Refugees left out in the cold by Canada: An overhauled health plan means limited care for refugees

It was a visit to the dentist that convinced Parisa Rezaiefar she might have a chance in Canada after all.

It was 1992, and the 22-year-old refugee was living in Montreal, with no family beyond her older sister and no means of support beyond social assistance.

She had left her parents and university studies behind when she left a repressive life in Iran and flew to Canada, asking for asylum when she arrived at Mirabel Airport.

Rezaiefar hoped to study medicine, a dream others scoffed at when she sharedit.

After studying French for several months while working in restaurants, Rezaiefar struggled to see a future for herself in this cold, snowy country.

She was also gripped by excruciating jaw pain.

A doctor told Rezaiefar her wisdom teeth needed to come out. She saw a Persian-speaking dentist, who found she also had lots of painful cavities to fill.

“I arrived here and I had nothing,” Rezaiefar recalls.

“How could I have ever afforded those dentist bills, when I couldn’t even afford winter boots that didn’t leak? I would have ended up in the emergency.”

The government paid for it all, and Rezaiefar says she got more than dental care.

“It took several visits and then I started realizing that

hey, here’s an Iranian who has become a dentist, I guess things do happen for immigrants in this country,” says Rezaiefar, who tears up at the memory. “That care was not about just my tooth, it was about giving me hope that I can make it, too.”

Now a family physician in Ottawa, Rezaiefar is one of several local doctors becoming increasingly vocal in opposing the federal government’s intention to overhaul its Interim Federal Health Plan, which pays the health-care costs for refugees not covered by provincial plans. The changes, announced on April 25 and due to take effect June 30, will eliminate supplemental benefits such as vision care, dental care and prescription medication for all refugees. They will limit health-care services for government-assisted refugees and for claimants from most countries to only “urgent and essential” care, a definition that has many practitioners baffled and uncertain. The changes also stipulate that coverage for rejected refugees or for claimants from some countries deemed safe for refugees to return to, such as members of the European Union, will be provided only for conditions that pose a risk to the health of the public, such as tuberculosis or HIV.

“We do 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,” Jason Kenney, the minister for Citizenship, Immigration and Multiculturalism, said in the April announcement. The reforms are intended, he said, to take away “an incentive from people who may be considering filing an unfounded refugee claim in Canada.”

The reforms, and what is perceived in some quarters as the anti-refugee political message of the Conservative government, have sparked outrage among refugee advocates, experts in refugee health and other medical practitioners. At the heart of the battle is what’s known as the “healthy immigrant effect.” Research has shown that most newcomers, including refugees, arrive in Canada healthier than the Canadian-born population, but lose that advantage the longer they stay here. The effect is not universal and is not yet fully understood, but one generally accepted explanation is that most newcomers don’t understand Canada’s health-care system and that refugees in particular don’t seek medical care until a small problem has become a serious condition. Opponents of the reforms see them as an attack on years of work to better integrate new Canadians into the health-care system.

In response, Kenney has accused some doctors of “political grandstanding and irresponsible rhetoric,” while staff at Citizenship and Immigration Canada quietly reach out to refugee advocates and doctors to clarify the complicated new policy.

It hasn’t eased their fears. Medical professionals demonstrated against the changes in Toronto and Ottawa in the beginning of June, and eight national health associations, including the Canadian Medical Association, have signed an open letter to Kenney asking for the cuts to be rescinded. Another protest is planned for several Canadian cities, including Ottawa, on Monday.

Rezaiefar, who studied medicine at McMaster University and did her residency in Ottawa, spoke to a gathering on Parliament Hill on May 11, the first time she publicly identified herself as a refugee. Her reluctance to do so in the past, she says, was a reaction what she sees as the common view of refugees in Canada as needy, weak and a burden to society.

Refugees “arrive and go on with their lives. They integrate, they send their kids to school and they move on,” Rezaiefar says. “A very small portion requires extraordinary care and need, and I find that small portion is overrepresented in terms of perception. I needed dental care and I moved on, just as the majority need a bit of help and then they move on.”

Other local doctors are speaking up, too, online, on Twitter and the airwaves. Dr. Chuck Hui, director of pediatric infectious diseases at CHEO, and Dr. Megan Williams of the Somerset West Community Health Centre are among several doctors organizing the Parliament Hill demonstration. Dr. Mark Tyndall, chief of infectious diseases at The Ottawa Hospital, had a testy exchange with Kenney in the letters pages of the Citizen.

“What’s very maddening is that Kenney is really pitting Canadians who are dissatisfied with their own health care against refugees,” Tyndall says. “He mentioned that refugees get better care — that’s his mantra. Well, it’s not gold-plated care, it’s what people on social assistance get. To suggest Canadians are getting ripped off is just not true.”

Not all health organizations are protesting the cuts, however. The Society of Obstetricians and Gynecologists says it is “pleased that refugee claimants will continue to have access to the obstetric and gynecologic services they require,” an interpretation at odds with that of the most vocal doctors.

Rick Dykstra, Kenney’s Parliamentary Secretary, says critics are overlooking the urgent need to both reduce government spending and to reform Canada’s refugee system.

“The applications we receive for refugee status from the European Union, 95 to 98 per cent are withdrawn, denied or they don’t show up for their hearing,” says Dykstra, MP for St. Catharines. “Why should those who are not truly refugees be using the Canadian health-care system?”

Dykstra adds that additional changes will speed up the time it takes to decide if someone will be accepted as a refugee or not, which means the time they are reliant on the federal health plan will also be reduced.

Just about the only thing the two sides agree on is that the government did not consult refugee health experts before announcing the policy change.

“It’s a little unfortunate that we made an announcement and the response from doctors was to outright disagree with the decision,” Dykstra says. “Under normal circumstances we would have a chance to work with them, sit down and move through the process … it’s still the intention.”

If so, though, it might be an uphill battle.

“There’s nobody you’ll find who thinks this is a good idea, and nobody at CIC will say it’s good for health,” Tyndall says. “What will happen is somebody will die, and the media will jump all over it.”

In Monday’s Citizen:The Conservative government makes two main argumentsin defending planned changes to refugee health benefits.Are those claims true?

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