Conversations that Matter: Is Canada’s Refugee Program Equitable?



Mahmoud Allouch, Coordinator of the Syria Project at the Arab Community Centre of Toronto

Ashna Bowry, Lead physician at St. Michael’s Hospital Syrian Refugee Clinic

Michaela Hynie, Associate Professor and Refugee and Migration studies researcher at York University

Audrey Macklin, Professor and Chair in Human Rights Law at the University of Toronto

When photos of three-year-old Alan Kurdi’s lifeless body surfaced in the international media, it sparked an intense and emotional response from many members of the Canadian public. But what is Canada’s duty to children like Alan Kurdi and to people around the world fleeing persecution and war?

On Thursday, October 20th, close to 100 academics, activists, doctors, and curious members of the public gathered at Innis Town Hall for a panel talk on Canada’s refugee program. The panel was moderated by two prominent faculty from the Dalla Lana School of Public Health: Assistant Professors Andrea Cortinois, the Co-Director of the Global Migration and Health Initiative; and Lisa Forman, director of the Comparative Program on Health and Society at the Munk School of Global Affairs.

In his opening remarks, Cortinois emphasized how easy it is to think of the conflict in Syria as merely an opportunity for generosity. In fact, such crises entail a duty for the rest of the international community, and this kind of mislabelling can in fact be problematic.

Provisions of the 1951 Convention Relating to the Status of Refugees (Refugee Convention), the 1966 International Covenant on Civil and Political Rights (ICCPR), and the 1984 Convention Against Torture and Other Cruel, Inhuman and Degrading Treatment or Punishment (CAT) oblige Canada to protect specific classes of people, including refugees. While it is inspiring and heartwarming to witness compassionate private individuals making a difference in the lives of vulnerable people, we should not forget that granting refugees protection is a legal obligation and not an optional “bonus.”

Dr. Cortinois invoked the image of Alan Kurdi in his opening remarks to the panel, suggesting that while many of the actions that were taken in the wake of the tragedy were the right actions, numerous questions about Canada’s role in helping refugees remain unanswered. How many refugees does it take to fulfil Canada’s obligation? What are we, as a country, willing and able to do?

The central question of the evening was this: Is Canada’s refugee program equitable? The event’s four panelists each responded from a unique perspective, shaped by personal and professional experience.

Mahmoud Allouch was born in Syria, and lived in seven countries before coming to Canada to study engineering at the University of Toronto. Unlike most engineers who work with concrete or mechanical structures, Allouch works with the social structures designed to help refugees integrate in Toronto. Allouch shared his experience of working at the Arab Community Centre of Toronto, explaining some of the differences between groups of Syrian refugees that are often glossed over in the media. Some come to Canada with advanced degrees, speaking excellent English, or with relatives or friends they can turn to for help. Others come with absolutely nothing, and may not have ever attended school in their hometown.

Michaela Hynie spoke to the value of using access to healthcare as a marker of social inclusion. The Canadian government’s recent history relating to refugee healthcare, according to Dr. Hynie, has been one source of inequity in the refugee program.

“People without health insurance coverage are less likely to be able to access care, and more likely to die,” said Dr. Hynie. Rolling back health insurance coverage for particular groups is, in this sense, an implicit endorsement of the idea that certain groups of people are less deserving of the means to live a healthy life than others.

Dr. Hynie offered a recent history of refugee healthcare coverage in Canada. Prior to 2012, refugees, as well as all claimants, received coverage for healthcare services quite similar to what Ontario residents receive under OHIP. In what was ostensibly a cost-cutting effort intended to stymie an “undue” burden on the healthcare system, Bill C31 categorized people claiming refugee status and offered or denied them care coverage accordingly. Dr. Hynie describes the categories as distinguishing between the “deserving” and the apparently “undeserving” refugee claimants – people whom the government thought required support due to factors outside of their control, and others who needed help due to factors that were somehow within their control.

Some refugees were deemed to have entered Canada through a “safe” country and thus would no longer be covered. Others, like claimants who were waiting to be deported, lost their coverage, too. As a consequence of this selective coverage, healthcare providers were forced to navigate difficult bureaucratic hurdles when seeking to get paid by the government for providing care. In some cases, eligible refugees were simply refused care because the system made it too difficult to discern who was covered. Even when, in 2014, healthcare was largely restored, these categories remained, and the system continued to be riddled with unnecessary obstacles to refugees in need of medical care.

Dr. Ashna Bowry, a lead physician in the Syrian refugee clinic in St. Michael’s Hospital, cites lack of coordination as a major obstacle to equity as well.

“When refugees fleeing the Syrian Crisis first began to appear in Toronto, doctors weren’t entirely sure how to accommodate the newcomers’ specific health needs,” said Bowry, noting that provincial health authorities did not provide a standard set of guidelines for health practitioners to follow when delivering care. To compensate, dozens of concerned institutions gathered together to create the Refugee Health Network to standardize primary care assessments for Syrian refugees. The network had to move quickly, and special clinics were set up specifically for Syrians.

She highlighted several issues of equity that arose from these clinics. The first was related to communications: not all refugees knew about the clinics, and it seemed that privately sponsored refugees were using the clinics much more than government assisted refugees who demonstrated high need. While the capacity to handle larger volumes of refugees has been built, in this case, available resources are not being used to their full extent. The other issue is related to the fact that while millions of people have been displaced by the conflict in Syria, there are many other refugee crises: close to 60 million people are displaced around the world today.

Audrey Macklin highlighted the importance of looking beyond the policies that regulate access to care for refugees that are already here, and questioning the ways in which Canada filters and selects who is permitted within our borders. The “good” refugees — the ones that are allowed to exist in our country — are those who have been chosen.

“Choosing who gets to be a refugee is an exercise of Canadian sovereign control,” said Macklin, noting that those who are selected are considered to be more deserving of good treatment, of access to services, and, implicitly, of life, on that basis.

“Refugees who are desperate, and who sneak into the country, turn up without proper documentation, or who come in with forged documents are  detained, criminalized, and often subject to risk of deportation or prolonged detention.” In some cases, refugee claimants being held in detention are subjected to solitary confinement, which after 15 days constitutes cruel and unusual treatment.

The equity issue is thus broad-based, and touches upon a number of Canadian human rights and international law obligations. As the government seeks to expand the refugee program, coordination and coherence, as well as compassion are needed to ensure that the people who come to us for help are equitably taken care of.

In addition to exploring these important questions about equity, the evening supported a good cause: proceeds from ticket sales, as well as from a silent auction held after the panel, were channeled to the Marhaba Committee, a private sponsorship group helping a refugee family settle here in Toronto.