Thank you very much.
I want to first thank you for your invitation and for the work being done to determine the impact of Bill C-31 on the arrival of refugees in Canada.
Just as a bit of background, I'm a family physician who has worked extensively with newly arrived refugees, going back about 10 years. I did my undergraduate medical degree at the University of Toronto, completed my residency program at McGill University, and did some training at Johns Hopkins University in Baltimore. I am part of the steering committee of the North American Refugee Health Conference and was a member of the group that recently published evidence-based guidelines for the assessment of newly arrived immigrants and refugees.
At present, I'm the medical director of the Crossroads Clinic at Women's College Hospital in Toronto. It's a new clinic that serves newly arrived refugees in Toronto. Women's College Hospital is an academic site, and I'm affiliated with the Department of Family and Community Medicine at the University of Toronto.
Over the last 10 years, I would say that I've seen thousands of refugee patients who've arrived in Toronto. I was quite involved with the migration of the Karen refugees from Thailand, for example. More recently, I've seen numerous Hungarian Roma patients in my practice. As such, I've seen both resettled refugees and refugee claimants, and I feel well positioned to speak to the health issues that challenge these populations. I also feel comfortable speaking to the impact of elements of Bill C-31 and the resulting impact on the health of newly arrived refugees.
I want to start by acknowledging that from where I sit, Canadian refugee policy is something that should make Canadians very proud. Despite the negative comments that have been recently widespread in the media, many of us believe that Canada has been a leader in providing refuge to some of the world's most vulnerable people. Canada has truly settled people based on a need for resettlement, not just on the ability to integrate. And I think we should be proud of this legacy. We have done it in a manner that respects our international obligations, and we have provided people with a reasonable opportunity to articulate their stories.
Canada has historically been an ally to persecuted people internationally, and I believe this is a reciprocal relationship. I truly believe that many waves of refugees have thrived post-migration and have contributed in meaningful ways to Canadian society. I think of the success of the Vietnamese refugees or the South Asian refugees from Uganda as relatively recent examples.
Bill C-31 is a huge bill that will likely significantly change the refugee system in Canada for many people. I want to preface my comments by emphasizing that we know that many of those who will be affected by this bill will eventually become Canadian citizens. As such, maintaining the health of refugee claimants would appear to be not only a moral issue but an issue that in many cases will impact the health care costs of those who will eventually become new Canadians. Changes in policy that exacerbate existing health care issues will diminish the potential of successful claimants to seamlessly integrate into Canadian society.
Although the health issues vary significantly in different waves of refugees, one consistent reality is that the migration trajectory of refugees puts them at higher risk of having mental health issues, such as post-traumatic stress disorder, depression, and anxiety. I would suggest that this should be kept in mind as we examine particular aspects of the bill that will affect refugees.
A few years ago, I met a gentleman who had arrived from a country in Africa. He was a striking figure, well over six feet tall. He was immensely articulate. He was well educated. He'd done his Ph.D. in a neighbouring country before returning to his homeland, where he became involved in politics as a member of an opposition party.
The first day I met him, this striking figure sat in my chair and he cried for an hour. His story was such that a few days before he arrived in Canada, he had been taken into custody by officials there. It was the third time he had actually been incarcerated. This time, he was beaten into unconsciousness. He woke up in the hospital, and luckily, he had a sympathetic nurse who told him that his assailants were waiting for him outside and that as soon as he woke up, they were going to take him back into custody and continue their questioning. She smiled, and she said, “You know, there's a back door over there, and I'm leaving on break.” So in his hospital clothes, he took off out the back door and made a run for the border. Luckily, when he got to the border, he had a family member there with some means who actually arranged with an agent to get him on a plane to leave the country. He is certain that like many of his colleagues, he would have died in custody if he hadn't been able to get out of the country.
I cite this case to shed some light on the issue of using human smugglers to flee persecution. We all recognize the tremendous abuse often committed by such criminals. The stories of people who have been scammed by such agents have been well documented. My patient had no choice. He was lucky that in his case he was successful in getting to Canada and in being eventually recognized as a convention refugee.
Stories like this are unfortunately not uncommon. I would think that all of us, if our lives or the lives of our families were in immediate danger, would do what we had to do to flee such persecution. This sometimes leaves people with no other choice but to use agents. Of course, this is not the ideal, and many people are victimized by their desperation.
Nevertheless, Bill C-31 seems to strike another blow to those who have had to risk their lives by using such smugglers. By recognizing the use of smugglers, the bill allows for the detention of individuals for up to a year. It prohibits people from sponsoring family members for five years, effectively keeping people from their partners and children for even longer.
Bill C-31 correctly acknowledges the tremendous risk posed by smugglers and agents. Unfortunately, it doesn't recognize that for many, smugglers are the only channels available to flee persecution. Bill C-31 increases sentencing for smugglers, but there are tremendous consequences for the refugees themselves. We heard overtures of this bill being a deterrent for those considering the use of smugglers. My experience suggests a deterrence would not apply to those who are truly fleeing impending threats. When you feel imminent danger, you do whatever it takes to leave. We would all do the same thing.
Bill C-31 allows for the detention of those suspected to have used smugglers. The impact of placing vulnerable people in detention is well documented. We know this triggers mental health issues, and the severity of these issues is proportional to the duration of detention. This impact has been documented to be particularly profound on children. Bill C-31 will force families to decide whether they should keep their children in detention with them or place them in foster care in a country and a system with which they're usually completely unfamiliar.
I have another patient in my practice. She's in my practice currently. She's from a Spanish-speaking country, one that could very easily be placed on the designated countries list. She was a criminal prosecutor for the state. After successfully prosecuting gang members, she was taken hostage, beaten, and sexually abused. She remained in the country until her neighbours informed her that people had come looking for her again one day when she wasn't home. She fled and came to Canada with the hope of having her children join her in the near future.
I'm confident she'll be seen as an individual who requires protection and will be determined to be a convention refugee. Her greatest issue now, though, is not her safety. She's separated from her two sons who are in the care of their father. She has reason to believe that they may also be under threat, and in our conversation she's so worried about them that she has spoken about returning home despite the very real threat of her being killed. Their father takes good care of them, she says, but in her words, all children need their mothers.
There's nothing unique about the torment of a parent who is separated from her children. Unfortunately, in my practice, this is too common.
Provisions in Bill C-31 will prevent some refugees from sponsoring family members for five years. These would be successful refugee claimants who have already been recognized as convention refugees requiring protection. I can't fathom the motivation for such a policy. Most of my patients who fled without family members did so because of dire circumstances. Many struggle with social isolation after arrival. Keeping permanent residents from seeing family members for over five years seems unnecessarily cruel. It undoubtedly imposes tremendous emotional stresses on people who have already suffered tremendously. Separating families of soon-to-be Canadian citizens does not seem to serve anyone well.
Finally, I want to comment on the designated country list. I have witnessed many people over the years who have had successful refugee claims despite coming from countries where some would think refugees should not originate. I think of a whistleblower in Mexico who was threatened and nearly killed despite moving to different cities on a number of occasions. I've been impressed with how the IRB takes the precaution to judge each claim on its own merit. It seems unnecessary to fast-track people from countries that don't, upon first inspection, appear to be refugee-creating countries.
My experience with the Hungarian Roma has been very instructive for me. I had not seen many refugees from Europe until encountering this particular migration. At this point I would say I've seen over a hundred Roma refugees and I've heard numerous accounts of similar stories, unprovoked violence by organized groups of neo-Nazis. The present political situation in Hungary is certainly not a topic on which I have any expertise. Nevertheless, I have sat and listened to the stories of many of my Roma patients. Their fear seems very real. Their stories, although different, share many similar themes that speak to systematic violence.
Creating two groups of refugee claimants underlies the message that some groups of populations face persecution even if the larger population does not. I have met many patients who have been determined to be convention refugees from countries that have not produced large numbers of refugees. Making the distinction based on country of origin seems to diminish the credibility of minorities who may be true victims of persecution.
As a physician who has had the privilege of working with refugee patients for many years, I've always stated that I've worked with the world's heroes. I'm amazed at the true resiliency of the human spirit. Daily I have the opportunity to serve those who have endured unimaginable trauma. Consistently they arrive with tremendous optimism and a desire to contribute to Canadian society. I'm deeply concerned that Bill C-31 will unnecessarily retraumatize a significant number of these refugees. I applaud efforts to expedite the refugee process. Nevertheless, this cannot be at the expense of the mental health of such a vulnerable population.
I will finish with a quote from a medical article from Steel et al in the Australian and New Zealand Journal of Public Health. They conclude their analysis of the mental health impact of detention by stating:
In their attempt to manage the international asylum crisis, it is important that Western countries do not inadvertently implement policies that cause further harm.
I am afraid there are too many elements of Bill C-31 that will cause harm to such vulnerable populations.