Saudi Foreign Minister Adel Al-Jubeir speaks at a news conference Wednesday in Riyadh, the Saudi capital. (Nasser Al-Harbi/AFP/Getty Images)

A rift between Saudi Arabia and Canada widened Wednesday as the Saudi government rejected any outside mediation in the dispute and announced that it was transferring Saudi patients in Canadian hospitals to other countries.  

The Saudi foreign minister, Adel al-Jubeir, said that his government was considering other measures to punish Canada for criticizing, in a series of Twitter messages, Saudi Arabia’s detention of women’s rights activists. “Canada started this. It’s up to Canada to find a way out of this,” Jubeir said at a news conference in Riyadh.  

The toughening rhetoric came two days after Saudi Arabia, in a burst of anger, announced that it was expelling the Canadian ambassador, halting trade and investment deals with Canada and suspending flights there. Saudi Arabia has also said that Saudi citizens studying in Canada on government scholarships, including medical residents, would be moved to programs in other countries or back to Saudi Arabia.  

 The argument has highlighted Saudi Arabia’s increasingly aggressive approach to foreign policy over the last few years as Mohammed bin Salman, the 32-year-old crown prince, has assumed a more dominating leadership role. In punishing Canada, Saudi Arabia appeared to be warning other Western nations not to criticize the kingdom over its human rights record, analysts said. 

There were questions about whether the Saudi government had fully calculated the consequences as it prepared to relocate thousands of students as well as medical residents, who experts said would have trouble finding other training programs.  

“We will do our best to ensure there are no hardships,” Jubeir said.

Canadian Prime Minister Justin Trudeau answers questions from the media Wednesday in Montreal. (Christinne Muschi/Reuters)

Asked at a Wednesday news conference about the dispute, Canadian Prime Minister Justin Trudeau said, “We have always had a positive and constructive relationship with countries around the world while, at the same time, always making sure we’re bringing up human rights concerns.” His government, he added, would “remain firm on standing up for human rights everywhere around the world.”

But Canada is also worried about the possible loss of almost 800 Saudi medical fellows and residents completing specialized training in the country.

A decades-long program has allowed Canadian medical schools to “sell” training spots to Saudi students, with mutual benefits: The students’ tuition and expenses are paid by the Saudi government, meaning they treat Canadian patients for several years at no cost to Canadian taxpayers but are expected to return home after the training. The doctors’ training in Canada was also seen as an important part of a larger effort by the Saudi government to replace foreign doctors with Saudi physicians.

A large percentage of Saudi doctors had completed their residencies in Canada, according to Stephen Walston, the director of the master of health administration program at the University of Utah, who has worked in Saudi Arabia and served on the international advisory board of the Saudi Health Ministry.  

“They are going to have to find a country where they can do their fellowships and residencies, and there are very few countries that allow that,” he said. “There is no way they can access the U.S. system. Thousands of students are affected by this. I feel sorry for them.” 

According to a recruitment presentation published by the Saudi Arabian Cultural Bureau in Canada in 2016, the partnership between the two countries has produced more than 4,000 Saudi medical graduates, “many of whom have now assumed senior leadership roles within Saudi Arabia.”

Earlier this week, Saudi authorities announced a grace period for the medical fellows and residents, allowing them to keep working in Canada until Sept. 1. But even with the extra time, replacing them will be difficult, health officials said.  

Across the country, doing the same for all 800 students “will be a significant disruption on many levels,” said Geneviève Moineau, the president of Canada's national association of medical faculties. Emergency replacements will need their own replacements, creating a ripple effect. 

In the neurosurgery department of a single Ontario teaching hospital, for example, 13 out of about 20 residents and fellows are Saudis, said Andrew Padmos, chief executive of the Royal College of Physicians and Surgeons of Canada, who called their potential withdrawal a “catastrophe.” 

Those left in that department would be doubling their number of night shifts and their number of patients, he said. “There's innumerable pressures that then apply because of the lack of staffing,” he added. “And those positions can’t immediately be filled. You can’t take people off the street.”

Tensions between the two countries accelerated after Canadian Foreign Minister Chrystia Freeland posted a message last week on Twitter expressing alarm at Saudi Arabia’s recent arrest of Samar Badawi, a Saudi women’s rights activist. Badawi’s arrest was part of a larger crackdown by the Saudi authorities on a group of prominent activists who had campaigned for the lifting of a female driving ban and advocated other rights for women.  

After two more tweets about the activists — from Canada’s Foreign Ministry, and its embassy in Riyadh — the Saudi government exploded, denouncing what it called “blatant interference in the Kingdom’s domestic affairs” and announcing retaliatory measures against Canada.

Saudi Arabia has accused some of the detainees of contact with unspecified foreign powers but has not yet provided any evidence. “The charges will become public and the evidence will become public and the trials will become public,” Jubeir said on Wednesday.

Ross reported from Petawawa, Canada.