Canada is known around the world for its universal health care, covering the costs of appointments and treatments for those living within its borders. As permanent residents, these rights are extended to refugees. Additionally, after amendments to the Interim Federal Health Program in 2014, refugee claimants (those living in Canada who are waiting for refugee status) in Canada also have access to the same or similar health care coverage as Canadian citizens.
Despite the access to healthcare provided to refugees and refugee claimants, the care provided is not always equitable. In other words, barriers remain that prevent them from accessing the care in the same way as others in Canada. Refugees and refugee claimants often have unique health care needs resulting from physical and emotional trauma during displacement. However, these needs are not always met. In a study surveying the health care needs of Syrian refugees, most reported having unmet needs for up to two years after settlement (Tuck et al., 2019, p. 1306). These gaps not only affect the wellbeing of refugees and refugee claimants but can result in high costs in emergency procedures if illnesses are left untreated.
Unmet needs are often a result of barriers such as language, transportation, and understanding of the healthcare system. Many refugees arrive in Canada with limited English-language skills. However, the ability to communicate with a health care provider is important for quality care. Sometimes, providers will refuse to take refugee patients because there is no requirement to provide interpretation. Oftentimes, patients will use family and friends as interpreters, but this solution results in the loss of privacy. For example, a woman might be uncomfortable with her son knowing intimate knowledge about her health. Relying on someone else to communicate needs also removes agency and preventing the person’s control over their own life. Additionally, interpretation by a friend or family member is not always effective; the person may not have perfect English, and even with strong knowledge in both languages, likely lacks the interpretation skills of someone trained in the field of interpretation.
Refugees and refugee claimants who are new to the country may not know the area. Some refugees are not literate and cannot read maps or understand the bus system. Due to financial limitations, they often do not own a car or are unable to afford a taxi. As a result, some refugees have resorted to calling ambulances for minor health complications with no other way to go to the hospital.
People who are new to Canada do not always understand norms within the Canadian healthcare system. For example, the notion of a follow-up appointment might not be understood, which can lead to confusion, missed appointments, or not scheduling important procedures. Even norms such as being on time for appointments might not be understood.
In addition, refugees and refugee claimants might be discouraged from seeking care. Not all doctors are familiar with the health insurance of refugees and might ask for fees for treatments that are supposed to be covered or refuse to accept them as patients, leading refugees and refugee claimants to believe that they do not have access to the care.
Canada has many settlement agencies that understand the context of refugees and refugee claimants and already have access to resources such as interpretation services. The National insurance program for refugee claimants, the Interim Federal Health Program (IFHP), should go beyond providing monetary coverage to secure interpretation, transportation, and understanding of Canada’s health system. They should integrate settlement agencies in this national policy in order to capitalize on the experience and connections of the existing organizations and ensure the needs of refugees and refugee claimants are met. Canada cannot claim universal coverage is accessible to all if barriers to actually accessing it are left unaddressed for a portion of the population.
