Part of a series on |
Healthcare in Canada |
---|
Canadaportal |
Part of a series on |
Canadian citizenship |
---|
Canadaportal |
Refugee health care is the provision of health services to refugees and refugee claimants. As early as 2009, health researchers identified particular medical needs and health vulnerabilities amongst these populations. [1] Compared to other immigrants, they report more physical, emotional, and dental problems [2] and, compared to those born in Canada, they have higher rates of infections and chronic diseases that are both treatable and preventable. [3]
In Canada, the federal government has been responsible for the provision of health care to refugees since 1957. Under international law, this responsibility falls under Canada's human rights obligations to recognize the right to health for all, including refugees.
The concept of a “right to health” has been recognized in a number of international rights instruments to which Canada is a party. [4] It was first articulated in the 1946 Constitution of the World Health Organization as “the right to the enjoyment of the highest attainable standard of physical and mental health." [5] Article 25 of the 1948 Universal Declaration of Human Rights also mentions the right to health as part of the right to an adequate standard of living. [6] Some international human rights instruments acknowledge a right to health by general application and others through the protection of rights of specific groups such as women or children. In 1966, the right to health was recognized as a human right in article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), which imposes an obligation on state parties to the Covenant to create “conditions which would assure to all medical service and medical attention in the event of sickness”. [7]
The Canadian Charter of Rights and Freedoms does not include any express protection of the right to health. The Canadian government has frequently argued in court that social and economic rights—including the right to health—are merely ‘policy objectives’ that are not subject to judicial intervention. [8] The ICESCR Committee has voiced concern over Canada's lack of compliance to these international obligations. It argues that such submissions are incompatible with Canada's obligations to provide remedies to violations of Covenant rights in domestic law. [9]
Right to health claims under the Charter's section 15 equality provision have had limited success. In Eldridge v. British Columbia , in the context of the provision of sign language, the Supreme Court found that the government should ensure that disadvantaged members of society have equal access to benefits. The Court noted that any finding to the contrary would result in a “thin and impoverished view… of equality”. [10] In a later case about the provision of autism services, Auton v. British Columbia , the Court narrowed the Eldridge approach by requiring that protected benefits be ones “provided by law”. [11]
Though a substantive equality approach to section 15 has had limited success in remedying health and other social and economic rights violations of disadvantaged groups, Colleen Flood, one of Canada's leading health law professors, argues that failed claims can contribute to furthering equality by illuminating a problem and generating political support for its resolution. [12]
In Canada, the provision of basic health care for refugees and refugee claimants is regulated by the Interim Federal Health Programme (IFHP) before they are covered by provincial or territorial health insurance plans. The IFHP was introduced through an Order in Council by the federal government in 1957, [13] and has been managed by Citizenship and Immigration Canada since 1995.
Prior to June 2012, the IFHP provided refugees and asylum seekers with basic health care coverage as well as supplemental coverage including access to medication, dentistry, and vision care. [14] Those whose application for refugee status were denied retained coverage until they were deported.
The Canadian government introduced a series of changes in April 2012. As of its date of effect on 30 June 2012, IFHP divides asylum seekers into three categories with differing levels of health coverage depending upon the person's country of origin. There are now three baskets of services:
If the refugee claimant is from a designated country of origin, they will receive “very limited” health coverage. [15] Some of the provinces have stepped in to cover services and medication no longer provided under the IFHP. [16]
In defending the changes, the government explained its rationale as being to ensure equality between the health care received by refugees and that afforded to Canadians such that refugees would not receive superior benefits. Former Citizenship and Immigration Minister Jason Kenney emphasized the generosity of Canadians and Canada's immigration system, stating that the government did “not want to ask Canadians to pay for benefits for protected persons and refugee claimants that are more generous than what they are entitled to themselves.” [14] In a related case, Nell Toussaint v. Attorney General of Canada , the Supreme Court cautioned that by extending universal health care regardless of immigration status, Canada “could become a health-care safe haven.” [17]
The government also made cost and deterrence arguments in favour of reforming the legislation. These changes were estimated to save $100 million over five years. The government argued that the cuts would deter claimants who are drawn to the country for its health care. [14]
Critics of the 2012 reforms include the Canadian Medical Association Journal and the Canadian Paediatric Society. [18] [19] The heads of eight major professional associations including nurses, social workers, and physicians signed a letter opposing the cuts, demanding that pre-2012 refugee health provision be restored. [20] These advocates argue that the differential treatment of refugees and refugee applicants depending on their country of origin is discriminatory. Ontario's Health Minister Deb Matthews called for the changes to be reversed stating that “this policy change will create a class system for health care in Canada.” [21]
The Canadian Charter of Rights and Freedoms does not include any express protection of the right to health, but this right has been protected indirectly by Courts through the use of other provisions, such as the section 15 equality guarantee. [22] Cousins Section 15(1) provides that:
[E]very individual is equal before and under the law and has the right to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age or mental or physical disability. [23]
The current legal test for a section 15 equality analysis comes from Andrews as affirmed in R v Kapp . It requires that the court satisfy two conditions: (1) the law creates a distinction based on an analogous or enumerated ground; and (2) the distinction creates a disadvantage by perpetuating prejudice or stereotyping. [24]
The right to health has been litigated under Charter provisions outside of section 15. [22] In December 2013, the Canadian Doctors for Refugee Care (CDRC) and the Canadian Association of Refugee Lawyers (CARL) brought a challenge to the Federal Court of Canada claiming that the government's cuts to refugee health care were unconstitutional. [25] Specifically, CARL proposes that both “country of origin” and “immigration status” are discriminatory grounds under section 15(1) of the Charter. [26]
The CDRC/CARL challenge to the IFHP reforms is founded on two additional Charter provisions:
Prior to the 2012 reforms, in Nell Toussaint v Attorney General , Toussaint challenged the constitutionality of the IFHP on the basis of the proposed analogous grounds of disability and citizenship. [27] The Court found neither of these grounds to be applicable to the claimant in question, but made a point of leaving open the question as to whether immigration status could be an analogous ground. If found to be an analogous ground, the applicant's exclusion from IFHP coverage could have been in violation of section 15(1) of the Charter. [28]
The Canadian Civil Liberties Association, in its intervenor factum, drew a comparison between immigration status and non-citizens. [29] A number of cases have recognized that non-citizens, which capture many different types of immigration statuses, constitute an analogous ground under section 15(1). For example, in Andrews v. Law Society of British Columbia , the Court held that citizenship is an analogous ground since it was a personal characteristic “typically not within the control of the individual, and in this sense, is immutable.” [30] In Lavoie v. Canada , the Court held that “non-citizens suffer from political marginalization, stereotyping and historical disadvantage.” [31]
Recent studies have identified significant gaps in health care coverage for female refugees, particularly in the areas of pregnancy and mental health care. Specifically, barriers to health care access such financial difficulty have been shown to intersect with other post migration difficulties experienced by women with migrant status like downward social mobility, poor access to optimal nutrition, and limited social networks. [32] Moreover, women with migrant status are more vulnerable to being refused care on the basis of their insurance status, thereby relying on informal networks of volunteers and willing physicians, dentists, and pharmacies. [33]
Disparities have further been identified in the area of perinatal care, where uninsured migrant women are shown to receive less overall coverage than their insured counterparts, in addition to paying for diagnostic, physician, and hospital fees, leading to less than optimal outcomes. [34] Mental health issues among female Syrian refugees have been examined, specifically instances of maternal depression. [35] Causes for these mental health issues are varied and include lack of social support, in addition to cultural and socioeconomic factors. [35] Further, migrant and refugee women are more likely to succumb to postpartum depression due to the additional stressors of the migratory experience. [36]
Access to health care for refugees and other migrant populations has been constrained by language barriers, among other cultural factors. A 2012 study showed that roughly sixty percent of government-assisted refugees had no English or French language skills, therefore acting as a deterrent to accessing proper health care. [37] Concerns over privacy are also significant, as some women have expressed reluctance to using interpreters within the same, small ethnic community. [35] However, proper interpreter training may help bridge the gaps between patient and health practitioner, as is the case in British Columbia where the Provincial Health Services Authority trained thirty interpreters in anticipation of the arrival of 3,500 Syrian refugees in 2016. [38]
Steady declines in migrant health have been noted to occur within a few years of arrival in Canada, a phenomenon known as the "healthy immigrant effect," [1] due largely to Canadian immigration policy and medical evaluations of potential immigration candidates. [39]
In a study of Tamil and Iranian female refugees in Canada, instances of mental symptoms such as recurring nightmares, emotional detachment, hyper vigilance, and difficulty concentrating have been noted. [40] Moreover, it has been observed that youth who have experienced living as refugees demonstrate higher levels of emotional problems and aggressive behaviors due to past traumas. [41] It was further noted that instances of post arrival trauma, in the form of discrimination based on race or refugee status, have significant negative effects on mental outcomes for youth. [41]
A study on political violence asylum seekers detained in Canada also found that post-migration immigration status predicted the development of PTSD symptoms almost as strongly as rape or sexual assault. Financial and legal insecurity similarly predicted elevated rates of PTSD symptoms. [42]
In Canadian and New Zealand law, fundamental justice is the fairness underlying the administration of justice and its operation. The principles of fundamental justice are specific legal principles that command "significant societal consensus" as "fundamental to the way in which the legal system ought fairly to operate", per R v Malmo-Levine. These principles may stipulate basic procedural rights afforded to anyone facing an adjudicative process or procedure that affects fundamental rights and freedoms, and certain substantive standards related to the rule of law that regulate the actions of the state.
An asylum seeker is a person who leaves their country of residence, enters another country, and makes in that other country a formal application for the right of asylum according to the Universal Declaration of Human Rights Article 14. A person keeps the status of asylum seeker until the right of asylum application has concluded.
Permanent residency is a status granting someone who is not a Canadian citizen the right to live and work in Canada without any time limit on their stay.
Healthcare in Canada is delivered through the provincial and territorial systems of publicly funded health care, informally called Medicare. It is guided by the provisions of the Canada Health Act of 1984, and is universal. The 2002 Royal Commission, known as the Romanow Report, revealed that Canadians consider universal access to publicly funded health services as a "fundamental value that ensures national health care insurance for everyone wherever they live in the country."
Singh v Canada (Minister of Employment and Immigration), [1985] 1 S.C.R. 177 is a 1985 case of the Supreme Court of Canada. It determined that refugee claimants had a constitutional right to an oral hearing, by the principles of fundamental justice. The judgment was an early decision under the Canadian Charter of Rights and Freedoms and was also decided under the Canadian Bill of Rights. It had a significant impact on immigration law, human rights law, constitutional law, and administrative law in Canada. The Singh decision resulted in amnesty being granted to tens of thousands of refugee claimants and sweeping reforms which gave Canada one of the most liberal and most expensive refugee systems in the world. The anniversary of the ruling, 4 April, has been observed in Canada as Refugee Rights Day.
Suresh v Canada (Minister of Citizenship and Immigration) is a leading decision of the Supreme Court of Canada in the areas of constitutional law and administrative law. The Court held that, under the Canadian Charter of Rights and Freedoms, in most circumstances the government cannot deport someone to a country where they risk being tortured, but refugee claimants can be deported to their homelands if they are a serious security risk to Canadians.
Immigrant health care in the United States refers to the collective systems in the United States that deliver health care services to immigrants. The term "immigrant" is often used to encompass non-citizens of varying status; this includes permanent legal residents, refugees, and undocumented residents.
Illegal immigration is the migration of people into a country in violation of that country's immigration laws, or the continuous residence in a country without the legal right to. Illegal immigration tends to be financially upward, from poorer to richer countries. Illegal residence in another country creates the risk of detention, deportation, and/or other persecutions.
The U.S. Committee for Refugees and Immigrants (USCRI) is a 501(c)(3) nonprofit organization with locations in the United States, Mexico, El Salvador, Honduras, and Kenya, and a national network of nearly 200 partner agencies that provide support for those experiencing forced and voluntary displacement.
Physicians for Human Rights–Israel is a non-governmental, non-profit, human rights organization based in Jaffa. Physicians for Human Rights–Israel was founded in 1988 with the goal of promoting "a just society where the right to health is granted equally to all people under Israel’s responsibility."
Women migrant workers from developing countries engage in paid employment in countries where they are not citizens. While women have traditionally been considered companions to their husbands in the migratory process, most adult migrant women today are employed in their own right. In 2017, of the 168 million migrant workers, over 68 million were women. The increase in proportion of women migrant workers since the early twentieth century is often referred to as the "feminization of migration".
LGBT migration is the movement of lesbian, gay, bisexual and transgender (LGBT) people around the world or within one country. LGBT individuals choose to migrate so as to escape discrimination, bad treatment and negative attitudes due to their sexuality, including homophobia and transphobia. These people are inclined to be marginalized and face socio-economic challenges in their home countries. Globally and domestically, many LGBT people attempt to leave discriminatory regions in search of more tolerant ones.
The "comparator group" is an element that has been used in Canadian jurisprudence to analyze statutory human rights complaints and claims pursuant to section 15 of the Canadian Charter of Rights and Freedoms. Section 15 guarantees equality rights and the right to be free from discrimination on certain enumerated grounds.
A considerable portion of the United States' population is foreign-born. Undocumented immigrants make up about 28% of the foreign-born residents. A model analyzing data from 1990-2016 estimates the number of undocumented immigrants in the US range from 16.7 million to 22.1 million.
Immigration is the movement of an individual or group of peoples to a foreign country to live permanently. Since 1788, when the first British settlers arrived in Botany Bay, immigrants have travelled from across the world to establish a life in Australia. The reason for people or groups of peoples moving to Australia varies. Such reasons can be due to seeking work or even refuge from third world countries. The health of immigrants entering Australia varies depending on the individual's country of origin and the circumstance of which they came, as well as their state of travel to Australia. Immigrants are known to enter Australia both regularly and irregularly, and this can affect one's health immensely. Once in Australia, immigrants are given the opportunity to access a high quality of healthcare services, however, the usage of these services can differ dependent on the culture and place of birth of the individual. Researchers have proven this. Australia has strict health regulations that have to be met before one is allowed access into Australia and can determine if one is granted or denied such access. The quarantine process of immigrants into Australia has been in place since 1830, starting at the North Head Quarantine Station and continues all over Australia.
Special considerations are needed to provide appropriate medical treatment for refugee migrants to the United States, who often face extreme adversity, violent and/or traumatic experiences, and travel through perilous regions. Such considerations include screenings for communicable diseases, vaccinations, posttraumatic stress disorder, and depression.
Almost half of international migrants are women, generally travelling as either migrant workers or refugees. Women migrant workers migrate from developing countries to high-income countries to engage in paid employment, typically in gendered professions such as domestic work. Because their work disproportionately takes place in private homes, they are vulnerable to exploitation and abuse. Wages earned are largely sent home to the originating country to support the cost of living of the family left behind.
Mental health consequences of immigration detention include higher rates of depression, anxiety, PTSD, schizophrenia conduct issues, hyperactivity, compared to the general population. These harmful impacts exist regardless of past traumatic experiences, age, or nationality, or even time elapsed. Immigration detention may take place at country or state borders, in certain international jurisdiction zones, on offshore islands, boats, camps, or could even be in the form of house arrest. The use of immigration detention around the world has increased recently, leading to greater concerns about the health and wellbeing of detained migrants. A 2018 scoping review from BMC Psychiatry gathered information showing that immigration detention consistently results in negative impacts on detainees.
Paul Caulford is a Canadian advocate, academic, and family doctor in Scarborough, Toronto who provides free healthcare to refugees, undocumented migrants and other newcomers who are unable to get healthcare through the formal channels.
The Canadian Centre for Refugee and Immigrant Health Care is a healthcare clinic in Scarborough, Toronto, that provides free healthcare to refugee and immigrants.