Refugees, human rights and global health: what role can Canadian physicians play?

D_BDavid Benrimoh is a fourth year medical student at McGill UniverDr. Cecile Rousseausity

Dr. Cécile Rousseau is a professor of psychiatry at McGill University, working with refugee and immigrant children

 

The Syrian Civil War has become the greatest humanitarian crisis since the Second World War, creating over 4 million refugees. These refugees have, in large part, taken up precarious temporary residence in countries such as Egypt, Jordan, Turkey, Iraq and Lebanon. They are unlikely to find permanent residence there because of local integration policies, and so are left to either wait until the conflict in their homeland is resolved, or to apply to attempt to resettle in another country. It must be understood that those living in refugee camps face difficult conditions: sexual violence, trafficking of women and children, and lack of access to healthcare and education.

Because of poor conditions and limited opportunities in camps, many refugees try and make the move to another country. We have all seen reports of refugees drowning by the hundreds while trying to cross the Mediterranean, and the EU has been paralyzed by indecision with respect to who should take how many refugees. Canada has committed to taking in 10,000 refugees by year’s end, and a total of 25,000 in the next few months, but when we consider how many refugees are residing in lower-income countries like Jordan and Iraq, as well as the great need that exists, a purely humanitarian calculus should lead us to the conclusion that we ought to be doing more.

As a society, we are caught between conflicting concerns. On one hand, after the media disseminated a picture of a drowned Syrian child whose family had hoped to come to Canada, there was an outpouring of support and sympathy for those attempting to flee violence and persecution. This reaction is in line with the Canadian tradition of compassion toward refugees. On the other hand, the preoccupation with security and the perception of refugees as a possible threat has lent support to much more restrictive policies.  As the media coverage shifted to the horrifying attacks in Paris, opposition to the resettlement plan increased, with nearly 30% of Canadians expressing that they did not think Canada should be taking in refugees at all. What’s worse is the violence and aggression that has been perpetrated against Muslims here in Canada in the wake of the Paris attacks- a sad example of which is the burning of the Peterborough mosque. It is important to remember that both United States and Canada were very reluctant to welcome Jewish refugees during the Second World War. Feelings of fear and rejection toward refugees are nothing new and need to be understood as influencing society to adopt more restrictive policies.

Many worry that Trudeau’s deadline is too soon and will not allow enough time to ‘properly screen’ all refugees, and that this constitutes a security risk. This thinking does not take into account the screening and selection that takes place before the refugees ever set foot on Canadian soil. Canada takes part in the UNHCR’s resettlement program, which sees only a very small number of the most vulnerable refugees referred by the UNHCR to Canada. No refugees with a history of violence are admitted to the resettlement program and only about 1% of refugees make it through the five steps of screening; many of those who do are children. The refugees coming to Canada are truly the most vulnerable and are deserving of our care and support.

In this tense social context, what is the role, if any, of Canadian physicians? How can we- and should we- advocate and mobilize ourselves to protect refugees? The Trudeau government has said that it is now committed to bringing in 10,000 refugees by year's end. This means the refugees are coming, and will possibly be faced with resentment or discrimination when they arrive. This is concerning because one of the determinants of refugee mental health is “aspects of acceptance by the receiving society that affect employment, social status and integration”.

First, physicians have a public role to play to promote global health, an important part of which is the respect and promotion of human rights. We must act as advocates for the needs of the refugees because they have endured war, torture, sexual and psychological violence and are in need of protection. Many of them will not be in a position to speak for themselves as a result of language and cultural barriers. We must model the welcoming and empathic behaviour that our society must adopt in order to provide the safe haven that refugees so desperately need; for inspiration we need look no further than the solidarity with its Muslim citizens that the Peterborough community showed after the arson at the mosque.

Second, physicians are bound to serve patients, no matter their origin. We also have special ethical responsibilities with respect to vulnerable populations. As such our objective must be to create the clinical conditions needed to optimise the health of newly arrived refugees. Beyond reflecting on our personal biases we can take many concrete steps in this direction. One of the most important resources for refugees experiencing a new and disorienting healthcare system is language and cultural interpretation, and physicians working in areas expecting refugees should ensure that cultural and language interpretation services are available. Inquiring into the mental health and the social integration of refugee patients is also critical, and referral to appropriate services, like social workers and mental health teams, will be an important part of management. Training in cultural safety should be provided to physicians, nurses, and other health professionals. Engagement and partnership with local community groups will be important in order to assess needs and provide health education and access to healthcare services for refugees.

Finally, as resettlement needs greatly outpace global efforts, poor conditions in refugee camps lead to an unsustainable living situation, and illegal migration by desperate refugees involves them risking their lives and often results in legal purgatory, many physicians may wish to publicly support the government's stance towards refugees and encourage it to increase its efforts to resettle refugees in Canada, as we do now.

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