A hospital in London issued an apology to the family of a Sikh patient in December 2024, after staff cut his beard without his consent.
Although the 91-year-old patient was unable to communicate his needs, his family were left in tears and reported that he would have been ‘furious’ about what had happened [1].
Such is the strength of feeling behind religious expressions of identity for many, including articles of clothing and appearance. It is therefore not difficult to understand the value and sense of pride felt by NHS staff who wear religious articles of clothing, and the significance of religious rulings regarding appearance and dress to their identity. Muslim women who wear the hijab are such an example.
As a Muslim female doctor, there are unique challenges to practising medicine in the NHS. One of the greatest, although it may seem trivial to some, is the BBE (bare below the elbow) policy. Introduced in 2007 – despite a lack of evidence base for its implementation – it requires staff members to expose their forearms in clinical settings. This requirement is in direct contradiction to the religious dress code observed by a large proportion of Muslim women, creating a conflict for many between their faith and their profession, in a group of healthcare workers who are already vulnerable to discrimination because of their appearance [2].
This conflict is not inevitable. NHS England Uniforms and Workwear guidelines explicitly mention alternatives for Muslim women with regards to the BBE policy: the use of re-usable sleeves between patients and wearing long sleeves when not in direct patient contact [3].
As a former student member of University College London’s equality, diversity, and inclusion committee, I co-authored a guideline incorporating NHS uniform alternatives to facilitate medical students observing articles of faith and religious dress while also maintaining patient safety.
This encompassed four areas: mask fit-testing where a clean-shaven face is required – for those who cannot shave owing to religious reasons; religious head coverings in theatre; BBE for Muslim women; and the wearing of the Sikh kara, a religious bracelet.
We incorporated this guidance into the university’s dress policy, medical school examinations policy and implemented it in OSCEs (objective structured clinical examination) where disposable sleeves are now available for students sitting their examinations and are described in the examiner briefings.
Creating this guideline inspired confidence in me as a medical student in what could be achieved. However, the reality has been a stark contrast. Although the guidance within the NHS Uniforms and Workwear policy exists, it is up to individual trusts to implement it in their own uniforms’ policy, and the uptake is disappointingly low.
According to an analysis by BIMA (the British Islamic Medical Association), 48 per cent of NHS England trusts did not allow any BBE adjustments [4]. Another survey shows that 72 per cent of Muslim women were asked to be BBE when not engaged in direct patient care activity (contradicting the NHS Uniforms workwear guidance), 47 per cent felt they were treated differently at work owing to the uniform policy, 46 per cent felt their mental health had been affected by the uniforms policy, and a worrying 31 per cent considered leaving the NHS [5].
There has to be a shift in the perception of Muslim women who seek the BBE adjustments, and in the willingness of trusts to listen to them. Being constantly challenged because of the way you choose to dress has a toll; it causes self-doubt, a loss in confidence, and amplifies feelings of being at a crossroads between two deeply important things: your faith and identity, and your chosen career.
Furthermore, having to explain the reasons why you are dressed in a certain way leads to embarrassment and humiliation at work. Muslim healthcare workers have been told they are ‘a hazard to patient safety’ [2] and so significant is this conflict that some are abandoning their career paths altogether because of inflexible implementation of BBE policies [6]. The NHS Uniforms and Workwear guidelines are an example of how religious dress code can be respected and incorporated into clinical environments without contradicting safe practice or infection control policy.
Going from a medical student advocate to being a resident doctor, the responsibility is greater. I have spoken to international medical graduates new to the NHS who not only are unaware of the possible provisions regarding BBE but are also not comfortable advocating for themselves. The benefits of openly adopting the BBE alternatives policy are manyfold: colleagues are protected when challenged on their right to observe religious dress codes; staff are more aware of the policy; and there is normalisation of the presence of Muslim women in all clinical spaces. All without compromising patient safety.
Leaving medicine or surgery because of a dress code should be a never event. The university guidance that we authored is an example for medical schools, trusts, and medical royal colleges to learn from, especially as they pride themselves in diversity and inclusion, and are striving to tackle inequalities. Ensuring there is a culture of tolerance and respect gives all healthcare workers a sense of confidence and pride and makes us feel valued for who we are and what we do.
Mennatallah Yakoub is a core trainee 1 in general surgery from London
References
1. Sohal S. Family left ‘in tears’ after Sikh man’s beard cut. BBC News. 2024 Dec 21. https://www.bbc.co.uk/news/articles/c8ewy7581xgo
2. Aasma D. Exclusive: Muslim Medics Taunted About Bacon And Alcohol – By Their Own NHS Colleagues. HuffPost UK. 2020 Sep 13. https://www.huffpost.com/archive/in/entry/exclusive-Muslim-medics-taunted-about-bacon-and-alcohol-by-their-own-nhs-colleagues_in_5f5dfa4bc5b62874bc1e35f2
3. NHS England, NHS Improvement. Uniforms and workwear: guidance for NHS employers. London: NHS England; 2020 Apr 2. Available from: https://www.england.nhs.uk/wp-content/uploads/2020/04/Uniforms-and-Workwear-Guidance-2-April-2020.pdf
4. Javed U, Rila FM, Bhatti A, Momo M, Khan H, Vohra M. 7 How compliant are national health service (NHS) England uniform policies with regards to religious head coverings and bare below the elbow (BBE) adjustments?. BMJ Open Ophthalmology. 2025;10:. https://doi.org/10.1136/bmjoo-2025-WVUK.14
5. Javed, Ushna & Mohamed, Fathima & Bhatti, Amena & Momo, Maliha & Khan, Hanadi & Vohra, Munazzah & Hapeshi, Eleanor. (2025). Talk 2 Impact of NHS England uniform policies on Muslim female healthcare professionals. BMJ Open Ophthalmology. 10. A1.2-A1. 10.1136/bmjoo-2025-WVUK.2.
6. Malik A, Qureshi H, Abdul-Razakq H, Yaqoob Z, Javaid FZ, Esmail F, Wiley E, Latif A. 'I decided not to go into surgery due to dress code': a cross-sectional study within the UK investigating experiences of female Muslim medical health professionals on bare below the elbows (BBE) policy and wearing headscarves (hijabs) in theatre. BMJ Open. 2019 Mar 20;9(3):e019954. doi: 10.1136/bmjopen-2017-019954. PMID: 30898792; PMCID: PMC6475454.