Today, as we celebrate the National Day of Action against the Refugees Healthcare cuts on June 17th, I decided to interview Benjamin Langer, a third-year medical student, to enlighten Canadian readers regarding the budget cuts in Interim Federal Health Program (IFHP).
Benjamin currently holds the position of National Officer for Human Rights and Peace for the Canadian Federation of Medical Students, in this role coordinator the organization's Global Health Advocacy Program. He has been involved with activism for over a decade, ranging across many ecological, human rights, and social justice issues.
The Interim Federal Health Program (IFHP) is a program managed by the canadian government that provides access to health care for refugees and refugee claimants in the country. Last June, an important part of its funding was cut, restricting even more the limited provided coverage for "essential and urgent services." Many groups of physicians and other health professionals advocate to cancel or amend those disastrous changes, without any major success so far.
Benjamin, can you tell me more about those cuts?
In the past year, two main changes to Canada's refugee system have come into effect: changes to the Interim Federal Health Program (IFHP), which came into effect July 1, 2012, and the passage of Bill C-31, which came into effect December 15, 2012. The two changes complement one another, and together create significant moral, legal, and economic challenges.
Since 1957, the IFHP had provided health care to refugees and refugee claimants who were not yet covered under provincial health systems. Refugee claimants, those who have fled persecution and seek protection from another state, as required by international refugee law, are treated as legally residing in the country under their human right to seek asylum. This historically meant that they were protected from unlawful detention and provided social services at a level similar to Canadian citizens so long as they remained within Canada's borders.
The distinction between Refugees and Refugee Claimants is important here. Refugees have already been classified as such by the United Nations High Commissioner for Refugees (UNHCR) in refugee camps and are in the process of being resettled by states and private parties.
Refugee Claimants are people who have crossed borders on their own in fleeing persecution, and present themselves in good faith to the authorities of the state in which they find themselves, exercising their human right to asylum in another country. All states who are party to international refugee law (Canada included) are required to have a refugee status determination system that determines whether their claims are valid, and if so to allow them to provide asylum.
What the IFHP cuts essentially did was to create a stratified system, with government-assisted refugees (those registered with the UNHCR in a refugee camp and resettled by Canada) retaining full coverage, other refugees and refugee claimants losing access to crucial benefits like basic medication, vision and dental care, and claimants from so-called "designated countries of origin" (DCOs) receiving no coverage even in the event of a life-threatening emergency. A large proportion of these people will eventually become Canadian citizens, and we are throwing up a massive barrier to them starting their lives in Canada healthily.
Bill C-31, also known as Protecting Canada's Immigration System Act, is the other piece of the puzzle, coding in law the Minister of Immigration's prerogative to create a list of countries (DCOs) that according to the Minister are safe enough that they should not normally produce refugees. Claimants from these countries have a shortened time scale to present their claim, no right to appeal their decision, and due to the IFHP changes receive health care only if their condition is a threat to public health or safety.
Why have these changes taken place?
The federal government has attacked many refugee claimants, especially Roma who are fleeing fascist paramilitary persecution in Hungary, as "bogus", no better than parasites trying to cut the immigration queue, and said that the IFHP cuts and C-31 are necessary to end the incentive for them to take advantage of Canada.
However, many have noted that the changes go against the whole spirit of refugee law, which demands that every person's claim be evaluated on an individual basis; as history has demonstrated consistently, and as a Jew myself I am acutely aware, a country that is safe for the majority of citizens may not be safe for minority groups be they ethnic, political, or social.
The other major problem that health care workers especially detest is the use of health care as an immigration tool, and the de facto transformation of frontline healthcare workers into immigration agents. We did not pursue careers in health care to say "papers please", or do anything other than treat the human being in front of us. Making the immigration system cheaper, faster, and fairer is a laudable goal, but using the denial of a basic human right as a tool is unacceptable.
"As medical students, we're standing up to say that it is wrong to deny the human right to health to some of the most vulnerable people residing in Canada. These are people fleeing horrible circumstances and they are being punished simply for being from a particular country." - Benjamin Langer
Many physicians argue that those cuts affect the way healthcare is deliver to refugees in a very significant way. What differences are we seeing on the field?
The other major justification the federal government gave for the changes was that they would save the government up to $20 million per year. As health care analysts have argued from the start, however, any savings from the federal budget will simply be offloaded onto the provincial systems as people present to the health system further along in their illnesses, requiring far more expensive care.
A recent article in the Toronto Star documents just this happening, with hospitals either footing the massive bill for the care or slapping refugees with bills for thousands of dollars. This had led Ontario health minister Deb Matthews to renew her call for the reversal of the cuts. Many fear that this is only the beginning, however, as more and more people barely scraping by and worried about massive bills stay away from health care. This will allow their illnesses to progress to a point where both the human and financial cost spirals out of control.
On top of the denial of care for people no longer technically covered, the confusion surrounding the new cuts has also meant that many people who should legally be covered are being refused care. Some physicians are ending relationships with refugee patients, unable to determine if they are covered or not, and afraid of being left to pay out of their own pocket. While Dr. Danielle Grondin, the physician who heads the medical branch of Citizenship and Immigration Canada, has claimed the confusion is the result of misinformation spread by activists, those working on the front lines don't buy it -- they have experienced the confusion first hand.
We know that the Canadian Federation of Medical Students and the Fédération médicale étudiante du Québec have expressed their staunch opposition since the cuts were announced over a year ago, as well as many other health professionals organizations. As a society, why should we speak up against those cuts?
As outlined above, these cuts are harmful in every sense -- they are an affront to human rights, they seriously harm some of the most vulnerable people residing in Canada, and they are a bureaucratic and financial nightmare. The federal government is full of rhetoric about refugees receiving "gold-plated health care" and "bogus" refugees jumping the immigration queue, but it's time to call them out on what these changes really are: an ideological mistake, meant to bolster the hard-line conservative image of a government upholding law and order and protecting the taxpayer. It should be clear from all of the above that the recent changes in the refugee system are actually detrimental to both goals, thumbing our nose at international law and abusing the taxpayer in the process. This is not an issue for "militant leftists", as Immigration Minister Jason Kenney has hysterically branded Doctors for Refugee Care and the Canadian Association of Refugee Lawyers, it is an issue for all Canadians.
For more information, please visit Canadian Doctors for Refugee Care, join us on the National Day of Action happening on June 17th across Canada and follow the hashtag #IFHJune17 and #refugeehealth on twitter.
On a final note, I would recommand the reading of CFMS book 12 stories. Narratives from New Canadians, highlighting the importance of supporting new immigrant and refugee health within Canada.