Canadian doctors and nurses fight for refugees’ right to health care

On June 16, doctors, nurses and other healthcare practitioners gathered in cities across Canada for the third National Day of Action against cuts to federal refugee health care funding.
Bearing signs reading “Health care is a basic human right” and “No one is bogus,” they are protesting the changes made two years ago by the Conservative government to the Interim Federal Health Program (IFHP).

At the rally in Vancouver, nurse Hadassah Moes opened with personal stories from her work at the Bridge Community Health Clinic in Vancouver, a centre that provides primary and preventative health services for refugees. She was followed by other health practitioners – representatives from Canadian Doctors for Refugee Care, nurses from other clinics and representatives from the Vancouver Association for Survivors of Torture (VAST), among others.

Many of the organizations at which the practitioners work ask that their employees not take a political stance or an overt a role at rallies such as these. But compelled by what they see daily in clinics and offices across the country, they are increasingly speaking up in whatever ways they can. They join together in protest because as Moes said in her opening speech, “Behind the statistics are people who have survived suffering, yet still hope beyond hope for a brighter tomorrow. Yet with these fiscally ‘responsible’ cutbacks, hope for holism and health seems like a mere façade.”

But on July 4, these practitioners had something to cheer about as Canada’s Federal Court declared the government’s cuts to be “cruel and unusual,” giving Harper’s Tories four months to change them before the court would potentially strike them down itself. The government has vowed to appeal.

A reduction in care
The cuts were first introduced by the Federal Government in June 2012, in a move that received widespread condemnation not only from health care practitioners but also all provincial and territorial health ministers.

One effect of the changes is the cut to supplemental benefits previously given to privately sponsored refugees. Now refugees sponsored by churches, individuals and other organizations must ask their sponsors to pay for prescription drugs, prosthetic limbs, wheelchairs, vision and dental care. The other options are to pay themselves or go without.

The cuts also aim to delineate a sharp line between what the government calls “bogus” refugees (a term first used by former Immigration Minister Jason Kenney) and “genuine” ones. Refugee claimants – those seeking official “Government Assisted Refugee” status – who are from countries Canada has designated as “safe,” or rejected claimants, fit the former category. The only situation in which they can now receive funded care is if their condition makes them a threat to public safety. This means that while treatment for a contagious disease might be funded, a heart attack would not.

Many practitioners and others take issue with this line-drawing, saying the government is labeling as “bogus” even those claimants who are still awaiting court hearings to determine their legal status in Canada. As nurse Moes told Christian Courier in an exclusive interview, “when you’re seeking asylum, and you haven’t yet been given definitive status [but are still called “bogus”] – it’s saying you’re guilty before you’ve even had a chance to state your case.”

‘No one is bogus’
Akberet Beyene, 50, is a refugee who feels acutely what the IFHP cuts and the labelling as “bogus” can mean. Though now an official Government Assisted Refugee, she initially came to Canada on a fake passport in 2011, having fled imprisonment and house arrest for her work as a journalist in her home country of Eritrea.

After being shot at as she walked over the border between Eritrea and Sudan, she escaped to the capital, Khartoum, where she thought she might be safe. She was considering claiming asylum with the United Nations or the Canadian or American Embassies until her contacts in Sudan told her there was an imminent risk of being kidnapped by representatives of the Eritrean government and re-imprisoned. “For three months I hid inside this little dark room in Sudan,” she remembers, “I only came out at night.” Out of options, her friends managed to put her on a flight to Vancouver with a fake passport. She cried the whole way to Canada. “My intention was never to leave my country – I gave so much to it. But my world crumbled,” she says.

Upon arrival in Vancouver, knowing no one and with no money, a taxi driver took pity on her when she told him her story and asked him to take her “to African people like me.” He brought her to an Ethiopian restaurant where the owners took her home and gave her clothes and food. “I told them, ‘Take me to the police. I don’t want to do a crime,’” she says. “I want to tell the police [I’m here illegally]; I want to tell them right away.” However, the stress of her escape from Eritrea and Sudan had left her extremely ill, and it took her 10 days to recover, particularly as she was too afraid to go to the hospital. After she was well, her hosts brought her to Immigration Canada, who eventually referred her to a non-profit in Vancouver that provides housing, orientation and education to people in Canada’s refugee protection system. This non-profit helped bring her case before the courts. In July 2013, she received a positive decision.

In the two years it took for her court case to go through, she was still considered a claimant, a situation which Moes and other health care practitioners say would have labelled her as “bogus.” Suffering from severe anxiety and depression both because of her experiences in Eritrea and because of her fear of being sent back, she was prescribed medication by a doctor in Vancouver. Because she had arrived prior to June 2012, the medication was covered. Had she arrived just a year later, it likely would not have been. Her undetermined status meant that she could not receive the kind of documentation that would have allowed her to work or go to school, and she would have been unable to pay for her treatment.  

The hidden cost of cuts
Cities and provincial governments are, in some cases, trying to fill in the gaps created by the cuts, with Manitoba stepping in almost immediately and Alberta being the most recent province to start an investigation into how its provincial government can help. Private sponsoring organizations and non-profits are also footing some of the costs. But health care costs can quickly skyrocket, particularly beyond private/non-profit organizations’ budgets.

“We’re just going to see things go underground,” Moes told CC. “There are already uninsured clinics operating, which is a concern. We want to make sure that people get proper care.”

Refugees’ right to health care
In many ways, provincial governments are stepping in to foot costs they already were forced to take on as a result of the federal cuts. As the Embassy News reported following an interview with the founder of Canadian Doctors for Refugee Health Care, “Increasingly, refugees are being forced to use emergency medical services in lieu of the primary and preventative services they’ve now lost. Because provincial governments foot the bill for emergency health expenses, it’s a cost savings for the federal government but not to taxpayers or refugee-sponsoring groups.”

‘Mass confusion’
In addition to the hidden costs, the cuts have created what Canadian Doctors for Refugee Care calls “mass confusion on the front lines.” The government has done a poor job of keeping those involved in primary care informed of how and when the cuts are taking place, and a lack of information has left health care providers scrambling.

“What ends up happening is clinicians end up muddled in bureaucracy, trying to figure out who’s covered and who’s not and for what,” Moes says. She adds that all of the extra time taken to determine the best course of treatment for each level of coverage means less time spent with patients, and poorer quality of care.

Additionally, practitioners are noticing that even refugees who are eligible are afraid to seek treatment. They’ve heard about the cuts but due to the confusion (as well as to language and educational barriers) they have difficulty understanding whether or not they are affected. When they do seek help, even legal claimants are sometimes rejected in the confusion.

Radical welcome
Moes says that she understands the government’s fiscal responsibility and the pressure it receives from many taxpayers. And, while the funding prior to the 2012 cuts still had many holes, she would be happy if the government would just return to that. “I would love the federal government to reinstate the funding, but I don’t know if it’s realistic,” she admits.

When asked about the concerns many Canadians have about people abusing the system, Moes takes a generous stance, which she says comes particularly from her Christian faith. “I think we, as people, are called to a radical welcome. . . . If I came, and I was fleeing violence, I might also do things like using a fake passport, or trying to pass my nephew off as my son to get him health care. But we have a duty to care and duty to love.” She does not condone unethical behaviour, and acknowledges that not all abuse of the system comes out of desperation. But she returns to the oath she took as a health care practitioner to “do no harm”: “As a clinician, it’s not my call to make as to whether someone ‘deserves’ a vaccination – it’s about their health. That basic human right – you don’t negate people the basic human right to health.”

A plea to Canadians
“Once you see suffering, you don’t un-see it,” she adds. “I can’t ignore being an advocate. Once you’ve heard and once you’ve seen, you don’t not stand up for these people. What is it – 75 cents per Canadian to re-instate the funding? Even less now [in 2012, it was calculated to be 59 cents]. And it’s not like we have millions of refugees come in. That’s a misconception.”

Beyene echoes Moes. She says that when she criticizes the system, “I am speaking like a Canadian. But I want to say that I am grateful. I do feel that Canadians embraced me – they are so kind and generous. I feel loved here, and protected. I can sleep in safety, as I couldn’t at home in Eritrea. The people are great. The nurses, the doctors – they help you. It’s the system that hurts.”