Jason Kenney, Minister of Citizenship, Immigration and Multiculturalism, has been a very busy man as of late. In less than five months, he has sought to redefine Canada’s threshold for asylum seekers and to tighten the handshake that welcomes them to their new home. For those in the medical community providing care for and advocating on behalf of refugee patients, these efforts have caused considerable consternation. After a closer inspection of Bill C-31 and the more recent overhaul of the Interim Federal Health Program, it is not a stretch to see why.
Bill C-31 or the Protecting Canada’s Immigration System Act was first introduced to Parliament in February 2012 with the intention of clamping down on ‘bogus’ refugees, speeding up claimant processing times and reducing government costs. Stretching a healthy fifty-six pages, C-31’s most objectionable provisions related to health include:
- Automatic detention of asylum seekers for up to one year without review if deemed to land via an “irregular arrival.”
- An embargo on permanent resident applications and family reunification for five years after arrival.
- Conditional permanent residency with the possibility of a later revocation.
As a group of Ontario based physicians pointed out in a Toronto Star column, prolonged detention of refugee claimants leads to increased risk of suicidal thoughts, post-traumatic stress disorder and self-harm. This comes in addition to incubating infectious diseases and exacerbating chronic ones. Public outcry has led Kenney to amend this portion of the bill, granting review of detention at 14 days and 6 months. But the remainder stays unchanged. Delayed family reunification will still serve to weaken already fragile social supports and health, while revocation of already granted residency will still lead to social isolation, slow improvement of language skills and poor mental health.
In addition to the above reforms, C-31 also builds on the 2010 Conservative led legislation, Bill C-11, or the Balanced Refugee Reform Act. It divides refugee claimants into two categories: those from ‘Designated Countries of Origin’ (or DCOs) and those not. The stated aim of DCO policy is to deter abuse of the refugee system by those who come from countries generally considered ‘safe.’ One would expect a panel of experts to make such a crucial distinction – but not according to Minister Kenney. Bill C-11 contained no parliamentary oversight, but created a panel of public servants to make recommendation to the Minister. C-31 goes one step further, eliminating this provision and granting the Minister unilateral authority to deem which countries are considered ‘safe’ and which are not.
The DCO distinction is not an esoteric one. It has direct and very harsh implications for more recent reforms to refugee health services provided under the Interim Federal Health Program (IFHP). These changes do not require legislative reform; no Parliamentary vote or committee review is required. Their scope (though not their consequences) requires only the approval of Prime Minister Harper's Cabinet.
Like C-31, the stated aim of the IFHP change is cost-savings. It currently costs the Canadian government 84 million dollars annually – the Harper government is aiming for a reduction of 20 million. To achieve their ends they are leaving no category of refugee unaffected, even rolling back services for those who are government sponsored on recommendation from the United Nations High Commission on Refugees (UNHCR).
For these refugees, ironically deemed ‘protected persons’ in government releases, pre-reform benefits equate approximately to those available under most provincial social assistance programs. Post-reform changes will bear little resemblance to this, with health coverage available only for conditions deemed to be of an ‘urgent or essential nature’ or those to ‘prevent or treat a disease that is a risk to public health or a condition of public safety concern.’
What does that mean in practice? A ministry briefer illustrates a few examples. Come Canada Day, a protected person can be assessed for coronary artery disease by a physician, but their statins and anti-hypertensives will not be covered. A protected person will still be able to see a nurse or physician for a diabetic assessment, but will receive no coverage for insulin. For protected persons, many vaccines don’t even meet these new thresholds. All of these examples are significant changes from current policy. For claimants from the newly created DCO category, the news is even worse. Coverage has been completely eliminated for prenatal care, labour & delivery, as well emergency services. Every DCO acute myocardial infarction will go unfunded.
Kenney has defended these reforms on grounds that asylum seekers should not enjoy a level of government funding that Canadians themselves don’t receive. Physician and advocates have responded with both moral and economic arguments. Andre Picard has pointed out that it is exactly the vulnerability of refugees that necessitates broader health services. Dr. Mark Tyndall has also provided a reality check - the real challenge is connecting refugees with unfamiliar preventative services and primary care, not stopping ‘abuse.’ A Hamilton Spectator health provider Op-Ed highlights that according to the Ministry’s own data, refugee claimant’s per capita health costs are only 10% of Canadians, a number that is expected to rise with cuts to prevention.
Jason Kenney’s stated ends are to strengthen Canada’s refugee selection process and to save government dollars. But by choosing a path ignoring evidence contrary to his means and by adopting a hostile stance to those on refugee health’s frontlines, he risks doing just the opposite. Bill C-31 and the IFHP reforms come into force in less than 6 weeks. Minister Kenney, you still have time to change course. July 1st deserves to remain a celebration for Canadians already here and for those that have yet to come.
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