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Refugee decision a victory for compassion and common sense in Canadian health care


On June 18, 2012, I joined dozens of health care providers and concerned citizens in Saskatoon for the 1st National Day of Action against the cuts to the Interim Federal Health (IFH) program, which then offered health coverage to refugees in Canada.

Health providers in scrubs and lab coats, sporting stethoscopes and placards with slogans, marched in similar demonstrations across the country. I remember being struck then by the fact that 50 years earlier in Saskatoon, doctors had gone on strike in opposition to the introduction of universal health insurance. Now here was a movement of physicians and other health professionals taking to the streets to defend universal care for the most vulnerable. 

This past week, the Federal Court of Canada ruled that the Conservative government’s 2012 cuts to health care for refugees were unconstitutional, going against Section 12 of the Charter of Rights and Freedoms which forbids “cruel and unusual punishment”.

The court ruling is a victory for refugees and those who work with them, and more generally for compassion and common sense. But it is also a victory for a generation of newly politicized health care providers in Canada who fought to reverse the deplorable change in policy from day one.

Canada has long been known as a safe haven for refugees from around the world. For the past 50 years, refugees arriving here received access to health care services, including coverage for dental care, optometry and prescription medications. Given that people fleeing violence and oppression often emerge from long periods in refugee camps where no medical care is readily available, they typically have higher levels of illness. 

In providing for this vulnerable population, the IFH coverage reflected a kind and wise approach to health care Canadians of which Canadians were rightly proud. 

In 2012, however, the federal government, under then-Minister of Citizenship and Immigration Jason Kenney, made sweeping cuts to the coverage, drastically reducing services for all categories of refugees (though they were eventually reinstated for government-assisted refugees), and completely eliminating health services for certain categories except in cases of public health risk.

This meant that a refugee with tuberculosis might receive treatment, but not one who had diabetes or one who was having a heart attack. 

The rationale given for these cuts was that they would make the system fair, improve public health and decrease costs. It’s difficult to imagine something less fair than denying health services to someone who has just escaped oppression and violence. As for protecting public health and saving costs, denying people primary care means they are more likely to present in our healthcare system later – and when they are sicker. A sicker patient poses greater risk to those around them (for example, if they have an infectious illness). Treating more severe or worsened conditions costs more, too.

The evidence of the human cost of denying a vulnerable population essential care came quickly, with stories of pregnant women being turned away from receiving prenatal care, cancer patients being denied medications necessary for their treatment, and children with asthma not having access to their inhalers. Already, just two years in, the economic costs of this decision are also becoming apparent, with a study from Toronto’s Sick Kids Hospital showing increased admissions and overall costs for caring for children since the cuts.

The reaction the medical community and other health professionals had to the IFH cuts, however, is encouraging. Their opposition was not limited to individual activists, but included official bodies such as the Canadian Medical Association, the Canadian College of Family Physicians, the Canadian Nurses Association, Canadian Pediatric Society, Canadian Bar Association, the Royal College of Physicians and Surgeons and many others.  

Doctors for Refugee Care, an organization founded in response to the IFH cuts, took the lead on organizing the resistance from the medical community. They maintained consistent pressure through demonstrations, direct action techniques such as having physicians interrupt announcements by Conservative MPs to voice their opposition to the cuts, and through more official channels, including initiating the charter challenge that led to last week’s Federal Court ruling.

Despite the outcry from health care providers, dozens of organizations and even provincial governments of different political stripes, the Conservative government dug in its heels on these cuts. Hopefully this ruling will finally result in the reinstatement of the IFH program.

This week’s decision is a victory for common sense and compassion in Canadian health care. It’s also a sign of a new leadership emerging from within the health professions. Health professionals are becoming more vocal in advocating for better health policy, whether it be in health services to populations in need, or in promoting policies that address the upstream factors that determine those health outcomes, as we see from groups such as Ontario’s Health Providers Against Poverty.  

This renewed focus on health for all, led by trusted voices from the people whose work it is to fight illness, bodes well for politics and broader wellbeing in Canada.

Photo: Ryan Meili