AGM 2014: The State of Refugee Health: A Prognosis for Public Justice in Canada

From The Catalyst Summer 2014

A shortened version of Dr. Doug Gruner’s keynote address at CPJ’s 2014 Annual General Meeting.

Most of you are likely aware of what happened in the late 1970s and early ’80s with the boat people. I certainly remember because I was in grade eight and my parents, through their church, sponsored several families. These were mostly Vietnamese refugees and they simply fled their homes and got in boats hoping that nearby countries would take them in. Unfortunately, many of them died in these overcrowded boats that simply floated at sea for months and months.

Canada did step up and accepted many of these refugees. So, where are these refugees now? Well interestingly, where I work at Bruyère, one of my family medicine residents, her mom and dad were on a boat like this. Her sister is an architect. Her brother works in IT. And she is a physician serving Canadians. That is where refugees end up.

Now if this government has its way, there will be very few refugees coming to Canada any more. As most of you know, in 2012, the Federal Government implemented one of the most egregious policies ever by a Canadian government by cutting health care benefits for refugees.

The Impact

These cuts have created mass confusion on the front lines, both on the part of health care providers and of refugees themselves.

Many bona fide refugees are not seeking health care because they are simply confused about what is available to them. Many refugees think they will have to pay for their visits and in fact most are expected to pay up front now.

Many doctors and hospital administrators are unclear on which class of refugee is entitled to what benefit under the new grid. So what ends up happening is that some doctors and walk-in clinics do the simple thing; they just turn them away.

It is important to highlight the situation for the designated countries of origin refugee. These folks will not have any health care unless their condition is deemed a risk to public safety or public health. A risk to public health means, essentially, that they have a communicable disease.

As far as public safety, what that means is that if a patient, say from Mexico (a designated country of origin), comes to the emergency room and they are suicidal they will receive no health care. No medication. No psychotherapy.

If, on the other hand, they are homicidal, a risk to us, they will get all the care they need.

The Response

The response by the health care community has been unprecedented. I’ve been a physician for 20 years and I’ve never seen anything like this. We’ve had three national days of action with protests and rallies in over 20 cities across the country.

Doctors are also documenting the effects of these cuts. They have been lobbying government, liaising with media, and writing in medical and other scientific journals.

There are over 20 national health care organizations that have come out against these cuts. Seven of these organizations wrote letters as a group to the Minister of Citizenship and Immigration on three separate occasions simply asking to sit down and discuss the evidence for this policy. The minister didn’t even have the decency to respond to the letters. Not even a form letter was returned to us.

The Cost

So let’s look at the real cost of this policy change.

There’s obviously the real human cost of this poorly thought out policy which will lead to human suffering.

There’s also the moral cost to us as a nation as we fail to meet our international commitments under the Geneva Convention which clearly stipulate that any child living within our borders has a right to access health care regardless of nationality.

This policy is forcing refugees away from primary and preventative care and into the only other option they have: the emergency department, at ten times the cost. But the minister does not care about this cost since it is a provincial problem and a provincial cost.

Evidence-Based Decision Making

I believe it is important for us to remind this government that we require more than simple conjecture and opinion with respect to our decisions on policy. But rather we require high quality evidence with respect to policy changes.

When I asked Dr. Danielle Grondin, the Director General of the Health Branch at Citizenship and Immigration Canada – the person who signed off on these cuts, what evidence the government was using in the creation of this policy, she was speechless. There was no evidence used in the creation of this policy.

Two years later this government is completely uninterested in any evidence as to the impact of this policy.

These cuts are inhumane and they punish an already vulnerable group who are here legally. These cuts are simply medically irrational and fiscally irresponsible. The right thing to do is reverse and rescind these cuts immediately.