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Last week, Public Safety Minister Ralph Goodale unveiled a $138-million budget for developing “alternatives to [immigration] detention,” including $10.5 million dedicated to bettering health services in detention facilities.
However, ending indefinite detention is just one step towards migrant justice. “In the meantime, what needs to be addressed is health. People are dying, people aren’t receiving health care. [And in the long term,] what needs to happen is a regularization program where there’s a pathway to [permanent immigration] status,” Diana Da Silva, a settlement worker in Toronto, told rabble in a telephone interview.
An estimated 250,000 people in Ontario do not have access to the Ontario Health Insurance Plan (OHIP) as a result of their immigration status.
“Health care is a human right. Everyone should be able to see a doctor, even if they don’t have an OHIP card,” Chinnie, a 21-year-old Caribbean woman living without OHIP, who did not want to use her real name, told rabble in a telephone interview.
Uninsured clinics overburdened after IFHP cuts
Da Silva has helped migrants without status navigate the health-care system since 2013, when she began working at the FCJ Refugee Centre in Toronto.
In June 2012, the government under Stephen Harper made significant cuts to the Interim Federal Health Plan (IFHP), which provided health coverage to certain categories of refugee claimants.
A lot of coverages were cut, including prescription drugs and assistive devices, Da Silva told rabble. In response, a doctor with FCJ started a primary care clinic for uninsured individuals one day a week.
Two years after opening its doors, the uninsured clinic had secured funding and expanded its staff to include three physicians, a registered nurse, a primary care coordinator and accommodated internationally trained doctors who received mentor support.
“Before the 2012 cuts, [IFHP] was already having some issues just because there’s extra paperwork that physicians and doctors offices have to fill out,” Da Silva explained.
The 2012 cuts resulted in “a very complicated flow chart of who gets access to what, and it just became so administratively impossible to provide care to this group,” and while migrants with IFHP should be able to access hospitals and clinics, “what ended up happening most of the time is that refugees were being denied care,” Da Silva told rabble.
It became easier for refugees with IFHP to receive care at uninsured clinics, which were intended to provide care for migrants without IFHP.
“At [our] uninsured clinic we started to see more refugees, but we were already overburdened with people who didn’t have coverage and wouldn’t have it in the future,” Da Silva explained.
Barriers to health-care access
While working at the uninsured clinic, Da Silva met Chinnie, who moved to Ontario in 2013 with her family to “seek a better life.”
“I had some issues with my back, and a lot of it has to do with my weight,” Chinnie told rabble in a telephone interview.
The shelter where she was living referred her to the FCJ Refugee Centre’s uninsured clinic, where she could access primary care without status.
“They set me up with a nutritionist, and I was also suffering from a lot of pain in my shoulder and [FCJ Refugee Centre] sent me to a doctor to get a heart test,” Chinnie told rabble.
Da Silva helped Chinnie access doctors and nutritionists without having to pay the full costs associated with doctor’s visits, which are often prohibitive.
“My focus would be to get them past that front entrance where they would ask for an OHIP card or money. My goal was to push past that just so that we could get them inside and then I could deal and help them deal with that bill later,” Da Silva explained.
Da Silva told rabble that many migrants opt for hospitals because they aren’t aware of other options. “If they’re not feeling well they will just go to a hospital, which makes it way more difficult because you have to pay and are sometimes denied care if you [cannot pay],” Da Silva said.
But many migrants without status or health coverage are aware of the costs and avoid the hospital, even in emergencies. “They would come to our small clinic and we were able to help them navigate what they could do in terms of the system and how to deal with that huge bill that they would get at the end of their stay at the hospital,” Da Silva told rabble.
Bills aren’t the only barriers to accessing health care. Da Silva explained that language barriers and trust issues also prevent migrants from being able to communicate their needs to physicians.
“More often than not, this community has been exploited […] so by the time they reach me at the clinic, I dealt with quite a few people who didn’t trust me so they wouldn’t provide their information,” Da Silva explained.
“I did meet someone who was fleeing from CBSA and she didn’t want to leave any of her information […] and I had another woman who […] came several times a year but she provided a different name [each time],” Da Silva continued.
Unlike the FCJ uninsured clinic, which Da Silva says provides a caring atmosphere because it operates in a house, clinics and hospitals aren’t always sensitive to migrants’ privacy. Chinnie described how during one clinic visit, the intake worker “yelled out the information, she was like ‘so you have no status in Canada?’ and everyone heard.”
“I felt so uncomfortable,” she said, and argued that sensitivity training should be provided to all health-care professionals and community workers. “Everyone has different experiences, and Canada is a country of immigrants, so you don’t know what is going to set someone off or make them feel very uncomfortable,” she said.
Even with implied status, OHIP inaccessible
Migrants without status aren’t the only community without access to OHIP. “In Canada there’s quite a few statuses that are linked to your employer,” Da Silva told rabble. For these workers, health care is employer mediated.
In 2008, Astra Cenora Desembrana arrived in Toronto under the Live-in Caregiver Program, leaving her son and daughter at home in the Philippines.
In June 2014, Desembrana’s work permit expired, leaving her without OHIP or a valid SIN number.
Desembrana was also waiting for the government to process her permanent residency application, which she had filed in 2012 after meeting the employment requirement for application. Desembrana’s PR application was stuck in a backlog totalling nearly 60,000, leaving her with implied status.
“I [was] having coughs, and I [couldn’t] go to the doctor. I have high blood pressure and [couldn’t] get a refill on my prescription,” Desembrana told rabble in a telephone interview.
“I’m a support worker with seniors, of course [the seniors] started coughing, and they would call the office and ask to change the worker,” explained Desembrana. A friend with similar cough symptoms gave Desembrana cough syrup she was prescribed by a doctor, but Desembrana was unable to obtain medication for her high blood pressure.
“I’m really high risk. It was really scary. [I was] scared that something will happen to me and I don’t have the health card,” said Desembrana, whose parents died of conditions related to their high-blood pressure.
“The sad thing is, I was working in Saudi Arabia for eight years, and in Saudi Arabia we were not denied access to health [services]. We could go to our employee health centre to have check-ups and everything. I [am] frustrated that now I’m here in Canada and then I was denied of those things,” Desembrana told rabble.
“These people are paying their taxes, they’re workers who are contributing to the Canadian society. This is a human rights issue,” Esel Panlaqui, a settlement counsellor with the Thorncliffe Neighbourhood Office in Toronto who worked with Desembrana, told rabble in a telephone interview.
Desembrana agrees, reiterating: “It’s just unfair, we’re paying our taxes. I hoped we could be given equal opportunity with Canadians, not everything but at least most important things like our health care. We’re human also, we need those things,”
Desembrana’s renewed work permit arrived in late autumn that year, and she obtained an OHIP card several months later. Desembrana’s permanent residency application was finally approved last month, after Panlaqui and caregiver advocates met with Immigration Minister John McCallum and pressured him to approve Desembrana’s and other caregivers’ backlogged applications.
As soon as her permanent residency card arrives, she plans to start the sponsorship process for her two children, who she hasn’t seen since 2008.
“The psychological and emotional impact of the long process of family reunification is very huge,” Panlaqui told rabble, “and it’s the responsibility of the Canadian government to protect these workers.”
Solutions: OHIP for All, status upon arrival
“It’s very important that advocates continue to pressure the government,” Panlaqui told rabble.
Panlaqui is hopeful that Parliament’s review of the Temporary Foreign Workers Program (TFWP) will address barriers to accessing health services, but recognizes she is worried that “there is only limited access to the review process in terms of worker participation.”
For Da Silva, the OHIP for All campaign launched this summer is a necessary step towards opening up health services. OHIP for All is demanding Ontario extend full OHIP coverage to all Ontario residents, regardless of their immigration status.
“This isn’t a radical idea, there are European countries that are already doing this. Spain offers emergency care and provides identification to those without status. It’s not a perfect system, but we should jump on this as well” Da Silva argued.
Ultimately, Da Silva echoes many migrant justice groups’ demands for permanent status upon arrival for all migrants. “Off the bat we should be giving [migrants] permanent immigration status as soon as they land,” regardless of country of origin, employment, or the program under which they arrive in Canada.
“OHIP for All has been in contact with the Ontario Ministry of Health and Long-term Care to have these open conversations,” Da Silva told rabble.
“I’m definitely hopeful,” Da Silva said. “The fact that we’re having these discussions and there’s an actual conversation happening with the Ministry provides me with some hope that this potentially could change.”
“I’m so hopeful. I have faith, I keep my faith,” echoed Chinnie.
The OHIP for All campaign is calling on the government of Ontario to provide truly universal health care to all Ontarians regardless of immigration status, including:
Ending the three-month waiting period that prevents new immigrants, temporary foreign workers, and returning Canadians from accessing OHIP.
Providing OHIP coverage to those with temporary residency status, such as temporary foreign workers between contracts, and international students not otherwise insured.
Providing OHIP coverage for those with pending inland immigration sponsorship, and humanitarian and compassionate applications.
Providing OHIP coverage for other non-status individuals residing in Ontario.
Sophia Reuss is a Montreal-based writer, editor, and is a recent graduate of McGill University. She’s interested in how online media and journalism facilitate public accessibility and conversation. Sophia also writes and edits for the Alternatives International Journal. She is rabble’s current news intern.
Photo: flickr/Nicolai Grut