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Restoring funding for refugee health critical step, but much more work remains

| March 16, 2016
Image: YouTube: "Welcoming Refugees," The United Church of Canada

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In 2012, the Conservative government used its majority to pass a law that left almost 65,000 refugees with no access to healthcare coverage.  The Federal Court of Canada ruled against the government and the cuts 2014, but funding was not restored.

Recently, there have been a lot of changes in refugee policy. As of last month 26,000 Syrian refugees have been resettled in Canada and the Liberal government will be restoring funding for refugee health care on April 1, 2016.  rabble.ca's Activist Toolkit is interviewing people who are on the frontlines of refugee settlement to find out about what they are seeing on the ground and what additional supports they need to address the needs of this surge of refugees. 

Our first interview on this subject is with Dr. Michael C. Stephenson, the director of Sanctuary Refugee Health Centre. Dr. Stephenson took the time from his busy schedule to respond to questions which were emailed to him. Read through to find out about what he thinks and how to support the great work of Sanctuary Refugee Health Center.

rabble.ca: How long has Sanctuary Refugee Health been operating and how long have you been working with the organization?  What is your role?

Dr. Stephenson: Sanctuary has been in operation since April 4, 2013.  I had previously been working at Access Alliance in Toronto and PRAIDA in Montreal (both refugee clinics) and I wanted to continue to do this valuable and rewarding work. I moved to the Kitchener area for family reasons and found that there were no centres here dedicated to refugee health care. In late 2012 and early 2013, I ran focus groups with partner agencies and found that there was a huge need for a centre of this kind. We heard many stories of inappropriate and insufficient care (for example, individuals being asked to use their young children as interpreters) and denial of care. I heard several stories of individuals who had valid Interim Federal Health coverage who were being turned away from care (including at the Emergency Room on at least one occasion.) We repeatedly heard from refugees that they wanted a place that could respond to their specific needs in a welcoming location.

I am the director and chief physician here at the centre. Besides me, we have a full-time nurse and a full time social worker on paid staff. We have about 20 volunteers, from psychiatrists and gynecologists to family docs, nurse practitioners, nurses, receptionists, students, researchers, and all kinds of other folks. Many of our volunteers and staff came to Canada from refugee situations.

rabble.ca: Could you write about the impact of the Harper regime cutbacks on refugee healthcare for Sanctuary Refugee Health?  What was the impact for the people you serve, or did the organization continue to try to continue to bridge the funding gap?

Stephenson: The changes to the Interim Federal Health Program that began in 2012 were devastating to refugees. It took a relatively simple "one size fits all" system that reflected the coverage that other low income Canadians received, and created an administrative system that was illogical and difficult for health providers to navigate.  All refugees were impacted by the cuts, regardless of whether their actual coverage changed. Many providers stopped accepting any refugee into their practice because of how complicated this system had become.  I routinely have to advocate for patients who have valid coverage but are being denied care by a provider who does not understand the system.

Privately Sponsored Refugees, and their sponsors, were very much affected by the changes.  Sponsoring groups often select individuals from abroad who have overwhelming health needs that could not be met in their host country.  It is not unusual for us to see sponsored refugees with profound mental illness, sensory deficits and/or mobility issues.

The changes introduced in 2012 took away sponsored refugee's medication and special device (wheelchair, hearing aid etc.) benefits. Sponsored refugees are not eligible for provincial benefits, which otherwise would cover these things. Sponsors would often work for months or years to bring over a family, only to find out at the last minute that they were responsible for huge medical costs. Sometimes the sponsoring groups were not able to meet this need -- meaning that the refugee was left to suffer needlessly for a year before the province would pay for medication, a hearing aid or a mobility device.

Certainly, the situation has been most complicated for refugee claimants. Many of them had "Public Health and Public Safety Coverage" which was basically no coverage at all. I have seen many refugees whose health coverage changed without them being aware of it.

They may have, for example, gone to the hospital for a test or an emergency thinking that they had health coverage for this, only to get an unaffordable bill afterwards. I have seen bills of more than $10,000 -- I don't know many Canadians who could afford this. And those who were aware of their lack of coverage were forced into a difficult situation where they had to balance limited income with health care.

The "Public Health and Public Safety" issue really showed the lack of awareness of the medical system by whoever designed this program. In essence, the Federal Government would only extend health coverage to those who had an illness of public health concern (such as HIV or tuberculosis) or where there was a risk to other people -- and note that suicidal thoughts did not qualify.

The government was basing their coverage on a "downstream event" -- i.e., they would only determine coverage after an assessment had been made.  But how would an assessment be done if the individual may or may not have coverage for that assessment? The government was essentially forcing the health care system either to deny the patient outright or else potentially see the patient for free -- something that many providers would not or could not do. In short, the system was poorly planned with devastating effect.

rabble.ca: What is the impact of restored funding for refugee health?  What are some additional policy changes that can help improve refugee healthcare--beyond restoring the cuts?

Stephenson: The greatest benefit is that it restores a simple, accessible system. Refugees and health providers will now know what to expect from the health coverage. There should not be any more denial of care. This is an important step to ensure that we are living in healthy communities.

Certainly we need to see what happens after April 1. If providers still find the system difficult to navigate, some will continue to refuse care for refugees. We need to ensure that all health care providers, across disciplines, respond positively to the changes and adopt a practice of accepting refugees into their care once more.

There continue to be problems with the administration of the IFH system -- for example, there can be delay before refugee claimants receive their IFH document which allows for health care, there is often confusion around when to renew the document and how long this takes. Others have also made serious allegations about the fairness of the Immigration and Refugee Board determination system. I hope that the Federal Government chooses to investigate these issues.

rabble.ca: There are so many new refugees arriving in Canada from Syria and elsewhere under the new regime.  What should people keep in mind about the long term needs of these refugee populations, and what needs to be done to support these needs?

Stephenson: What Canada has done to bring in 25,000 refugees from Syria has been terrific.  The communities across the country who have been so involved in sponsoring refugees have to continue their efforts -- their work cannot stop once the refugees arrive. We know that mental health outcomes of refugees depend on their connectedness to society and their ability to find meaningful work. Sponsors and supporters need to help break down the barriers that exist for Syrians to participate fully in Canadian society.

People often ask me how to help out. There are a programs in communities across the country to help newcomers, for example with language support. In Kitchener, we have programs that run weekly to help with conversational skills.  These kinds of programs help refugees to learn outside of the classroom, and help them to feel more connected to Canadian society.

Employers should consider whether "Canadian experience" is necessary, and whether there are meaningful roles for refugees and other immigrants within their workplace. Educational facilities should look at whether admission criteria are creating barriers to entry for newcomer refugees. These are steps that we can all take to make this program successful.

rabble.ca: This is the Activist Toolkit, so we need something people can do to help and support a campaign that would help refugees or the work you do? Could you write about how others can support your work?

Stephenson: At Sanctuary, we are a volunteer-led initiative. Our funding is limited; therefore we try to find non-traditional ways of providing the care that refugees need. For those in the Kitchener/Waterloo area, we certainly welcome volunteers and partnerships with organizations.  While we do not have CRA Charitable Status, we welcome donations.  For those in other cities and regions, I encourage them to look into what is happening locally - many cities have refugee health centres and programs for refugees that they can get involved in.

Perhaps the biggest single thing people can do is to reach out to refugee reception centres and offer to volunteer for a family. Many of the government assisted refugees have limited connections to Canada; meeting an individual or a family from their new community, whether Canadian-born or themselves an immigrant, can be a huge step to feeling at home.  These types of connections are what makes refugee programs successful.

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Image: YouTube: "Welcoming Refugees," The United Church of Canada



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