For the website: www.refugeelegalaidinformation

I have just visited AMERA Egypt –http://www.refugeelegalaidinformation.org/egypt-pro-bono-directory, and was alerted to the need for ALL legal aid NGOs in the global south to know how to reunite refugee children with their families who may be in any other host country.

I looked briefly at  http://separated-children-europeprogramme.

org/separated_children/about_us/

contacts/index.html and could find no information even about family reunification in Europe.

It is a challenge, but if www.refugeelegalaidinformation is to provide lawyers with complete information they need, it  needs to give information for lawyers on how to reunite families? who to contact? for each country where there are refugees.

The thing that most ‘shocked’ me was that those (‘westernized’ children’s workers) dealing with the affected children did not seem to be aware of the fundamental principle of the importance of kinship ties throughout life for those (the majority of the world) socialized in the values of those outside ‘westernized society’. Workers with separated children may be without the skills required for family reunification where this should be their first emphasis.

Can you reply to me, barbara.harrellbond@gmail.com and Arya Somers AMSomers8@aol.com, if you are able to provide and write up accurate information on family reunification to your country; you are a lawyer or an NGO workers who can assist with this process to your country from another and are prepared to offer such services.

Dr Barbara Harrell-Bond

298 Banbury Road, Flat 2

Oxford OX2 7ED, UK

Phone: +44 1865 424 697

Mobile: +44 79 0620 3368

Skype: barbara.harrellbond

http://www.refugeelegalaidinformation.org

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2012 marks the 11^th anniversary of World Refugee Day held every year on June 20^th.Thousands of people take time to recognise and compliment the input of people forcibly uprooted from their homes and displaced throughout the world. The annual tribute is noted by an array of events in many countries, incorporating humanitarian workers, civilians, government officials and refugees and asylum seekers. In most corners it is an opportunity to credit the boldness, resilience and dedication of children, women and men who are compelled to escape their native country under threat of torture, brutality and warfare. It is also an opportunity to recognize the contributions that refugees make to the countries that host them. In South Africa, World Refugee Day is taking a special significance to honor asylum seekers, refugees and non nationals.

Yet, there are still reports about xenophobia in the country documented by News 24 South Africa and the Sowetan. Four years ago the nation came together with a mass pledge of solidarity against xenophobia to say, “never and never and never again”.

In May 2008 poverty stricken mobs of local black South Africans invaded informal settlements equipped with machetes, clubs and torches and attacked black immigrants from foreign countries. Physical and commercial insecurity propelled these bloodbath campaigns. This resulted in several hundred maimed, 62 non-nationals killed and mass displacement. The aftermath of xenophobia saw South Africans and non-nationals protest nonviolently through marching, collecting clothing, food and blankets for the victimized, conducting vigils and speaking out against violence.

News 24 recently reported that 104 people are in court for xenophobic attacks in Limpopo for the charges of public violence, looting shops and malicious damage. The suffering of non South African nationals eking out a living in South Africa has amounted to xenophobic levels requiring collective global justice intervention. It is argued that independent Africa has done more harm to black people than colonialism itself. Organisations corroborate their fear, saying this is not the first hints of possible violence and there is no respect of human dignity, when it comes to non-South Africans.

Celebrated since 2001, World Refugee Day emphasizes unity. There is need to keep strengthening this unity as the only channel of fuelling sustainable peace and development, and upholding this unity against all forms of genocide or xenophobic violence. It is appropriate that much of this year’s celebrations are taking on the theme: “One refugee without hope is too many.”

There are refugees and asylum seekers all over the world, on every continent and in every country. The system of migration may change, but the movement of people will always remain that of individuals or families moving to a place that offers them better opportunities. People from many countries migrate to South Africa because of the opportunities it affords them, either economic, or social in that South Africa is not at war and has a liberal constitution, but sadly, due to the intense competition for jobs and housing many Africans continue to be persecuted once arriving in South Africa. Unfortunately, with such high unemployment in South Africa, many South Africans perceive the arrival of foreigners as a threat to their already endangered access to resources. It is unfortunate that so many black Africans are treated as a threat whereas immigrants from other countries are often welcomed as sources of skills, talent and expertise.  It is important for any person who is able to contribute positively to South Africa to be recognised as such, wherever they come from, and above else for the human rights of refugees and asylum seekers to be upheld. Rather than automatically treating non-South Africans as competition for resources etc, South Africans should also try to consider what circumstances have forced people to leave their home and think about the type of welcome they would want to experience if the same were to happen to them.

Four years ago, many expressed fury at the lack of action despite signs and warnings, while for others the xenophobic violence came as an absolute surprise. But, nobody can ever again say they did not see it coming. Everybody knows that xenophobia is a problem, and for all the promises made four years ago, how much has changed?

As we celebrate the World Refugee Day, let us remember that South Africans also fled during apartheid and accepted refugee status elsewhere in the world. It is our duty to accommodate and show compassion to refugees who are fleeing persecution in their home countries. We all must raise our voices loudly say “never, never and never again” against xenophobic violence.

 Introduction  

            Recent changes introduced to the Canadian Immigration Policy have been a subject of heated debate between the conservative government and various groups that advocate for immigrant and refugee rights. Major areas of debate focus on the government asserting its right to choose who should be allowed to settle in the country on one hand and advocate groups calling for the government to respect and abide by its international obligations on the other.

            One area of such debate is the change in the Interim Federal Health Program (IFHP); a temporary health insurance plan which is funded by the Citizenship and Immigration Canada to provide immigrants and refugees who are unable to pay for health care become eligible for benefits until they become eligible for a provincial/territorial or private health plan coverage.

            The government’s reasons for changing such a life saving and crucial health insurance plan is to reduce cost and the “extra” healthcare coverage supposedly provided to refugee claimants and to deter “bogus” refugees who come here to take advantage of Canada’s “Generous” immigration policy.

            However, the per capita cost for refugee claimants under the IFHP is only about 10% ($660 per year) of the average per capita cost for Canadians (CIC,2012); immigrants’ health on arrival is better and decline the longer they stay in the country (Ng, 2011) and the per capita refugee load Canada hosts is lower than that of the poorest countries (UNHCR, 2011).

            In this paper, I will provide a history lens on Canadian Immigration Policy to show possible reasons for the changes, their impact on health and mental health of refugees and how the rationale for changing the Interim Federal Health Program is another way to discriminate between deserving and undeserving immigrants.

Historical background

            Looking back at how Canada’s Immigration policy has been shaped during various periods of its history enables us to put the current debate in perspective and look back to see forward. Similar to the ongoing debate, Canada’s immigration policy have always been shaped by demographics, history, geography, economics and personal biases of those who are in charge of shaping and implementing it.

            During the mid-nineteenth century, Canada had a “Whites only” immigration policy that primarily stemmed from the xenophobia of that period. Reflecting such bias, the Immigration Act of 1910 established the right to prohibit “immigrants of any race deemed unsuited to the climate or requirements of Canada” (Hawkins, 1991).

            Such exclusionary immigration policies that primarily discriminated between deserving and undeserving immigrants had various forms. Some stated explicitly as a policy while others took a more subtle and implicit form. For example, the “head tax” on Chinese migrants in both Canada and the US began in 1885 and continued into the twentieth century with an annual head tax of $500 being applied to Chinese migrants and prohibition of Chinese women to Canada, which ensured that male migrants would not settle and raise families (Ralston, 1999).

            These historical accounts of exclusionary Canadian immigration legislations and procedures clearly show explicit ways of an anti-Asiatic bias and a preference for migrants fitting an Anglo centric and Gallic norm that persisted through the early 1960s (Richmond, 1976)

              Other implicit ways of restricting immigration and excluding undeserving individuals to settle in Canada have also been part of the immigration policy. For instance,  in 1907, the Canadian Government reached an agreement with its Japanese counterpart that the latter would allow no more than 400 Japanese to leave the country for Canada (Mongia 1999).   

            Similarly, British subjects from India were prevented from arriving in (British) Canada during the early 1900s by imposing a series of restrictions, such as the “continuous journey” requirement, that were racially exclusionary, but did not explicitly name “race” or “nationality” as the basis for keeping them out for a simple reason that they were seen as being an undeserving immigrants. The continuous journey requirement meant that all Indians arriving in British Columbia had to prove “continuous passage” (travel on a single ticket from India to Canada) at a time when no such single journey existed (Mongia, 1999). Such  explicit racial discrimination, however, was abolished later in 1962 when the then government established the “points system” (Richmond, 2001).

            Although these changes should be given a lot of credit for shaping the multicultural demographics of the country today, the current government seems to take it’s immigration policy back to the previous times when immigrants and refugees were stigmatized, excluded and discriminated against. For instance, explicitly stated Immigration messages characterize asylum seekers in a biased and stereotypical ways, suggesting that they are ‘bogus’ and are a drain on Canadian society. These beliefs, and not evidence, seem to be the primary sources of changes to policies and programs such as the IFH.

            Canada is not facing “floods of refugees”, as most suppose. Reports indicate that in 2010, 80% of the world’s refugees lived in the world’s poorest countries  and countries like Canada had only 4.2 refugees to GDP per capita compared to Pakistan at 709.7, Congo at 475, Kenya at 247.3 and Chad at 224.5 (UNHCR,2011). As such, there was no need to tamper with such life saving and crucial public policies and programs.

The Interim Federal Health Program (IFHP)

            In 2010, Canada accepted only 24,696 refugees in all classes; 11,000 fewer than the 35,776 refugees accepted in 2005. That same year, refugees in all classes accepted in Canada were about 13% of all permanent resident arrivals. Refugees accepted in 2010 were only 8% of all permanent resident arrivals, a drop of almost 5%. In 2005, the number of refugee claimants present in the country constituted approximately 0.3% of the Canadian population. In 2010 the percentage of refugees compared to the Canadian population was slightly lower at 0.28%. In 2010, 3,438 fewer refugee claimants entered Canada compared to 2005. (CIC, 2012)

            While such a declining trend is seen with respect to admission of forcibly displaced persons to Canada, the number of such population is on the rise globally. According to the UNHCR Global Trends Report 2010 released in 2011, roughly 43.7 million people are displaced worldwide out of which 27.5 million people are displaced within their own country due to conflict (UNHCR, 2011).

            The 1951 Convention Relating to the Status of Refugees, while not referencing health care specifically, sets out in other cases that refugees should have the same rights with regards to welfare as other nationals (e.g. public education, public relief as other nationals). Article 7 of the Convention states that, “except where this Convention contains more favourable provisions, a Contracting State shall accord to refugees the same treatment as is accorded to aliens generally.” (UNHCHR, 2007).        

            This suggests that a person who has the same access to healthcare as a national in a country of asylum is subject to a favourable protection situation, i.e. with regards to healthcare they are not at any particular disadvantage in the country of asylum relative to other refugees, foreign nationals, or nationals.

            Given such an international provision to which Canada is party, granting refugees access to healthcare is a matter of Canada carrying out its international obligation and not charity and/or generosity. As a result of such international conventions that the country signed, it’s policy has so far been consistent with implementing it. Especially when it comes to health care, where the Citizenship and Immigration Canada funds the Interim Federal Health Program (IFHP).

            Refugee claimants, resettled refugees, persons detained under the Immigration and Refugee Protection Act, victims of trafficking in persons and the in-Canada dependants of these groups who are unable to pay for health care are eligible for benefits under the IFHP until they become eligible for provincial/territorial or private health plan coverage. Under this program, resettled refugees with provincial/territorial health coverage are provided with supplemental coverage for one year from the date of entry to Canada (CIC,2011).

            The IFHP cost was $84.6 million in the 2010-2011 fiscal year. During the same year, 128,000 persons were covered by IFHP which means that the average IFHP cost was about $660 per refugee claimant per year. However, the current government plans to cut this budget by $20 million each year starting June 30, 2012 and this will apply to all current beneficiaries, as well as those who apply after that date (CIC,2012).

            Up to and including June 29, 2012, the services covered by the IFHP for all eligible beneficiaries included basic coverage (i.e., treatments normally covered by provincial or territorial health insurance plans); supplemental coverage (i.e., health-care benefits similar to those provided through provincial social assistance plans, such as drugs and dental and vision care); and costs related to the Immigration Medical Examination (IME) (CIC,2012).

            After the changes are in place, the IFHP will offer only two basic types of coverage.1) Health-care services that are only of urgent or essential nature; medications and vaccines only when needed to prevent or treat a disease posing a risk to public health or a condition of public safety concern or  2) Public Health or Public Safety Health-Care that will cover the cost of products and services  only to prevent or treat a disease posing a risk to public health or a condition of public safety concern (CIC,2012).

            In an effort to justify this action, Minster Kenney stated that “Canadians are a very generous people and Canada has a generous immigration system. But 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. With this reform, we are also taking away an incentive from people who may be considering filing an unfounded refugee claim in Canada” (CIC,2012).

            As briefly discussed in the previous section, such changes can only be explained by the bias and attitude of those who are in charge of setting the policy. In this case, an official of a Minster capacity seems to continue perpetuate a bogus claim that refugees and immigrants are receiving more assistance than Canadians; a misperception that has been debunked by the government itself (CIC,2010)

            The government already has an exclusionary policy which effectively screens out individuals who are unable to contribute to the Canadian economy due to their “excessive demand” on health care. Under Paragraph 38(1)(c) of the immigration and refugee protection act, a foreign national is inadmissible on health grounds if their health condition might reasonably be expected to cause excessive demand on health or social services (DOJ,2012).

            Part 1, Division 1 of the Immigration and Refugee Protection Regulations, defines “excessive demand” as: “a demand on health services or social services for which the anticipated costs would likely exceed average Canadian per capita health services and social services costs over a period of five consecutive years immediately following the most recent medical examination required by these regulations, unless there is evidence that significant costs are likely to be incurred beyond that period, in which case the period is no more than 10 consecutive years”;  Or “a demand on health services or social services that would add to existing waiting lists and would increase the rate of mortality and morbidity in Canada as a result of the denial or delay in the provision of those services to Canadian citizens or permanent residents” (DOJ, 2012)

            Given such exclusionary immigration policies, the rationale provided by the Minster that protected persons and refugees add cost to the health care remains unfounded as his own policy explicitly states that individuals who have more health care needs are not allowed to come to Canada in the first place.  

            Furthermore, the cost of IFH per protected person per year, according to the government’s  own figures, was about $660 for the 2010-2011 fiscal year (CIC,2012) while the current overall per capita cost for health and social services for Canadians is about $6,141.2.(CIC,2012); clearly indicating that protected persons and refugees are not getting a better deal than Canadians as the minster suggested.

            Even if the minster’s wrong justifications were true, a good public policy would aim at insuring all people in the land have access to a better health care instead of finding a certain group to exclude and deny them access to health care for a mere fact that he considers them undeserving.

            These biases are also clearly reflected by public statements made by the Minster who stated that he does not expect people to come to Canada and become completely dependent (CBC, 2012).           Such comments are basically not true as they have an underlining wrong assumption that people who come here are unhealthy and stay the same over time. However, evidences have shown that immigrants’ health is generally better than that of the Canadian born and that it declines as their years in Canada increase.

            For instance, a study based on the 1991-2001 census mortality follow-up found out that for Canada’s adult population overall, the age-standardized mortality rates (ASMRs) per 100,000 person-years at risk were 1,230 for men and 703 for women. Immigrants had significantly lower ASMRs than did Canadian-born adults: 1,006 versus 1,305 for men, and 610 versus 731 for women. However, as immigrants’ time in Canada lengthened, their ASMRs tended to rise.

            The AMSRs among men were 720, 913 and 1,054 for recent, medium-term and established immigrants, respectively. Among immigrant women, the corresponding rates were 491, 546 and 637. Nonetheless, these rates remained significantly lower than those of the Canadian-born population. Such upward trends in ASMRs reflect a loss of immigrants’ health advantage over time (Ng, 2011). Given such a declining health status of immigrants, restricting access to health care remains a bad policy.

            The changes introduced to the Interim Federal Health Program become of paramount importance for mental health status of refugees and new immigrants as they continue to face particular challenges that put their mental health at greater risk. They often have difficulty getting a job that matches their level of skills and education, earning a decent income, obtaining adequate housing, and face significant barriers to their seeking or obtaining help. (Mental Health Commission of Canada, 2012)

            The new changes state that refugees and immigrants will receive Health-care services that are only of urgent or essential nature; medications and vaccines only when needed to prevent or treat a disease posing a risk to public health or a condition of public safety concern (CIC, 2012). This means that a refugee who suffers from depression or other similar mental illness will not be able to receive adequate treatment; further aggravating his/her condition because such condition may not be perceived to be neither urgent nor a danger to the public.

            Mental health services in general are already given a lesser priority than most other services. This is clearly reflected by the fact that only one in three people who experience a mental health problem or illness—and as few as one in four children or youth—report that they have sought and received services and treatment (Mental Health Commission of Canada, 2012). Given these, the restrictions introduced to the Interim Federal Health Program will create additional barrier to an already compromised system; adding insult to an injury.

            Furthermore, the changes will gravely affect refugees’ and immigrants’ mental health situation who are at an even more disadvantage due to their culture and the systemic discrimination they face when it comes to accessing health services in general and mental health services in particular.

            For instance, a qualitative phenomenological study  conducted by Martin and his colleagues (2010) indicated that lack of trust in doctors and race of doctors were among factors that were influenced by culture and discrimination that participants faced. Furthermore, Gender and language of immigrants have also been found to greatly impact their access to health care (Pottie et al, 2008) adding more barriers to refugees’ and immigrants’ health care access.

Conclusion/recommendation

            As indicated above, Canada’s immigration policy have come a long way to abolish systemic discrimination between deserving and undeserving refuges through explicit and implicit policies. These changes in public policy have resulted in the current multicultural demographics of the country which calls for celebration.

            Unfortunately, there are still possible ways by which assumptions, and not evidence, are used to shape it. This is clearly reflected by the rationales used to change Interim Federal Health Program. Evidences show that although Canada’s willingness to accept and host refugees is commendable, its per capita share of such a global crisis is not comparable to other poor countries; that refugees and immigrants’ health decline the longer they stay in Canada and the cost of providing life saving health programs such as the IFH is not more than what Canadian’s get as most would presume.

            Such changes in public policy have a grave consequence at an individual level. Tampering with an already compromised health care system where access is restricted from the very onset aggravates the declining health status that refugees and immigrants face over the long run.

            Given these facts, the changes introduced to the IFH should be reversed. A rather inclusive approach should be used as a strategy instead of an exclusionary one where categorical groups are identified and become further labile to stereotyping and discrimination. Efforts have to made to identify and solve issues that lead to refugees’ and immigrant’s health decline over time, not worsen it. The government must be able to provide a transparent and publicly available aggregated cost data which could be comparable with similar datasets for Canadian born individuals, and last but not least, the overall immigration policy has to become bias proof.

References

CBC radio. (2012, May 14). CBC-The Current with Anna MariaTremonti. Retrieved May 25,       2012, from CBC: http://www.cbc.ca/thecurrent/episode/2012/05/14/health-care-for-refugee-claimants/

CIC. (2012, February 16). Facts and figures: Immigration overview- Permanent and temporary residents. Retrieved May 27, 2012, from Citizenship and Immigration Canada:             http://www.cic.gc.ca/english/resources/statistics/menu-fact.asp

CIC. (2012, April 25). News Releases – 2012. Retrieved May 24, 2012, from Citizenship and       Immigration Canada: http://www.cic.gc.ca/english/department/media/releases/2012/2012-04-25.asp

CIC. (2012, June 11). Refugees: Health Care. Retrieved May 26, 2012, from Citizenship and       Immigration Canada: http://www.cic.gc.ca/english/refugees/outside/arriving-healthcare.asp

CIC. (2011, September 28). Resettlement assistance. Retrieved May 24, 2012, from Citizenship    and Immigration Canada: http://www.cic.gc.ca/english/refugees/outside/resettle-assist.asp

CIC. (2010, October 21). True or False: Aid. Retrieved May 27, 2012, from Citizenship and Immigration Canda: http://www.cic.gc.ca/english/department/media/facts/aid.asp

DOJ. (2012, June 25). Immigration and Refugee Protection Act. Retrieved May 29, 2012, from     Department of Justice: http://laws-lois.justice.gc.ca/eng/acts/I-2.5/page-12.html#docCont

DOJ. (2012, June 25). Immigration and Refugee Protection Regulations. Retrieved May 30, 2012, from Department of Justice: http://laws-lois.justice.gc.ca/eng/regulations/SOR-2002-227/page-1.html#h-2

Hawkins, F. (1991). Critical years in immigration: Canada and Australia compared McGill-Queen’s University Press.

Mongia, R. (1999) ‘Race, nationality, mobility: A history of the passport’, Public Culture 11(3):   527-556.

Martin, S. S., Trask, J., Peterson, T., Martin, B. C., Baldwin, J., & Knapp, M. (2010). Influence of culture and discrimination on care-seeking behavior of elderly African Americans: A qualitative study. Social Work in Public Health, 25(3-4), 311-326.

Mental Health Commission of Canada. (2012). Changing directions, changing lives: The mental health strategy for Canada. Calgary, AB

Ng, E. (2011). The healthy immigrant effect and mortality rates. Health Reports / Statistics Canada, Canadian Centre for Health Information = Rapports Sur La Santé / Statistique Canada, Centre Canadien d’Information Sur La Santé, 22(4), 25.

Pottie K, Ng E, Spitzer D, et al. Language proficiency, gender and self-reported health: An          analysis of the first two waves of the Longitudinal Survey of Immigrants to Canada.    Canadian Journal of Public Health 2008; 99(6): 505-10

Ralston, H. (1999) ‘Canadian immigration policy in the twentieth century: Its impact on South     Asian women’, Canadian Woman Studies 19(3): 33-37.

Richmond, A. (2001) ‘Refugees and racism in Canada’, Refuge 19(6): 12-20.

Richmond, A. (1976). Recent developments in immigration to Canada and Australia: A comparative analysis. International Journal of Comparative Sociology, 17, 183.

UNHCHR. (2007, January 1). Refugee Convention. Retrieved May 25, 2012, from Office of the United Nations High Commissioner for Human Rights: http://www2.ohchr.org/english/law/refugees.htm#wp1037049

UNHCR. (2011). Global Trends 2010. Geneva: UNHCR.

 ‘Asylum, Migration and Humanitarian Action‘ is a collection of 14 papers written by Jeff Crisp, Head of UNHCR’s Policy Development and Evaluation Service.

In what is shaping up as an academic Battle of the Titans — one that offers vast new learning opportunities for students around the world — Harvard University and the Massachusetts Institute of Technology on Wednesday announced a new nonprofit partnership, known as edX, to offer free online courses from both universities.

View the full article here: http://www.nytimes.com/2012/05/03/education/harvard-and-mit-team-up-to-offer-free-online-courses.html?_r=1&hp

How a Cambridge mathematician’s protest has led to demands for open access to scientific knowledge: http://www.guardian.co.uk/science/2012/apr/09/frustrated-blogpost-boycott-scientific-journals

Wellcome backs campaign to break stranglehold of academic journals and allow all research papers to be shared free online.

Link to article: http://www.guardian.co.uk/science/2012/apr/09/wellcome-trust-academic-spring

Wow. Just…wow. Some interesting discussions on the RRN Facebook page –  www.facebook.com/groups/30614536012/

 www.kony2012.com

Matt Galloway spoke with Robin Roth, she is a professor of geography at York University, and with Ei Phyu Han, she is a PhD student and a teaching assistant at York. They were speaking about a geography course taught at the university, that is also offered to refugees living on the Thai-Burma border.

The podcast can be found here: http://www.cbc.ca/metromorning/episodes/2012/02/22/course-for-refugees/