseas test-of-competence route (CBT + OSCE) → NMC registration and PIN. A relevant piece of recent history: the NMC relaxed some IELTS/OET scoring norms in 2022 in a change reported to specifically benefit Indian (including Kerala) nursing applicants, alongside the broader NMC English-language standard reviews covered in our Study Nursing in the UK guide. Confirm the current NMC minimums directly at nmc.org.uk before booking a test, since these figures are reviewed periodically.
United States (via NCLEX-RN)
The US route is the most document-and-exam-heavy of the major options: CGFNS credential evaluation → English proficiency evidence (IELTS Academic most widely accepted) → state Board of Nursing application → NCLEX-RN itself (Next Generation NCLEX format) → CGFNS VisaScreen if applying on an immigrant visa. See our full NCLEX-RN guide for international nurses for format and timeline detail. This route generally takes longer and costs more upfront than the Gulf pathway, but tends to offer significantly higher pay and a more defined long-term settlement route.
Canada (via NNAS)
Already-qualified Kerala nurses can pursue Canadian registration through NNAS (National Nursing Assessment Service) credential assessment, followed by NCLEX-RN in most provinces. See our dedicated NNAS process guide for the full step-by-step.
Practical Considerations Before Committing
- Verify every recruitment agency independently. Fraudulent or unlicensed agencies remain a real risk in Kerala's nurse-migration ecosystem — check eMigrate/MEA registration status and ask for the exact hospital and contract terms in writing before paying any fee.
- Don't assume the Gulf route needs no preparation just because it skips a licensing exam. Contract terms, accommodation arrangements, and employer reputation vary hugely — research the specific hospital, not just the country.
- If keeping UK and US options open simultaneously, IELTS Academic is the more broadly useful test — it's accepted by both NMC and (for the US) most state Boards of Nursing, whereas OET's US acceptance is still more limited by state. See our OET vs IELTS for Nurses comparison for a full breakdown.
- Budget for the fact that Gulf openings are shrinking — a plan built entirely around the historically dominant Gulf pathway is riskier today than it would have been five years ago; UK/US routes take longer to complete but are less exposed to the nationalization trend currently reducing Gulf openings.
Prepare for IELTS with Gabble — IELTS Academic is accepted for NMC registration in the UK and by most US state Boards of Nursing for NCLEX-RN eligibility, making it the single most broadly useful English test if you're weighing more than one destination. Gabble's AI-powered speaking and writing feedback gives instant, criterion-based scoring to help you reach the exact band score your target pathway requires.