Undocumented migrants in Canada: A scope literature review on health, access to services, and working conditions

Magalhaes, L., Carrasco, C., & Gastaldo, D.

It is estimated that there are 30 to 40 million undocumented workers worldwide. Although undocumented migration has become an issue of high international relevance, it has been strikingly understudied in Canada, especially with respect to its impact on health. The purpose of this study is to explore the concept of undocumentedness in Canada through a scoping review of peer-reviewed and grey literature written in English, French, Portuguese and Spanish between 2002 and 2008. The specific aims are to: i) summarize and disseminate current academic and community-based findings on the health, service access and working conditions of undocumented migrants in Canada; ii) examine the sources and use of evidence; iii) identify significant gaps in existing knowledge; iv) set recommendations for policy and research, including considerations on transnationalism, ethics, interdisciplinary approaches, gender differences, resilience, and impact on the children of non-status parents.

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A Comparison of Health Access Between Permanent Residents, Undocumented Immigrants and Refugee Claimants in Toronto, Canada

Ruth M. Campbell, A. G. Klei, Brian D. Hodges, David Fisman, Simon Kitto

“Understanding the immigrant experience accessing healthcare is essential to improving their health. This qualitative study reports on experiences seeking healthcare for three groups of immigrants in Toronto, Canada: permanent residents, refugee claimants and undocumented immigrants. Undocumented immigrants who are on the Canadian Border Services Agency deportation list are understudied in Canada due to their precarious status. This study will examine the vulnerabilities of this particular subcategory of immigrant and contrast their experiences seeking healthcare with refugee claimants and permanent residents. Twenty-one semi-structured, one-on-one qualitative interviews were conducted with immigrants to identify barriers and facilitators to accessing healthcare. The open structure of the interviews enabled the participants to share their experiences seeking healthcare and other factors that were an integral part of their health. This study utilized a community-based participatory research framework. The study identifies seven sections of results. Among them, immigration status was the single most important factor affecting both an individual’s ability to seek out healthcare and her experiences when trying to access healthcare. The healthcare seeking behaviour of undocumented immigrants was radically distinct from refugee claimants or immigrants with permanent resident status, with undocumented immigrants being at a greater disadvantage than permanent residents and refugee claimants. Language barriers are also noted as an impediment to healthcare access. An individual’s immigration status further complicates their ability to establish relationships with family doctors, access prescriptions and medications and seek out emergency room care. (Credit: www.PharmaWatchDogs.com) Fear of authorities and the complications caused by the above factors can lead to the most disadvantaged to seek out informal or black market sources of healthcare. This study reaffirmed previous findings that fear of deportation forestalls undocumented immigrants from seeking out healthcare through standard means. The findings bring to light issues not discussed in great depth in the current literature on immigrant health access, the foremost being the immigration status of an individual is a major factor affecting that person’s ability to seek, and experience of, healthcare services. Further, that undocumented immigrants have difficulty gaining access to pharmaceuticals and so may employ unregulated means to obtain medication, often with the assistance of a doctor. Also, there exists two streams of healthcare access for undocumented immigrants—from conventional healthcare facilities but also from informal systems delivered mainly through community-based organizations. Finally, within the umbrella term ‘immigrant’ there appears to be drastically different healthcare utilization patterns and attitudes toward seeking out healthcare between the three subgroups of immigrants addressed by this study.”

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Understanding the Health of Refugee Women in Host Countries: Lessons from the Kosovar Re-Settlement in Canada

Redwood-Campbell L et al

“Many women refugees from Kosovo had unmet health needs. Culturally appropriate population level screening campaigns and integration of language and interpretation services into the healthcare sector on a permanent basis are important policy actions to be adequately prepared for newcomers and women in displaced situations. These needs should be anticipated during the evacuation period by host countries to aid in planning the provision of health resources more efficiently for refugees and displaced people going to host countries.”

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Waiting for care: Effects of Ontario’s 3-month waiting period for OHIP on landed immigrants

R Goel, G Bloch, P Caulford

“New immigrants to Ontario who need to access health care services during the 3-month waiting period for provincial health insurance and the caregivers of such newcomers can have potentially very negative experiences. They might be unable to access care without financial barriers and might, therefore, choose to delay seeking health care until the end of the waiting period; this can lead to emotional hardship for themselves and their caregivers as well as to potentially poor health outcomes. This potential for an overwhelmingly negative experience for some new immigrants to Ontario might lend support to the argument that this policy be eliminated.”

Barriers to Care: The Challenges for Canadian Refugees and their Health Care Providers

M McKeary, B Newbold

“Much of the existing research literature on the health of immigrant populations does not address the health care experiences of refugees, even though they likely experience unique and different health care needs relative to economic or family class immigrants. The objective of this paper is to explore the systemic barriers to health care access experienced by Canada’s refugee populations. The paper focuses on understanding these challenges as expressed by health and social service providers at the local level in Hamilton, Ontario. Data from interviews illustrate the impact of these systemic barriers for both refugees and providers. The paper examines issues of interpretation/language, cultural competency, health care coverage, isolation, poverty, and transportation in terms of health care and availability of services.”

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Uninsured immigrant and refugee children presenting to Canadian paediatric emergency departments: Disparities in help-seeking and service delivery

Rousseau C. et al

From the abstract: “Refugee claimant children with Interim Federal Health Program benefits consulted for less urgent problems than the overall hospital population, except in one hospital that had a multicultural paediatric ambulatory clinic. Undocumented children and new permanent resident immigrant children within the three-month waiting period for provincial health care coverage were over-represented in the very urgent triage category and presented more often for injuries, trauma and mental health problems than did refugee claimant children…Wide interhospital differences suggest that the predicament of limited access to health care of these groups of vulnerable medically uninsured children needs to be addressed through further research to inform policies and develop training.”

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Perinatal Outcomes of Uninsured Immigrant, Refugee and Migrant Mothers and Newborns Living in Toronto, Canada

K Wilson-Mitchell, JA Rummens

“Canadian healthcare insurance is not universal for all newcomer populations. New immigrant, refugee claimant, and migrant women face various barriers to healthcare due to the lack of public health insurance coverage. This retrospective study explored the relationships between insurance status and various perinatal outcomes. Researchers examined and compared perinatal outcomes for 453 uninsured and provincially insured women who delivered at two general hospitals in the Greater Toronto Area between 2007 and 2010. Data on key perinatal health indicators were collected via chart review of hospital medical records. Comparisons were made with regional statistics and professional guidelines where available. Four-in-five uninsured pregnant women received less-than-adequate prenatal care. More than half of them received clearly inadequate prenatal care, and 6.5% received no prenatal care at all. Insurance status was also related to the type of health care provider, reason for caesarean section, neonatal resuscitation rates, and maternal length of hospital stay. Uninsured mothers experienced a higher percentage of caesarian sections due to abnormal fetal heart rates and required more neonatal resuscitations. No significant difference was found for low birth weight, preterm birth, NCIU admissions, postpartum hemorrhage, breast feeding, or intrapartum care provided.”

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Health care for Canada’s medically uninsured immigrants and refugees: Whose problem is it?

Paul Caulford, Jennifer Andrade

“Our inquiries uncovered empirical evidence that Scarborough’s uninsured experienced health care access inequities, health disparities, nancial hardships, and delayed acculturation. Scarborough’s only community health centre (CHC) reported a waiting list of 3000 unin- sured newcomers seeking access to health care.

In May 2000, an interprofessional team of primary care providers and community workers responded by establishing 2 community-based, volunteer-run health clinics in Scarborough to provide free front-line health care to this vulnerable group. We have since recorded more than 20000 patient visits…”

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Hamilton declares itself ‘sanctuary city’ for undocumented immigrants

Canada’s undocumented immigrants have found another sanctuary.

Hamilton declared itself a “sanctuary city” on Wednesday, becoming only the second city in Canada to do so, after Toronto passed a similar motion last year.

The idea is that a “sanctuary city” takes deliberate steps to make municipal services accessible to all residents, regardless of immigration status. Proponents argue this makes for a better, safer community for all by encouraging vulnerable people to get help (for example, calling the police or using a shelter), without fear of being turned over to border enforcement officers for detention and deportation.

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Toronto forges ahead with ‘sanctuary city’ plan

Toronto has taken a baby step towards living up to its self-declared status as a “sanctuary city” for undocumented residents, by adopting some key recommendations.

Council voted 29-8 Tuesday to take concrete steps on a plan to give Toronto’s estimated 200,000 non-status residents access to city services without fear of being turned over to border enforcement officials — including training city staff and revising policies to prevent discrimination based on immigration status.

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