Refugee children left uninsured

Clinic issues report after surge of patients without coverage

Mariam Tadesse felt weak and had a dry mouth for a week before staff at a Toronto refugee shelter found out and urged the 12-year-old girl’s father to take her to a doctor.

The father and daughter, newly arrived for asylum from Eritrea, were hesitant to seek medical help because they were still waiting for their interim health-care coverage from the federal government to kick in — a process that can take weeks.

By the time Mariam was taken to the Canadian Centre for Refugee & Immigrant Health, a community clinic in Scarborough for people without health-care coverage, in early September, she was entering a coma. She suffered a diabetic attack and was immediately taken to a hospital, where she remained in intensive care for four days.

“They arrived at 3 p.m. but the clinic opened at 5. The father was banging on the door with Mariam leaning against him. Her 9-year-old brother was there, too,” recalled Dr. Paul Caulford, who tended to the girl at the clinic.

“Her life was at risk. She had a first onset of diabetes and would soon be in a diabetic coma. This can lead to brain injury and death.”

Mariam is among a growing number of uninsured children Caulford’s clinic has seen in the past three years — one of many documented in a recent report released by the clinic.

One in three refugee and immigrant patients seeking care at the clinic is a child or youth. The number of uninsured pediatric patients has gone up by 36 per cent in the past three years to more than 360 in 2016.

Many of the clinic’s patients are refugees who have made asylum claims from within Canada and must go through a waiting period to get their federal interim health coverage (as opposed to those who make claims at ports of entry, who get immediate coverage).

The clinic also treats undocumented migrants living underground and new immigrants and Canadians who must live in the province for three months before they’re eligible for OHIP.

“In December, we began seeing a new refugee group, entering Canada from the United States with their parents and making refugee claims. It’s a new phenomenon. The numbers were high and the influx rapid,” said Caulford, who co-wrote the report with Sumathy Rahunathan.

The clinic’s medical team treated more than 50 refugees from the U.S. between Dec. 10 and Jan. 7.

Of those, 35 were children and youth, all originally from Africa.

“Some had severe frostbite. Some were pregnant, afraid if they gave birth in the U.S. Most crossed into Ontario from Buffalo hidden in the backs of trucks for fear they would be turned away,” Caulford said.

Mariam, who has since been granted asylum with her father and brother, was grateful that her life was saved and she could go back to school.

“We need to help other children like me who don’t have medical care or a doctor,” she said.

Of the 814 uninsured pediatric patients seen by the clinic in the last three years, 32 per cent were without status and not eligible for any health coverage.

One-quarter encountered difficulties in getting doctors to treat them despite Ottawa’s coverage for refugees; 24 per cent were permanent residents or Canadians returning from abroad or another province who had been in the province for less than the three months required to qualify for OHIP.

While one-third of the children and youth patients were there for immunizations, 22 per cent suffered respiratory and infectious diseases.

Others needed treatment for rash, gastrointestinal problems and even female genital mutilation assessment.

The study recommends Ottawa require Canadian physicians who bill public insurance programs to enrol with the interim health program, accept refugee patients and ensure all refugee claimants who are minors receive health coverage immediately when an asylum claim is made.

“Will it take the death of a refugee child here for lack of care to get the policies changed for children to access health care?” Caulford asked.