Non Compliance with refugee court ruling by Canada’s Conservative government hurting everyone.

January 22nd 2015

On November 4th 2014 Federal Justice Wyman Webb rejected the Canadian federal Conservative effort to appeal the decision in July 2014 to overturn the cuts to the Interim Federal Health Program ( IFHP).

Both decisions required that the federal conservative government restore the Interim Federal Health Program ( IFHP) to its pre 2012 status. It is our first hand experience at the Community Volunteer Clinic in Scarborough that this has still not happened – over 2 months after.

For countless years pre 2012 cuts to IFHP, refugee claimants were processed at their port and time of entry.  IFHP benefits were granted at that time until their hearing at the Immigration and Refugee Board.

After the 2012 cuts, refugees were no longer processed for IFHP at their port of entry. They were directed to make a claim at an inland Citizen and Immigration Canada (CIC) office. This  has resulted in delays of 4-12 weeks before their IFHP becomes effective, During this time the refugee claimants are medically uninsured in Canada.

As of January 2015 this policy and procedure has not been corrected I am not a lawyer but is this non compliance, or contempt of court – and Canada?

Here are 2 cases that clearly underscore the harm resulting from the government’s refusal to restore IFHP to pre cut programs and policies.


L.S. age, 47, arrived in Canada on November 12th, 2014 from one of the 3 nations in West Africa caught up the Ebola epidemic. He came from the epicentre of the outbreak. When L.S. arrived he was not given IFHP. He was instructed to stay in his son’s apartment for 3 weeks ( 21 days). According to the patient and his son, they were not monitored.

Because L.S. did not have IFHP,  or money to pay for healthcare, he arrived at our Community Volunteer Clinic for care. It was 2 months after he entered Canada. He indicated no one form public health of Citizenship visited him in the 21 self monitored quarantine. He was alone, no healthcare, given no documents confirming he had successfully passed the quarantine period. No one came to give any health information or support.

L.S. has an appointment at the inland CIC office in 3 weeks – almost 3 months after he entered Canada. He might get his IFHP. He might not. Sometimes they want more documents.

This is not what would have occurred had he arrived pre July 1st 2012.

Case 2

S.M is 42. She arrived from Iraq and Afganistan. She lived in a village that ISIL attacked. ISIL slaughtered over 200 villagers. S.M. hid in the mosque with her 2 children and her elderly mother-in-law. Her husband managed to flee. They have not heard from him for over a year.

They managed to escape, and came to Canada as refugee claimants in early November. They still have no IFHP or any other health coverage. The children can not attend school without documents, All 4 of them live in one motel room on Kingston Road. It has a bathroom and a hotplate to cook on and bunk beds. Last week the mother in law had a small stroke and fell. She landed on a hot iron and burned her eye. She burned her cornea and could not see anything.  She went to the Scarborough ER. The shelter sent her.

At the hospital she was refused care because she had no IFHP or CIC documents. She did not have the $500 requested to be seen. They left. They came to the Volunteer Clinic. Her blood pressure was 240/120. This is why she had the stroke and fell, and burned her eye. Her medical condition in the ER was life threatening.

Government refusal to fully restore IFHP is beyond simple non compliance with a court order. It is abusive. It is unfair harmful and mean spirited. It may well be an assault. It is also dangerous to everyone – our refugees, and Canadians.


A Victory for Canadian Refugees. A Victory for Canada

Friday July 4th, 2014

My portion of this diary entry will be briefer than usual. It is time to let the voices of others describe Friday’s court decision that overturned the 2012 Federal cuts to refugee healthcare. Below is what I wrote to our colleagues and friends following Friday’s momentous decision, followed by links to the comments of others.

Dear Colleagues and friends of the Scarborough Community Volunteer Clinic

“Today, as yesterday, a nation is judged by its attitude towards refugees.”
 Elie Wiesel, Nobel laureate, Globe and Mail, July 7, 2012

On Friday July 4th 2014, the week of Canada Day, and almost 2 years to the day that Federal Immigration changes cut healthcare to refugees new to Canada, Federal court Justice Anne MacTavish delivered a decisive ruling —  “intentional targeting of those seeking protection of Canada — an admittedly poor, vulnerable and disadvantaged group” amounts to “cruel and unusual treatment.
And with that she struck down the Government’s cuts – a momentous day for Canada, and for all the most vulnerable members of Canadian society seeking medical attention.
None of what happened yesterday would have been possible without everyone’s enormous and collective contributions and support over many years. From all the healthcare professionals providing refugee and immigrant care, the CVC volunteers and the medical case work the clinic contributed for the challenge (50% of the cases), the amazing legal team who were “brilliant” and so supportive to those of us who tremble in court rooms, the dedication and unwavering work of Canadian Doctors for Refugee Care who spearheaded the challenge and who kept the firelight burning, the researchers….. everyone pulled together in a remarkable team effort.
This victory is powerful and momentous, on so many levels. Citizens can and must make a difference when injustice happens. Advocacy works. Professionals can give voice to those without one. And, it is victory for Canada. Canada’s social justice, generosity to the most vulnerable, and our humanitarian traditions and values are at the very centre of what defines us as a fair and just society, and nation. They are not for dismantling in the inner recesses of our governments. The stakes were huge on Friday
In 2012 a nation’s humanitarian soul was weakened. Today, it was restored. Best, and well deserved to all. How remarkable !! Paul




Every Women, Every Child? (Just not refugees in Canada)

Volunteer Clinic, May 2014

Adella arrived from Nigeria, pregnant. She came as a refugee claimant. She had no intention of coming but the Chief of her village, criticized by his tribe for the high number of maternal mother and child deaths, decreed it was due to a reducing number of female circumcisions in the village. He implemented a stepped up “mutilation” program of newborns and young girls. That’s when Adella grabbed her daughter, and pregnant she paid an “agent” and left her life behind. She know of the Harper initiative. She could not wait.

What Adella didn’t know was that Canada’s “Every women, Every Child” initiative didn’t include her, her pregnancy, or her daughter once in Canada. Quite the opposite in fact.

At the same time as implementing this program overseas in developing countries, Canada’s same Conservative Government, through Citizenship and Immigration Canada quietly inserted an array of “viral stumbling blocks” designed to baffle, complexify and impede refugee claimants prompt access to IFH healthcare coverage upon arrival. Adella and her children’s safe access to maternity and child care here in Canada was thus delayed 6 weeks when Canada Border Service Agents – employees of CIC – prevented her from claiming refugee status at their time of arrival. She was directed ( forced) to make the claim at a CIC office once she could get an “appointment”. During this wait time she delivered without health insurance – entering the hospital as an emergency delivery. Infant and maternal mobility and mortality rise at leaf 3 times in such circumstances.

Libby arrived here as a Temporary Foreign ( domestic) Worker 4 years ago. She worked as a domestic for 2 years, covered for healthcare. That was at least until she was fired when she became pregnant and could get another job. Her health coverage under the program was cancelled. She delivered without health coverage, requiring an emergency C section after entering the ER in labour.

All requests for the next 2 years to stay in Canada were denied. She is now here with an application submitted for humanitarian and compassionate reasons. A decision will come a number of months down the line. Her current pregnancy requires a C-section. A vaginal birth will jeopardize her life and her pregnancy. She was denied access to a planned safe C section because she did not have the money to pay the hospital what they demanded for an operating room booking. She went into labour, then the ER and then to an emergency C section.

Figures from the United Nations show a devastating reality – 300,000 women worldwide, almost all from developing countries die annually, unnecessarily from complications of pregnancy and childbirth. Some 6.5 million children surviving childbirth die daily world wide in developing countries– the vast majority in their fist month of life.

Canada, under Stephen Harper’s government has initiated the Every Women, Every Child project in an effort to ameliorate this growing crisis in the developing world. That’s good.

If only Mr Harper would apply his program to new Canadian refugees like Adella and Libby, and other new Canadian women and children his Government has so quietly and callously denied healthcare to.



Desperate Uninsured?

April 2014

Where do the uninsured go for care and where do they get their medications from? Are physicians from other countries who are not licensed to practice in Canada providing medical care to uninsured new arrivals, including refugee claimants and others?

We ask these questions after observing uninsured Canadian newcomers at our clinic be unable to afford healthcare in many situations that are life threatening. They are questions that became more concerning after a recent patient with cancer an uninsured newcomer to Canada died. He was refused treatment unless he could pay $ 68,000 for surgery and then chemotherapy. He could not. The patient died without treatment.

Does it happen that others seek care underground? If it happens how pervasive is it? We don’t know; but we hear the rumours. We hear of “basement clinics”. We hear stories of medications being imported from outside Canada, purchased for much less cost from developing countries, and administered for many illnesses, including cancer.

When you are medically uninsured in Canada Chemotherapy can be $50, 000 to $300,000 for a common cancer. It can be 3 times that for some cancers. Who can come up with that kind of  money? When you face death, you face desperation.

We know of patients importing medications – including chemotherapy –  from developing world nations where they are available and much less expensive.

If I were uninsured in Canada, and unable to find and afford medical care for a dangerous life threatening cancer, I wonder what I would do? I think I know the answer.

Why do we put our newcomers at risk like this, force them into this position?



Intererference and breach of privacy with refugee claimants???

April 2014

If this is true it is deeply disturbing. Perhaps others can add information?

This week I was informed by immigration lawyers and others that Canada Border Service Agents routinely contact Ontario Works. They call and inquire as to which refugees who have failed an Immigration and Refugee Board hearing are still receiving Ontario Works benefits. They then attempt to have these benefits ended.

Is this true? If it is true is it legal? Does it contravene privacy and other legal statutes?

If anyone cane can shed any light on this matter please write us.

Time to put the “Canada is the most generous nation to refugees” argument to bed – once and for all.

March 2104

Here are 2 links. One is a link to a bold and unequivocal statement in the Canadian Medical Association Journal (CMAJ). This is a searing condemnation of Canadian Government actions harming the health of Canada’s refugee claimants, and the governments insistence on marginalizing professional healthcare voices.

The second link is the reply from Chris Alexander, Minister of Citizenship and Immigration.

This comment is ours:

Mr Alexander has stated again, and he is not alone, that Canada has one of the most generous approaches to refugees in the world. In his response in the  CMAJ Mr Alexander writes “ Canada is second to none in its generosity and fairness towards newcomers, as demonstrated by our world-leading refugee resettlement system”. 

The Minister has either been kept poorly informed by his staff, or he chooses to ignore the research of the United Nations and others. Data from 2010, reported by the United Nations High Commission on Refugees debunks Mr Alexanders oft repeated myth. Canada ranked 6th, behind Turkey and Portugal  for acceptant rates for refugees. According to the OECD Canada ranked 13th, behind Luxembourg for intake of refugees per 100,000 population, and 16th in the world behind bankrupt Greece in % of total refugee inflow per country. In 2014 The United Nations reported that refugee claims to Canada dropped by over 50% in the past year.

This is due to Canada’s hardened immigration policies. Immigration policy is a Federal responsibility in Canada. But generosity and medical care, when urgently ill, are not.


How is this permitted?

March 2014

She came to Canada on a work permit, legally issued. She worked as a domestic. After several years the job dried up.

She tried to find new work. She could not. She lost her healthcare in Ontario. She met her current partner in Canada. They became pregnant.

In her home country, she had two C sections. She needed a C- section again. A vaginal delivery this time would endanger her life.

The community Hospital in Toronto refused to book her C-section. She did not have the money to pre-pay up front for the Operating Room. The hospital refused a payment plan. This was not an elective C section. It was a medically necessary one to be done before she entered labour. If she went into labour her life would be at risk from a uterine rupture during a vaginal birth.

Despite this known risk to her life, she was denied the C section by the hospital. She went into labour. She came in through the ER. She was rushed to OR where she underwent an emergency C section.

Is this possible in Canada? Can hospitals refuse life saving medical care? Would the refusal to provide such medically necessary care because of inability pay in full, up front, be considered an assault, or extortion?




The 3 month wait for OHIP saves nothing.

January, 2014 —   Your money or your life. (amended)

Besides straining the legitimate bounds of Canada’s humanitarian credibility, the 3 month wait for Ontario Health Insurance (OHIP) for landed immigrants and returning Canadians likely saves no one a penny. It certainly can cost many their health, their ability to live a productive life in Canada and contribute.  and it can prove deadly.

He came to Canada at age 3. He had no say in that. His parents arrived as landed immigrants. They were leaving poverty and violence far behind. They came (as others do) to succeed, to raise their child and family in Canada’s stability and safety. After 6 years working and living here, and becoming a Canadian citizens, they returned home. The Great Recession of 2008 dried up jobs. They were not alone.

In 2013, now 16, back in his birth country, he was diagnosed with a rare and deadly genetic disorder. New effective treatments have been discovered. He will die without them. They are not available in his country. They are available in Canada. He is a Canadian citizen.

His disease can progress quickly. His was. It causes advanced neurological deficits – inability to speak, inability to walk, to lift a fork to eat. It damages the liver and other organs.

The boy returned to Canada, to Ontario specifically, with his mother so he would not die. Sadly, he was denied treatment once here. As a returning Canadian away more than 212 days he found himself caught up in the 3 month wait for OHIP. His father stayed behind in Asia. he had a job. It paid the money his wife and son needed for travel and living expenses in Canada.

Our/their phone calls to OHIP officials, and others within the Ministry of Health fell on deaf ears. The life threatening emergency nature of his disease made no impact. There were no avenues for compassionate discretion. There was no accommodation to relax the rules to save his life. All bended knee and passionate requests for humanitarian consideration to obtain treatment and save his life were humiliatingly dismissed.

A 16 year old Canadian youth was dying before our eyes. Only the generosity of volunteer free medical care — most importantly from paediatricians, saved his life.

What do Children and Youth new to Canada know about 3 month waits arbitrarily imposed by adults who govern and ( supposedly protect them? If you or I harmed a youth we would be charged. If we neglect and cause harm to a child, we would be charged. When I was 13 I became ill with a deadly disease. I remember being sick, and very frightened. I trusted the adults in my life. I trusted they would help me. They did.

This youth’s story has one final twist. Some of his treatment had to be administered in hospital (much of it was done as an outpatient, for free, in the community, saving the Government and taxpayers many thousands of dollars). OHIP declined to cover the $18,000 for that hospital stay. That bill cannot be afforded by by mother. It will sit on the public hospital’s financial sheet.

A few will say ( because we have heard it)  ” it’s not my problem. It serves them right. They left Canada. Follow the rules”. To them we say the current costs to OHIP to ensure a 16 year old for 3 months, is $25. That would save a life, and everyone else $18,000. Most will say ( because we have heard it) “ How can this happen to a youth, a Canadian, in Canada? This is an Ontario and a Canada I no longer recognize?” To them we say, we agree.

Incredulity at the humanitarian hypocrisy and insensitivity best describes our visceral reaction. Why are we costing ourselves such unnecessary expense describes our intellectual reaction.

So, solutions….

In January 2014 Ontario rightly took on health coverage for refugee claimants cut off by the Federal government in 2012. Ontario went a step further – and this is where the first steps of solution lie. Although Ontario applied its same 3 month wait to its new coverage for refugee claimants, Ontario added a paradigm policy shift. The 3 month wait for care is waived for refugee claimants who are pregnant, children and youth 18 and under, and anyone else deemed to have a life threatening emergency, the 3 month wait is waived – at the discretion of the treating physician. So, and the question is obvious, why not do the same for returning Canadians, particularly Children and Youth including those New to Canada when they are risk of death from illness or injury while in the 3 month wait?

Canada is country whose very prosperity and freedoms have been built and defended by the new arrivals that define every generation – since the first. Our is no different. We are a nation of new arrivals, a compilation of 500 years of newcomer fusion. We should start acting like it when newcomers to Canada suffer medical emergencies.


The 3 month wait continued.

December, 2013

When they arrived as landed immigrants to Ontario, they came to be with family, to support their family. They lived half a world away. Their daughter, her husband and their grandchildren are in Canada.

Like others new to Canada, their daughter and son-in-law came to Ontario as landed immigrants 20 years ago. Like the majority of New Canadians, these newcomers succeeded. They became Canadian citizens. They furthered their skills and education. They took jobs. They started a family. They contributed and continue to do so.

Some years back, her parents applied to come as landed immigrants. Their children had secured the financial resources to support the application. In November, 2013, the grandparents were granted landed immigrant status.

They made their way to Canada to be their family, their grandchildren. They would help with care of the children so the parents could work.

A week after arriving, one of the grandparents became ill. It turned out to be a cancer. There was a chance to cure it with surgery — a major operation.

But, and here it is again, there was deal breaker in the works. The 3 month wait for OHIP. Unable to afford the surgery, doctors bills and hospital costs, and with no guarantee private insurance would pay the bills, they returned home for care.

Coming to Canada is off. Another protracted application will be required – that can easily consume years.

This unimaginable tragedy is more common than most Canadian realize. In fairness, Ontario has shown leadership by providing healthcare coverage to refugee claimants abandoned by the current Federal Government. For this, our Premier and our Health Minister are to be commended for humanitarian leadership.

It is just one more small step to end the 3 month wait Ontario imposes ( one of only 3 provinces to do so). Let’s do it. Its the right step to take.