REFUGEE DIARIES: CANADA

“Refugees Inside Borders”.

Yetunde’s refugee journey in Canada is all too common. “When Canada fails to provide health care to every member of its society equally, it fails to treat any of us.”
Yetunde is 54. After making her refugee claim in Canada in 2016 she began working as a healthcare aide in a Toronto’s Long Term Care Homes. Interim Federal Health (IFH) coverage and a work permit was provided while she navigated her claim. In early 2019 Canada’s Immigration and Refugee Board (IRB) denied Yetunde’s Refugee Claim. On the same day, Canada revoked her medical coverage. Refugee claimants are not eligible for OHIP. Yetende was suddenly medically uninsured, without health care. She has diabetes. Canada rejects half of all refugee claims it receives. 
Yetunde began her appeals. Returning to the violence and persecution in her African country was a deadly option. In late 2019 Yetunde received a work permit so she could continue working in our Nursing Homes caring for our seniors during COVID. Canada continued to deny OHIP or IFH health coverage while Yetunde kept working for 3 full years during COVID. She paid income taxes. She became sick with COVID caring for her ill seniors, yet was unable to afford access to her own healthcare needs, doctors. 
As the Pandemic wound down in late 2022 Yetende received a letter from Canada Border Services terminating her work permit and demanding she report to the Refugee Detention Centre at Airport Road in Toronto, for immediate deportation. Yetende left her PSW job the same day. Like thousands of others she slipped underground and into the shadows to avoid deportation. Now homeless and with all funds used for legal costs, Yetunde couch surfed at a friends. She worked at cleaning jobs off the grid to buy food. A diabetic with high blood pressure and no money to pay for care Yetende went without any diabetic treatment, insulin, medications. For almost 4 years. 
In early January 2023 Yetunde’s foot became swollen, with severe pain, and quickly turned black. Severe infection and gangrene had set in. Yetunde’s foot, leg and her life were at risk. She went to a Toronto Hospital ER where she was told to pay $800 before being seen. Unable to pay Yetunde literally begged for help, promising to pay when she could. She signed the papers. Yetunde received a prescription for antibiotics and was sent home that night, shivering with fevers. She could not afford the antibiotics.
Yetunde was then turned down for care by a Toronto Community Health Centre (CHC), who referred here to our free clinic for the uninsured in Scarborough. Two days later Yetunde limped in. She had deteriorated. Our volunteer nurses, doctors and staff arranged for transfer to a downtown hospital. Yetunde was admitted. After every effort to save her foot, a partial amputation was performed. After 6 weeks in hospital for wound care Yetunde was discharged to a long term rehab care hospital for another 6 weeks. Now transferred to a homeless shelter she will be disabled and unable to work for a year. A sponsor has step forward. Yetunde can now stay in Canada.   ———————————————————————-
Sadly Yetunde’s story, one she has permitted us to share, and her devastating outcomes are all too common when Canada says no to health care for its refugee claimants, asylum seekers and forced migrants. Something it does quite regularly, and often unfairly. Canada is currently denying the basic human right to health care to at least a million rejected, underserved, under-empathized refugees. Working off the grid, filling Canada’s vital 5-D dangerous, dirty, deadly and demeaning, deadly frontline jobs. This humanitarian failure is an international humanitarian disgrace and stain that governments have worked to keep below Canada’s healthcare inequity radar.    
It shouldn’t be, nor does it have to be this way, inside the borders of Canada, a wealthy United Nations lauded refugee receiving nation. Whose prosperity continues to be fuelled by and dependant on the contributions of newcomers — just like Yetunde. Who seek our safety and sanctuary while helping build the Canada they come to.  

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).

http://www.thestar.com/opinion/letters_to_the_editors/2014/11/03/tory_stance_on_refugees_grotesque.html

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.

Case.1

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.

http://www.cbc.ca/metromorning/episodes/2014/07/07/refugee-healthcare/

Dr Goel, and others, are new emerging leaders working in the field of new Canadian healthcare and global health

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.

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.

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?

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.

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.

http://www.cmaj.ca/content/early/2014/01/20/cmaj.131861.full.pdf+html

http://www.cmaj.ca/content/early/2014/01/20/cmaj.131861/reply

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.

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?

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.