Standing beside a physician who trained in Oran, Algeria, Emmanuel Macron recently praised the work of foreign-trained doctors and called the administrative system governing them “chaotic and in need of radical reform.”
The remarks landed in the middle of a sharper political row. Interior Minister Bruno Retailleau had argued that foreign doctors should retake competitive examinations before practising in France. Macron rejected the idea and pointed to numbers that make his case plain.
More than 19,000 doctors trained outside the European Union now hold active practice rights in France. Nearly 39% hold Algerian degrees, with 15% from Tunisia and smaller shares from Morocco, Syria, and Lebanon.
Macron’s hospital visit exposed a deep, structural need that EU border policy has yet to fully absorb. The EU’s Pact on Migration and Asylum entered into application today, the most sweeping overhaul of EU asylum rules in over a decade. The pact redesigns border screening, asylum processing, and solidarity mechanisms among member states. Labour migration and systematic workforce planning sit outside the pact’s scope entirely.
A Pact Built on One Problem
That gap matters because the EU’s workforce problem has become acute. Between 2022 and 2060, the EU’s working-age population is projected to shrink by 13%. In 2022, roughly 22% of the EU’s population had already passed 65. Persistent shortages grip healthcare, construction, agriculture, transport, and tech.
Italy’s case shows the fiscal stakes. Employed migrants currently support roughly 600,000 Italian pensions through social security contributions, paying around €8 billion annually into the welfare system. Since 2019, non-EU nationals have filled more than half of net job growth across the EU.
The pact’s architecture sidesteps those channels. Legal labour migration routes remain fragmented, shaped by bilateral deals and national preferences without a unified EU framework to pull them together. The EU Talent Pool and Skills and Talent Mobility Partnerships offer structured channels, but policy experts have flagged them as far short of the systematic overhaul the continent’s demographic trajectory demands.
North Africa’s Demographic Reversal
The old assumption was that the Maghreb would keep supplying workers as long as Europe aged. A study published in May 2026 by France’s Institut national d’études démographiques quietly dismantled that assumption.
The Institut national d’études démographiques found that fertility rates across Algeria, Morocco, and Tunisia have fallen at the same time and in fundamental ways. Morocco’s rate dropped to a record low of 1.97 children per woman in 2024, slipping below the 2.1 replacement level for the first time. Tunisia’s rate fell to 1.53, placing the country in the “very low fertility” bracket. Algeria’s rate stands at 2.61, still above replacement, but well down from its mid-2010s peak above 3.0.
The causes are embedded in the region’s social fabric. Longer schooling, later marriage, rising female university enrolment, and economic pressures that raise the cost of starting a family all work together. In Morocco, contraceptive use among married women rose from about 40% in the 1990s to 70% by 2020.
In Tunisia, women aged 25 to 34 now make up nearly 60% of university students, a shift that delays or closes off earlier family timelines. Continued fertility decline will gradually slow natural population growth across all three countries.
Population ageing has already picked up speed. In Tunisia, people aged 60 and over now account for 17% of the total population. That share was just 8% in 1997. Morocco’s 60-and-over population has reached 13.8%. Algeria remains the youngest of the three but will follow the same path as annual births fall.
One Squeeze, Both Shores
The convergence of ageing on both sides of the Mediterranean produces a concrete outcome. Fewer Maghrebi workers will be available to migrate at precisely the moment European economies need skilled and semi-skilled labour most. Political systems across contexts tend to treat migrant workers as an economic burden even as economies build them into indispensable services, a habit that leaves the underlying structural need unaddressed.
The EU’s pact tightens border procedures for irregular arrivals. Legal routes for the healthcare workers, construction trades, and agricultural labour that European economies systematically rely on remain underdeveloped. Sub-Saharan Africa holds the only near-term demographic surplus in the wider region, but political attitudes toward future labour flows remain contested across both Europe and the Maghreb itself.
Demographic Honesty
The EU’s pact was designed to manage the migratory pressures of the early 2010s. It was not designed to answer the labour calculations of the 2030s.
A workable strategy needs at least three elements to hold together. The EU should harmonise legal labour migration routes, with common shortage occupation lists and fast qualification recognition frameworks.
Bilateral agreements with Maghreb governments should formalise circular migration corridors backed by strong worker protections. Automation and longer working lives will help, but neither closes the structural gap that demography has opened on both shores.
Emmanuel Macron’s instinct, standing beside the doctor from Oran, points toward the honest answer. The workers already embedded in European public services have earned their place in systems that need them. The question now is whether EU policy can extend that logic systematically, and whether it can do so before the demographic window on both shores narrows further.
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