US travel bans and executive orders: How the Canadian health community can respond
Much has happened in the past few weeks that has caused fear and anger on both sides of the Canada-US border. Since his inauguration, US President Donald Trump has issued several executive orders targeting migrants, including plans to increase immigration detention and deportation, cut funds to sanctuary cities, suspend entry to refugees and individuals from six Muslim-majority countries, and build a wall at the Mexican border.
Increasingly hostile rhetoric levied against migrants and Muslims has led some to flee to Canada, crossing in frigid temperatures with cases of severe frostbite and amputation. Several Canadian citizens of Muslim origin have been arbitrarily questioned or refused entry to the US, including a Sarnia physician of Afghan origin, and a hateful and murderous attack has occurred on a mosque in Quebec city.
The question for us is how can the health community in Canada respond to such events?
It is heartening to see that many have openly denounced the travel ban, including Canadian universities, lawyers’ groups and more. We are seeing increasing conversation opposing Islamophobia in Canada, with a motion passed in the Ontario legislature and one proceeding before the federal government.
Sanctuary cities, which aim to ensure accessible municipal services for all people and to end cooperation with border enforcement, now include Toronto, Hamilton, London, and Montreal, with Ottawa, Vancouver and others strongly considering. As well, many calls have been made to end Canada’s Safe Third Country Agreement which forces migrants coming via the US to cross into Canada in a covert manner as they would otherwise be turned away at the border.
However, there are still many issues we have to face.
Current federal Conservative leadership candidates have called for tests of “Canadian values” stoking xenophobia and Islamophobia among the public. The drastic immigration reforms of 2012 have been largely left in place, significantly reducing the time available to prepare refugee claims and instituting differential rights for claimants based on “Designated Countries of Origin.”
While the cuts to refugee healthcare were reversed, claimants still face months of delay in accessing health coverage due to the arduous new claims system and a requirement to wait for an “eligibility interview.”
Canada also continues to be denounced by the UN for our immigration detention system, which allows for indefinite detention, detention in jails, and even the detention of children. Sanctuary city policies, while important symbolically, have been poorly enforced on the ground without adequate funds or training of frontline staff.
We know the health impacts of poor immigration policy well. Insecure immigration status, racialization, and Islamophobia all have evidence of negative health impacts. Migrants held in immigration detention suffer from higher rates of PTSD, anxiety and depression symptoms after even short periods of incarceration. And despite our universal healthcare system, we continue to couple healthcare coverage with immigration status, leaving an estimated 500,000 people in Ontario without OHIP. This includes permanent residents and returning citizens in the three-month wait, non-status individuals and some temporary foreign workers and international students. A recent study of Ontario emergency rooms demonstrated that uninsured people had a higher chance of presenting with a serious health issue, and were more likely to leave untreated or dying.
The response from the medical community to recent events in the US has been strong, with statements being released by the College of Family Physicians of Canada, the Canadian Pediatric Society and the University of Toronto Department of Psychiatry. The Hospital for Sick Children in Toronto has even come forward to provide necessary surgeries to children impacted by the travel ban.
However, we need to also have a robust response to the pre-existing issues in our own backyard. Our associations are here to reflect our values and we can encourage them to take bold and necessary actions.
So let us continue to add our voices to the call to end the Safe Third Country Agreement so migrants fleeing the US can present at a border and make their claim safely. But let us also call on our federal government to reverse the detrimental immigration reforms of 2012 that impact access to healthcare for refugee claimants.
We should stand firm against xenophobic and Islamophobic pronouncements from our own politicians or fellow Canadians. We can join migrant communities and health workers calling for an end to indefinite detention and child detention.
We must fight for OHIP for All so no Ontarian delays seeking care, is turned away, charged upfront, given a bill or dies as a result of healthcare coverage being linked to immigration status.
Finally, let us support our municipalities to not only declare themselves sanctuary cities, but also hold them accountable to implement and enforce these policies. If we truly want to ensure Canada is a safe, healthy and welcoming place for migrants, there is much that we can do together, and we can start right now.
Ritika Goel and Michaela Beder are physicians working with marginalized populations with Inner City Health Associates in Toronto. Both are lecturers at the University of Toronto.