Healthcare is for saving lives not for deterring refugees

By Yogendra B. Shakya, Ritika Goel, Sideeka Narayan, Duncan Eby and Axelle Janczur

On July 4th 2014, the Federal Court struck down the 2012 Federal Government changes to the Interim Federal Health Program (IFHP) by ruling that these changes are in direct violation of Section 12 and Section 15 of the Canadian Charter of Rights and Freedom. These Charter sections guarantee that no one in Canada (including refugee claimants) should be subject to “cruel and unusual treatment” or be denied equality of rights (in this case, healthcare) based on their backgrounds, including national origin.

The key message to the federal government from the presiding Judge Anne Mactavish’s 268 page report: stop using our healthcare as a political instrument to deter refugees from seeking refuge in Canada. It is unethical and unconstitutional. As healthcare professionals and researchers, we could not agree more. We join healthcare providers across Canada to strike down any appeal from the government on this ruling.

The 2012 IFHP changes introduced by the Harper government has little to do with saving costs and more to do with advancing Bill C-31 to reduce backlog and influx of refugee claimants to Canada. This government is not interested in pursuing real solutions put forth by sector leaders geared at making refugee determination process more fair and transparent and thereby more efficient. Instead they are putting the blame on refugees for burdening our system and a priori label certain groups of refugees as “bogus” and “cheats” to deny them a fair determination process. To make it worse, this government wants to punish refugee groups by limiting their access to healthcare.

The 2012 IFHP changes are sickening – symbolically and literally. These changes replace a universal model of healthcare for refugees with a complicated, multi-tiered system that gives very unequal coverage based on national origin, refugee determination status and other conditions. This uneven coverage has propagated a culture of fear and confusion to the point that even refugees eligible for full coverage (e.g. Canadian-born children of refugee families) are either not accessing healthcare in timely manner or being denied treatment by healthcare agencies unable to navigate the red tape.

The added administrative costs of navigating this complicated system, combined with inflated downstream costs from delayed treatment and higher emergency department use, greatly outweigh any savings to the $90 million per year required to operate IFHP. Rather, as provincial health ministers have rightly pointed out, these costs are merely being downloaded to provinces.

The IFHP is a unique policy introduced after the Second World War with humanitarian goals to provide life-saving federal level healthcare for vulnerable immigrants and refugees. The pre-2012 IFHP had its share of limitations but healthcare professionals had managed to use this program to develop a globally recognized model of care for refugees in Canada.

We would get constant inquiries from around the world about our healthcare for refugees. The fact that we provided care even to rejected refugee claimants until they were deported not just exemplified our universalist values, but also made full sense from a public/global health angle. We prioritize taking care of the most vulnerable (seniors, unemployed, refugees) – often with extra supports – so that their families, particularly children, are not denied equality of rights just because they are poor or came to Canada as refugees. As Judge Mactavish reminded us, this is enshrined in our Charter rights.

Rather than fully restoring refugee health coverage by November 2014, as ordered by the Federal Court, the federal government instead launched a legal appeal of the decision. Further to this, as revealed in the February issue of the Canadian Medical Association Journal the federal Cabinet quietly revoked the legal basis for federal funding of refugee health care.

The IFHP changes are sickening and unconstitutional. We call on the Federal Court of Appeal to immediately strike down any appeal from the federal government against Judge Mactavish’s ruling to reinstate IFHP to pre-2012 levels.

Yogendra B. Shakya is a healthcare researcher, Ritika Goel is a family physician and public health professional, Sideeka Narayan is a registered nurse, Duncan Eby is a nurse practitioner and Axelle Janczur is the executive director of Access Alliance Community Health Care. All authors are based in Toronto.


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