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On June 18, physicians and other health care providers carried out a National Day of Action in over a dozen cities across Canada to oppose the Conservatives' cuts to refugee health care. This article is a modified version of the speech delivered to the Montreal rally by pediatrician Samir Shaheen-Hussain.
As a pediatrician, I've been asked to speak about the specific impacts the cuts to the Interim Federal Health Program (IFHP) will have on children and on public health.
What we've already learnt about the proposed cuts to the IFHP apply equally to children as they do to adults. So, what does this mean, tangibly, for children and their families? Let me give a few examples.
If a young child from Haiti is diagnosed with sickle cell disease, she won't have health care coverage for her medical appointments. Meanwhile, her daily medications - including daily antibiotics that are imperative to prevent severe and life-threatening infections that kids with sickle cell disease are at risk for - will not be covered. Why? Medical appointments won't be covered because this child is a "failed refugee claimant" who can't be deported back to Haiti because of a moratorium on deportations to Haiti due to the conditions there. Medications won't be covered because sickle cell disease is not deemed to be a communicable disease.
If a toddler, who is a refugee claimant along with other members of his family, is in need of dental work because of cavities, his family will have to pay for this dental work out of pocket. Since his family may not be able to do so, he will have to endure the pain caused by his teeth rotting. He will be at increased risk of developing a dental abscess, with the risks and complications that come with that. Why? Because dental coverage will no longer be covered for any refugee claimant, regardless of which country they're coming from.
Finally, let's take the example of an adolescent who is diagnosed with leukemia. This adolescent will not receive the chemotherapy that she should receive. Why? Because the adolescent is from a "designated country of origin" - a country that, through the "Balanced Refugee Reform Act" (passed in 2010) and the more recent "Protecting Canada's Immigration System Act" (Bill C-31), would be designated at the discretion of the Immigration Minister - which means that she will have no health care coverage for medical appointments. Meanwhile, since leukemia is not thought to be a communicable disease, the adolescent will not receive the chemotherapy that she needs. As a result of this situation, if this adolescent falls into a depression and/or becomes suicidal, then hospital services, out-patient follow-up and prescribed medications will not be covered. If her depression causes her to be aggressive and she is deemed to be a threat someone else, however, then hospital services, out-patient follow-up and prescribed medications will be covered because she is deemed to be a threat to "public security."
The scenarios are surreal.
There are hundreds of other examples that we can come up with (e.g., any refugee claimant -- child or adult -- with diabetes will no longer have their insulin covered, refugee claimants from "designated countries of origin" will not be eligible for any care if they have a heart attack, and so on), but I don't think they're particularly necessary to drive home the point that, to put it bluntly, the cuts are draconian and will have dramatic consequences on children throughout the country by putting them through unnecessary suffering and misery. It is also very likely that deaths will result as a direct consequence of these cuts.
As someone who has been involved in various grassroots social justice movements for over a decade, it's difficult for me to address this issue without trying to identify some root causes and without speculating on the future. After all, as a health care provider, it is not enough for us to simply treat symptoms; it is imperative for us to identify the cause of the symptoms in order to deal with them and, ideally, to prevent illness and suffering whenever possible in the first place.
The false narrative used to justify the cuts to the IFHP
Some of you may remember the "conflict" between Citizenship and Immigration Canada (CIC) and the Quebec pharmacy-owners' association (AQPP) in early 2011, when the AQPP encouraged its members to not fill prescriptions from IFHP beneficiaries.
Some of us wondered whether CIC used the conflict as a test-case for future cuts to the IFHP, in order to gauge whether there would be an outcry. In retrospect, it is too bad that we did not mobilize more forcefully to denounce that situation and ring the alarm of what may be coming. Interestingly, at the time, Jason Kenney, Minister of Immigration and Citizenship, took the following position in a release dated January 27, 2011: "[W]e need to ensure that refugees get important medications, such as insulin, chemotherapy drugs, and treatment for sexually transmitted diseases or tuberculosis. Anything less than this will compromise the health of vulnerable immigrants in Quebec, as well as the public at large."
This was barely a year ago. Today, Kenney sings a very different tune. Clearly, politicians can say something one day and its opposite the next.
The three main justifications now provided by the Conservative government for the cuts - namely 1) "fairness for Canadian taxpayers", 2) "the need to protect public health and safety" and 3) "taking away an incentive for migrants from filing unfounded claims" - are simply preposterous and hypocritical.
Fairness and equality
Using "fairness" to mean "equality" as an argument to cut health care provision for marginalized sectors of society callously ignores the many systemic and institutional barriers (often referred to as the "social determinants of health") that prevent such people from equitably accessing healthcare services.
Pitting "equality" (ie., everyone should have access to the exact same services) versus "equity" (ie., people should have access to services based on their needs and in recognition of the "social determination of health") engages us in a false debate that is predicated on an assumption that the current allocation of fixed resources by the government is just and appropriate. The argument follows, in this false dichotomy, that expenditures must be controlled out of concern for the "Canadian taxpayer." Meanwhile, the fact that many migrants who are not Canadian citizens pay taxes in various ways -- including sales tax and income tax -- is conspicuously ignored.
However, if controlling expenditures is really an issue, then why has the Conservative government prioritized spending billions of dollars on purchasing warplanes and expanding the prison system? At the end of the day, the IFHP cuts will only result in transferring the costs of healthcare provision from the federal government to provincial governments and, more dramatically, to migrants themselves, at the cost of their lives and well-being.
Public health and safety
If the health and safety of the public was truly a concern, why isn't the Conservative government expanding health care coverage for all people who live here? This would be a more effective way of ensuring the health and safety of all. After all, despite what they would have us believe, immigrants and refugees are as much part of the "public" as anyone else!
Instead, they are proposing piecemeal coverage for a restrictive and non-comprehensive list of health issues to address purported concerns around "public health" and "public safety", but which will actually address neither. The piecemeal coverage will, however, severely limit access to healthcare for a population that is already exploited in the workplace and marginalized in society. Removing access to screening and diagnosis for most illnesses will severely compromise efforts focused on prevention and health promotion, which are the cornerstones of sound public health policy.
Understanding why people migrate
If the Conservative government wants to take away an incentive for migrants from filing what they refer to as "unfounded" claims, why don't they make an effort to understand why people migrate in the first place? Implying that people migrate here to "take advantage" of the healthcare system is bordering on paranoia!
People migrate because of various forms of political, social and economic violence. People come to Canada because they have been forced to migrate as a result of displacement. In fact, there are many causes of displacement, including the roles played by Canada actively through, among other things, its foreign policy (i.e. via military interventions abroad) and its corporate complicity (i.e. by allowing mining companies that operate abroad to be based here).
It is sheer hypocrisy for Canada to be active or complicit in producing conditions that result in forced displacement and migration, while simultaneously wanting to prevent people from migrating to Canada, a country itself founded on violent theft of land and genocide of Indigenous peoples. People leave their homes, effectively un-rooting themselves, and come here to make new lives amidst great difficulty. They must be treated as full members of our communities.
Draconian health policy tied to draconian immigration policy
We cannot understand the implications of the cuts to the IFHP unless we understand the broader implications of immigration policy and the realities of forced displacement and migration. This is why it is difficult to understand the cuts to the IFHP without understanding changes to immigration policy that are occurring through, for example, the "Balanced Refugee Reform Act" and Bill C-31 that allow for the discriminatory act of naming "designated countries of origin" by the Immigration Minister.
This is also why it is important to understand the Immigration and Refugee Protection Act, which predates the Conservatives coming into power. Restrictive and punitive immigration policy - particularly the politics of detention and deportation - have significant impacts on those to whom we provide care. Even when immigration policies and decisions don't have direct impacts on children, they can have serious life-or-death indirect impacts on them.
Deportation and preventable deaths
We were asked to share examples from our clinical work, so I will share my recollection of one particularly heart-wrenching anecdote from when I was working in the pediatric intensive care unit (PICU) several years ago.
There was a toddler who had arrived from South Asia not too long ago, for assessment and treatment of a rare type of cancer that is more common in infants and young children. Several years prior, both his parents had applied for refugee status. In a decision that reveals the arbitrariness and contemptuousness of the refugee determination process, his mother was eventually accepted, his father wasn't. So, his father was deported back to his country of origin.
The rest of the family, including this child, ended up going back soon after to stay together as a family, despite the risks that they would incur in doing so. It was possibly during this tumultuous period that the child may have started exhibiting symptoms and signs of his disease. The diagnosis was made in the family's country of origin in South Asia, but the health care team there eventually conveyed to the family that they didn't have the expertise to deal with the case. So, the mother decided to bring the child back to Canada.
The health care team here did its utmost to ensure the survival of the child. Among other interventions, he underwent a major surgery (lasting over 12 hours) to remove as much of the tumor as possible, which is why he needed to be admitted to the PICU where I was working at the time. But, despite everyone's tireless efforts, it was all probably too little, too late. I was informed later on that the child died a few weeks afterwards.
I still remember looking into his eyes -- quiet, lost, suffering -- a day or two after his surgery while working an overnight shift, and being drawn to tears. Those eyes haunt me to this day. Perhaps if his father had never been deported, this tragedy could have been avoided because the child may have come to medical attention at an earlier point in time, and to a healthcare team that may have had more to offer because of the healthcare resources that are available here.
The child I just referred to was not an IFHP beneficiary because he had health care coverage (presumably as a consequence of his mother's refugee application having been accepted years prior). I use this example, however, because of how significant the impacts of migration and forced displacement can be. There are many other similar examples those of us who work in the health care field can provide. As I mentioned earlier, even when immigration policies and decisions don't have direct impacts on children, they can have serious and life-or-death indirect impacts on them.
Demanding the bakery: Healthcare for all!
As healthc are providers, we have to denounce all health policy that has nefarious consequences on the people we serve. We must be motivated by principles of social justice to ensure that all people in our communities are treated justly and with dignity.
So, when speaking about migrants, yes, I think the cuts to the IFHP must be denounced. But, we also have to denounce the fact that the current form of the IFHP is not a panacea as it is, because access to health care was limited for IFHP beneficiaries even before the proposed cuts.
We also have to denounce the "délai de carence" policy, which calls for a three-month period before some provincial health plans kick in, during which time permanent residents risk going uninsured if they can't afford private insurance. In such situations, they are on the hook to pay out-of-pocket if they have the misfortune of getting sick or injured during this limbo period.
Finally, we also have to denounce the fact that there are likely hundreds of thousands of people - including children - who are living in Canada without any health care coverage at all because they are non-status and therefore uninsured. At the end of the day, we have to seriously question, and oppose, the politics of detention and deportation altogether.
As health care providers committed to providing competent healthcare, we shouldn't be asking for bread on behalf of the people we see in our clinics and hospitals every day -- we should be demanding the bakery. And its name is "health care for all"!
Ultimately, the point is that cuts to the IFHP should not be viewed as an isolated issue. The cuts are not occurring in a vacuum. The cuts to the IFHP fit into a larger agenda to gut social services and social assistance programs. These cuts may be a harbinger of even more draconian cuts to come (ie., in health care, housing, social assistance, etc.) that will have disastrous consequences on other marginalized and oppressed communities.
These cuts are occurring in a political and economic system that values profit over people and favors economic growth through environmental and societal destruction. A system that is in overdrive whether in Quebec, in Canada or the rest of the world.
And, there's only one force that can stop it: Everyday people. Together. Organizing against injustice. Fighting back.
Samir Shaheen-Hussain has been involved in radical grassroots social justice movements for over a decade. He is also a pediatrician who was involved in the planning for the Montreal component of the National Day of Action against the IFHP cuts on June 18, 2012.
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