The french version of this article was originally published in Le Devoir. The Montreal Gazette declined to publish the english version.

A list of signatories to this op-ed (updated as of February 20, 2011) are found at the end of this text.

February 4, 2011 -- The recent conflict between the Association québécoise des pharmaciens propriétaires (AQPP) and Citizenship and Immigration Canada (CIC) should be resolved imminently. The lack of a formal agreement about reimbursement policies was ostensibly at the core of the impasse.

The AQPP, which represents almost 1800 pharmacy-owners across the province, effectively encouraged its members to refuse filling prescriptions for people presenting their Interim Federal Health Program (IFHP) coverage. Instead, those covered by this program, mostly refugee claimants, were told to pay up front -- a disdainful request given the financial precarity that many of those covered by the IFHP are forced to live in. On January 31, the AQPP issued a release stating that a meeting with CIC resulted in a temporary arrangement for the reimbursement of IFHP services until a more definitive agreement is reached. We will continue to follow the situation closely to ensure that people covered by the IFHP aren’t made to pay -- both literally and figuratively -- again.

As healthcare providers and front-line workers dealing with the health needs of migrant people, we denounce the AQPP’s pressure tactic. Our objection is not solely informed by public health concerns or by the burden placed on an already-strained healthcare system, as has been argued with the best of intentions by some. We unequivocally denounce the tactic simply because healthcare must be guaranteed for everyone living in this society. In fact, Section 1 of the Quebec Charter of Rights and Freedoms and Section 7 of the Canadian Charter of Rights and Freedoms state that “Everyone has the right to life, liberty and security of the person”; those with precarious immigration status (including refugee claimants) are no exception.

The belligerent and unethical de facto service refusal on the part of many pharmacists has exposed the vulnerability of refugee claimants in Canada. It is also reflective of the contempt with which asylum seekers are often treated. Indeed, it is difficult to imagine that any other sector in society would ever be threatened with an outright refusal of a healthcare service, let alone having such a threat actualized. However, as is too often the case, people with precarious immigration status are regarded as second-class human beings. In this situation, they were held hostage in a power-play between two institutions that, at face value, should have the interests of IFHP beneficiaries at the core of their respective mandates. The AQPP and its members who refused providing services to those presenting their IFHP coverage should face disciplinary action due to breaches of the Quebec pharmacists’ ethics code caused by their refusal to respect IFHP coverage.

We also denounce CIC’s handling of its conflict with the AQPP, which ultimately imperiled the health of countless IFHP beneficiaries. Immigration Canada should not be allowed to appear as an unwitting player in this avoidable mess. It is unlikely that CIC was unaware of the AQPP’s frustrations before the latter finally decided to encourage its members not to register with the new third-party administrator of the IFHP, Medavie Blue Cross, thereby precipitating the crisis. Immigration Canada should have acted earlier to prevent the impasse from degenerating as it did. It is worthy to note that it is CIC that decides on eligibility criteria for the IFHP and on the limited services available to IFHP beneficiaries. This is a fundamental issue that has not been addressed in the current debate, yet it contributes to the health precarity of many migrants.

Unfortunately, CIC’s ineffectual handling of this situation is in keeping with its immigration policies in general. The historical legacy of ignoble Canadian immigration policies aside, CIC continues its legislated violence against migrants to this day. Whether it be the Safe Third Country Agreement, (which prevents migrants from abroad who transit through the U.S. from filing a refugee claim in Canada), the Designated Country of Origin proposal in Bill C-11 (which will make it more difficult for refugee claimants to apply for asylum because some countries “do not normally produce
refugees”), the new imposition of visas for certain foreign nationals (such as in the cases of Mexico and the Czech Republic in 2009), or the proposal to detain and restrict health-care services for asylum seekers deemed to be part of a “human smuggling operation” (as proposed in bill C-49, following the hysteria and mass detention of Tamils in the MV Sun Sea incident on the west coast), the anti-migrant underpinnings of CIC are laid bare. Meanwhile, the root causes of forced displacement and migration -- many of which can actually be traced back to Canadian foreign policy and Canada-based companies operating abroad that produce the very conditions which force people to migrate -- continue to be ignored.

Grounded in a perspective that places human beings and their dignity at the core of our daily work, we assert that everyone -- regardless of immigration status, place of residence, ability to pay, etc. -- must have access to free, comprehensive and accessible health care. With respect to the IFHP, the confusion related to what services are covered can be avoided by simply extending coverage for IFHP beneficiaries to all services that are already available to provincially-covered residents. Meanwhile, all migrants not covered by comprehensive provincial programs should benefit from IFHP coverage. Money is not the issue here: if we can afford to purchase F-35 stealth fighter-bombers that force people to leave their homelands because of war, we can afford to provide health care for everyone. This is simply a matter of political will and of on-the-ground organizing for health justice. If not struggled for collectively, the rallying cry “health care for all” will remain elusive. Right now, that struggle begins with standing beside those who are rendered most vulnerable.

A french version of this open letter appeared in Le Devoir on February 8, 2011. Neither the Globe & Mail nor The Gazette published the english version.

Written by Samir Shaheen-Hussain, pediatrician and member of the No One Is Illegal campaign.

Anne-Marie Gallant (registered nurse and member of Solidarity Across Borders), Sylvain Thibault (coordinator of Project Refuge, Montreal City Mission) and others contributed to this op-ed.

Signed by the following healthcare providers and members of community organizations:

Bronwen Agnew, midwifery student (Montreal)

Yusra Ahmad, psychiatry resident, University of Toronto (Toronto)

Ghassan B. Alami, orthopedic surgeon, St-Jérôme Hospital (Montreal)

Andrea I. Albagli, Master's in Public Health candidate, University of Toronto (Toronto)

Nada Ashkar, practitioner of traditional Chinese medicine (Toronto)

Keith J. Barrington, pediatrician, Director of the Neonatology service, Sainte-Justine Hospital (Montreal)

Ahmed Bayoumi, physician, University of Toronto (Toronto)

Michaela Beder, psychiatry resident and member of Health for All (Toronto)

Nicolas Bergeron, psychiatrist at the CHUM and president of Doctors of the World-Canada (Montreal)

Nazila Bettache, internal medicine resident and migrant-justice activist (Montreal)

Joane Bourget, registered nurse in Inuit territories

Stephanie Bouris, research coordinator in migration and maternal child health (Montreal)

Nikki Bozinoff, medical student and member of the Health Justice Radio collective (Hamilton)

Claudette Cardinal, healthcare worker, retired jurist and human rights activist (Montreal)

Juan Carlos Chirgwin, family physician, chief of service at CLSC Park Extension (Montreal)

Janet Cleveland, Ph.D., psychologist (Montreal)

Rivka Cymbalist, director of Montreal Birth Companions (Montreal)

Soledad Delgado, registered nurse, Sacré Coeur Hospital of Montreal (Montreal)

Mike Desroches, paramedic student and member of the Ontario Coalition Against Poverty (Toronto)

Jackson Ezra, outreach worker, Trans Health Action of Quebec, a project of CACTUS-Montreal (Montreal)

Anne-Marie Gallant, registered nurse and member of Solidarity Across Borders (Montreal)

Camille Gérin, family physician and member of Quebec Physicians for Public Healthcare (Montreal)

Ritika Goel, family physician and member of Health for All (Toronto)

Rick Goldman, coordinator of the Committee to Aid Refugees (Montreal)

Marie-Claude Goulet, physician and president of Quebec Physicians for Public Healthcare (Montreal)

Jaswant Guzder, child psychiatrist (Montreal)

Helen Hudson, registered nurse, MSc(A) (Montreal)

Andrea Hunter, pediatrician, McMaster Children’s Hospital (Hamilton)

Farha Najah Hussain, speech-language pathologist and migrant-justice activist (Montreal)

Annie Janvier, pediatrician and clinical ethicist, Sainte-Justine Hospital (Montreal)

Jad Abou Khalil, general surgery resident at McGill University (Montreal)

Abby Lippman, Professor and researcher at McGill University, and women's health activist (Montreal)

Robbie Mahood, family physician, CLSC Côte-des-Neiges (Montreal)

Abeer Majeed, family physician and migrant justice activist (Toronto)

Gillian Morantz, pediatric resident, Hospital for Sick Children (Toronto)

Baj Mukhopadhyay, medical student, McGill University (Montreal) Marie Munoz, family physician, L'Actuel Clinic (Montreal)

Julia Murphy, registered nurse and member of Health for All (Toronto)

Chi-Minh Phi, pediatrician (Montreal)

Nanky Rai, Master's in Public Health candidate and member of Health for All (Toronto)

Priyadarshani Raju, psychiatry resident, CLSC Park Extension (Montreal)

Saleem Razack, Pediatrician, Montreal Children's Hospital (Montreal)

Nikki Rink, pediatrician, Médecins sans frontières Canada (Montreal)

Marlo T. Ritchie, Executive Director, Head & Hands (Montreal)

Olivier Sabella, family physician (Montreal)

Sophie Schoen, registered nurse and member of Solidarity Across Borders (Montreal)

Brett Schrewe, pediatric resident and clinical educator fellow, University of British Columbia (Vancouver)

Samir Shaheen-Hussain, pediatrician and part of the No One Is Illegal campaign (Montreal)

Alok Sood, physician (Toronto)

Danesh Sood, family physician (Toronto)

Rickesh Sood, family physician and family physician-anaesthesiologist (Toronto)

Sylvain Thibault, coordinator of Project Refuge, Montreal City Mission (Montreal)

Scott Weinstein, registered nurse (Montreal)

Sheila Wijayasinghe, family physician and medical director of Immigrant Women's Health Centre (Toronto)

Rosalind Wong, Movement Against Rape and Incest (Montreal)