Learning from the Interim Federal Health Program
Canada is currently witnessing a revitalized interest in the plight of refugees, starting in early September when the tragic photos of the Kurdi family’s attempt to escape Syria were widely published in the news and shared on social media. Since then, a large number of different non-government organizations, activist groups, and public intellectuals have criticized Canada’s current refugee policies, claiming that more can, and should, be done to ensure that we provide adequate support for refugees. Many of these groups have made policy suggestions to both increase the number of refugees we have agreed take in and to speed up the refugee application process.
Many Canadians have expressed eager support for these changes to Canada’s refugee policies. However, there is little discussion on the issues that refugees face once they actually arrive in Canada and are properly admitted as refugees. While living conditions here are almost certainly better than those in their country of origin, refugees still face a number of different systemic challenges that should also be examined and criticized.
One of these challenges involves access to Canada’s healthcare system. Given the journey refugees undergo in order to escape their country of origin, many require healthcare services soon after their arrival in Canada. However, many of them have no financial resources to pay for the care themselves given the cost of travel and their socioeconomic background.
Fortunately, the Interim Federal Health Program (IFHP) provides low-income refugees and refugee claimants with certificates that entitle them to federally-funded health insurance coverage. Through this program, these at-risk populations can access a large range of basic healthcare services, such as urgent or essential healthcare, preventative care, some dental and vision care, and essential prescription medications. This federal insurance is expansive, and is similar in scope to the provincially-funded healthcare benefits that are provided to low-income, social assistance Canadians.
Despite the IFHP’s clear benefits, it is currently facing strong challenges from the federal government. In 2012, the IFHP received budget cuts that severely limited the kinds of refugees who can apply for a certificate, excluding those who were not technically admissible to Canada based on their country of origin, those who failed to file their refugee claims on time, or those who made an unsuccessful refugee claim. Additionally, the majority of the IFHP’s revised coverage focused on urgent or essential services, excluding preventative care like screening tests and annual check-ups.
These cuts were immediately felt by the refugee and refugee claimant populations, prompting strong responses from healthcare professionals and social activist groups. Three groups, Canadian Doctors for Refugee Care, the Canadian Association of Refugee Lawyers, and Justice for Children and Youth, sought legal action to reverse those cuts, claiming they were unconstitutional.
On July 2014, in Canadian Doctors for Refugee Care v Canada (Attorney General), the federal government’s cuts to the IFHP in 2012 were declared invalid because they violated sections 12 and 15 of the Canadian Charter of Rights and Freedoms. For the section 12 ruling, the judge held that the cuts constituted cruel and unusual treatment, in particular because they imposed health and life-endangering treatment on children. For the section 15 ruling, the judge held that it was discriminatory to withhold and limit core health care coverage for individuals based on their country of origin.
As of late 2014, the cuts were successfully reversed, returning IFHP health coverage back to a number of marginalized populations. The federal government has since expressed interest in appealing the decision, especially given the judge’s particularly novel section 12 ruling.
The 2012 cuts to the IFHP should serve as an important lesson when considering the plight of refugees once they get into Canada. First, there are often formal institutional barriers that make it difficult for refugees to obtain essential services. Certainly, organizations that are concerned with the government’s treatment of refugees still worry about unequal access to jobs, shelters, and legal resources.
However, equally important are the social barriers that prevent refugees from being treated fairly and as deserving of respect by the broader Canadian public. Many Canadians hold prejudiced and discriminatory views about refugees, believing that these refugees are false claimants who simply want to take advantage of Canada’s healthcare system. Some treat refugees as temporary aliens, deserving our pity but not our citizenship. Still others simply ignore refugees altogether, preventing them from integrating meaningfully with Canadian society and leaving their issues unaddressed. Our social perception of refugees deeply affects our relationship with them, and are often the underlying source of larger issues. Informal beliefs, after all, can serve to justify the creation of formal institutional barriers, such as the cuts to the IFHP in 2012.
As future lawyers, it is easy to devote our attention to reform at the institutional level, where laws, regulations, and social policies affect entire populations. However, it is also important to care for individuals at the social level in order to effectively tackle issues of perception, treatment, and respect. The former guarantees that refugees have a place in Canada, but the latter ensures that they have a community.