Journal of Immigrant and Minority Health

, Volume 20, Issue 1, pp 203–213 | Cite as

Health Inequity and “Restoring Fairness” Through the Canadian Refugee Health Policy Reforms: A Literature Review

  • Valentina AntonipillaiEmail author
  • Andrea Baumann
  • Andrea Hunter
  • Olive Wahoush
  • Timothy O’Shea
Review Paper


Refugees and refugee claimants experience increased health needs upon arrival in Canada. The Federal Government funded the Interim Federal Health Program (IFHP) since 1957, ensuring comprehensive healthcare insurance for all refugees and refugee claimants seeking protection in Canada. Over the past 4 years, the Canadian government implemented restrictions to essential healthcare services through retrenchments to the IFHP. This paper will review the IFHP, in conjunction with other immigration policies, to explore the issues associated with providing inequitable access to healthcare for refugee populations. It will examine changes made to the IFHP in 2012 and in response to the federal court decision in 2014. Findings of the review indicate that the retrenchments to the 2012 IFHP instigated health outcome disparities, social exclusion and increased costs for vulnerable refugee populations. The 2014 reforms reinstated some services; however the policy continued to produce inequitable healthcare access for some refugees and refugee claimants.


Refugee health policy Interim Federal Health Program Canada Refugees Refugee claimants 



This research did not receive funding.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

As this article does not contain any studies with human participants or animals performed by any of the authors, informed consent is not applicable.

Supplementary material

10903_2016_486_MOESM1_ESM.docx (32 kb)
Supplementary material 1 (DOCX 32 kb)
10903_2016_486_MOESM2_ESM.docx (18 kb)
Supplementary material 2 (DOCX 18 kb)


  1. 1.
    United Nations High Commissioner of Refugees: World at War, Global Trends Forced Displacement 2014. Geneva, 2015. Accessed 12 Sept 2015.
  2. 2.
    United Nations: As Conflicts Multiply, World Community’s Capacity to Respond to People Uprooted by Violence Being Tested in ‘Unforeseen Ways’, Third Committee Told | Meetings Coverage and Press Releases. 2012. Accessed 12 July 2015.
  3. 3.
    United Nations High Commissioner for Refugees:War’s Human Cost Global Trends. Geneva; 2014.Google Scholar
  4. 4.
    United Nations High Commissioner of Refugees. Asylum trends in industrialized countries. Oxford: Oxford University Press; 2003.Google Scholar
  5. 5.
    Dauvergne C. International human rights in Canadian immigration law—the case of the immigration and refugee board of Canada. Indiana J Glob Leg Stud. 2012;19(1):305–26.CrossRefGoogle Scholar
  6. 6.
    United Nations High Commissioner for Refugees: Asylum Levels and Trends in Industrialized Countries, 2014. Geneva: 2014. Accessed 12 Sept 2015.
  7. 7.
    Canada. Parliament. Library of Parliament:Legislative Summary of Bill C-31: An Act to Amend the Immigration and Refugee Protection Act (Report 41-1-C31-E) 2012. Accessed 12 July 2015.
  8. 8.
    Government of Canada, Citizenship and Immigration Canada: Information Sheet for Interim Federal Health Program Beneficiaries. 2012a. Accessed 12 Sept 2015.
  9. 9.
    Seeking Solutions Symposium: Access to health care for the uninsured in Canada. Toronto, 2013.Google Scholar
  10. 10.
    Government of Canada, Public Works and Government Services Canada: ARCHIVED—Canada Gazette—Order Respecting the Interim Federal Health Program, 2012. Accessed 12 July 2015.
  11. 11.
    Government of Canada, Citizenship and Immigration Canada: 2014 Annual Report to Parliament on Immigration. 2014. 12 July 2015.
  12. 12.
    Canadian Doctors for Refugee Care v. Canada (Attorney General). 2014 FC 651.Google Scholar
  13. 13.
    United Nations High Commissioner for Refugees: Convention and Protocol Relating to the Status of Refugees. Geneva; 2010.Google Scholar
  14. 14.
    Immigration and Refugee Protection Act [Canada]. S. C. 2001, c.27, 77.Google Scholar
  15. 15.
    Casswell DG. Singh v. Minister of employment and immigration. Alta L Rev. 1985;24:356.Google Scholar
  16. 16.
    Manjikian L. Refugee narratives in montreal: negotiating everyday social exclusion and inclusion. Montreal: McGill University; 2013. p. 1–333.Google Scholar
  17. 17.
    Bhuyan R, Osborne B, Sajedeh Z, Tarshis S. Unprotected, unrecognized: Canadian immigration policy and violence against women, 2008–2013. Toronto: Migrant Mothers Project; 2014.Google Scholar
  18. 18.
    Jackson S. ‘Citizenship Theatre’: refugee claimants, security, and performing citizenship at the immigration and refugee board. Hamilton: McMaster University; 2013. p. 1–25.Google Scholar
  19. 19.
    World Health Organization: News Release. Worldwide action needed to address hidden crisis of violence against women and girls. 2014. Accessed 12 Sept 2015.
  20. 20.
    METRAC, Barbara Schlifer Clinic, & LE AF:Bill C-31 will re-victimize women refugees and their children [Press release]. 2012. Accessed 12 Sept 2015.
  21. 21.
    Government of Canada, Citizenship and Immigration Canada:The Refugee System in Canada. 2015 Accessed 12 Sept 2015.
  22. 22.
    Goldring L, Bernstein C, Bernhard J. Institutionalizing precarious migratory status in Canada. Citizsh Stud. 2009;13(3):239–65.CrossRefGoogle Scholar
  23. 23.
    Cleveland J, Rousseau C. Mental health impact of detention and temporary status for refugee claimants under Bill C-31. Can Med Assoc J. 2012;184(15):1663–4.CrossRefGoogle Scholar
  24. 24.
    Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in Western countries: a systematic review. Lancet. 2005;365(9467):1309–14.CrossRefPubMedGoogle Scholar
  25. 25.
    Ryan DA, Kelly FE, Kelly BD. Mental health among persons awaiting an asylum outcome in Western countries. Int J Ment Health. 2009;38(3):88–111.CrossRefGoogle Scholar
  26. 26.
    Besier M. The health of immigrants and refugees in Canada. Can J Public Health. 2005;96(2):530–44.Google Scholar
  27. 27.
    McKeary M, Newbold B. Barriers to care: The challenges for Canadian refugees and their health care providers. J Refugee Stud. 2010;23(4):523–45. doi: 10.1093/jrs/feq038.CrossRefGoogle Scholar
  28. 28.
    Miedema B, Hamilton R, Easley J. Climbing the walls. Can Fam Phys. 2008;54(3):335–6.Google Scholar
  29. 29.
    Barnes S. The real cost of cutting the interim federal health program. Toronto: Wellesley Institute; 2013. p. 1–19.Google Scholar
  30. 30.
    Sheikh H, Rashid M, Berger P, Hulme J. Refugee health providing the best possible care in the face of crippling cuts. Can Fam Phys. 2013;59(6):605–6.Google Scholar
  31. 31.
    Minister of Justice: Consolidated federal laws of Canada, Order Respecting the Interim Federal Health Program, 2012. Accessed 12 Sept 2015.
  32. 32.
    Morrison J: Cuts to supplemental health benefits for refugees: Expanding the understanding of patient-centred care. Canadian Pharmacists Journal/Revue Des Pharmaciens Du Canada 2012; 145(6), 285–286. Accessed 12 Sept 2015.
  33. 33.
    Raza D, Rashid M, Redwood-Campbell L, Rouleau K, Berger P. A moral duty why Canada’s cuts to refugee health must be reversed. Can Fam Phys. 2012;58(7):728–9.Google Scholar
  34. 34.
    General Issues Committee: Report 12-014. Hamilton, ON: City of Hamilton; 2012. Accessed 12 Sept 2015.
  35. 35.
    Eggertson L. Doctors promise protests along with court challenge to refugee health cuts. Can Med Assoc J. 2013;185(7):E275–6.CrossRefGoogle Scholar
  36. 36.
    Government of Ontario, MOHLTC: Newsroom: Ontario Temporary Health Program 2013.
  37. 37.
    Benzie, R: Health Minister Eric Hoskins says Ontario is sending Ottawa the bill for the $2 million the province will spend this year on basic medical services for refugees. The Toronto Star 2014, July 23.
  38. 38.
    Wahoush EO. Equitable health-care access: the experiences of refugee and refugee claimant mothers with an ill preschooler. Can J Nurs Res. 2009;41(3):186–206.PubMedGoogle Scholar
  39. 39.
    Newbold B. Linking immigrant settlement, health, housing and homelessness in Canada. Canadian Issues/ThèmesCanadiens (Newcomer’s experiences of housing and homelessness in Canada). Montréal: Association for Canadian Studies; 2010. p. 8–15.Google Scholar
  40. 40.
    Berman H, Girón ERI, Marroquín AP. A narrative study of refugee women who have experienced violence in the context of war. Can j Nurs Res. 2009;41(1):144–65.PubMedGoogle Scholar
  41. 41.
    Olsen C, El-Bialy R, Mckelvie M, Rauman P, Brunger F. “Other” troubles: deconstructing perceptions and changing responses to refugees in Canada. J Immigr Minor Health. 2014;. doi: 10.1007/s10903-014-9983-0.Google Scholar
  42. 42.
    Greenaway C, Sandoe A, Vissandjee B, Kitai I, Gruner D, Wobeser W, Schwartzman K. Tuberculosis: evidence review for newly arriving immigrants and refugees. CMAJ. 2011;183(112):E939–51. doi: 10.1503/cmaj.090302.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, Tugwell P. Evidence-based clinical guidelines for immigrants and refugees. CMAJ. 2011;183(12):E824–925. doi: 10.1503/cmaj.090313.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Rossi C, Shrier I, Marshall L, Cnossen S, Schwartzman K, Klein MB, Greenaway C. Seroprevalence of chronic hepatitis B virus infection and prior immunity in immigrants and refaugees: a systematic review and meta-analysis. PLoS One. 2012;7(9):e44611. doi: 10.1371/journal.pone.0044611.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Zencovich M, Kennedy K, MacPherson DW, Gushulak BD. Immigration medical screening and HIV infection in Canada. Int J STD AIDS. 2006;17(12):813–6. doi: 10.1258/095646206779307469.CrossRefPubMedGoogle Scholar
  46. 46.
    Fowler N. Providing primary health care to immigrants and refugees: the North Hamilton experience. CMAJ. 1998;159:388–91.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Gagnon AJ, Dougherty G, Wahoush O, Saucier JF, Dennis CL, Stanger E. Stewart DE (2013) International migration to Canada: The post-birth health of mothers and infants by immigration class. Soc Sci Med. 2013;76:197–207. doi: 10.1016/j.socscimed.2012.11.001.CrossRefPubMedGoogle Scholar
  48. 48.
    Redditt VJ, Janakiram P, Graziano D, Rashid M. Health status of newly arrived refugees in Toronto, Ont Part 1: infectious diseases. Can Fam Phys. 2015;61(7):e303–9.Google Scholar
  49. 49.
    Government of Canada, Citizenship and Immigration Canada: Canada News Centre-Archived–Reform of the Interim Federal Health Program ensures fairness, protects public health and safety [News Releases]. 2012. Accessed 12 Sept 2015.
  50. 50.
    Basok T. Refugee policy: globalization, radical challenge, or state control? Stud Political Econ. 1996;50:133–66.CrossRefGoogle Scholar
  51. 51.
    Evans A, Caudarella A, Ratnapalan S, Chan K. The cost and impact of the Interim Federal Health Program cuts on child refugees in Canada. PLoS One. 2014;9(5):e96902. doi: 10.1371/journal.pone.0096902.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Redditt VJ, Graziano D, Janakiram P, Rashid M. Health status of newly arrived refugees in Toronto, Ont Part 2: chronic diseases. Can Fam Phys. 2015;61(7):e310–5.Google Scholar
  53. 53.
    Sanders C: Province steps up for refugees. 2012. Accessed 12 Sept 2015.
  54. 54.
    Government of Canada, Citizenship and Immigration Canada: Interim Federal Health Program Policy. 2014.
  55. 55.
    Government of Canada, Citizenship and Immigration Canada: Interim Federal Health Program: Summary of Benefits. 2015. Accessed 12 Sept 2015.
  56. 56.
    Goel R: OPINION: Federal reversal of refugee health cuts still leaves many uncovered. 2014. Accessed 12 Sept 2015.
  57. 57.
    Government of Canada, IRCC: Guide 5568: Applicaton for the Interim Federal Health Program Coverage. 2016. Accessed 12 June 2016.
  58. 58.
    Government of Canada, Citizenship and Immigration Canada: Restoring Fairness to the Interim Federal Health Program [New Releases]. 2016. Accessed 15 Jan 2016.
  59. 59.
    Government of Canada, Immigration, Refugee and Citizenship, Canada [IRCC]:# WelcomeRefugees: Canada Resesttles Styrian Refugees. 2016. Accessed 12 June 2016.
  60. 60.
    Loescher G. Introduction. In: Loescher G, Monahan L, editors. Refugees and international relations. New York: Oxford University Press; 1989. p. 1–33.Google Scholar
  61. 61.
    Ghosh B. Managing migration: towards the missing regime. Chapter 5 in migration without borders: essays on the free movement of people, edited by Antoine Pécoud and Paul de Guchteneire. Paris: UNESCO Publishing; 2007. p. 97–118.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Global HealthMcMaster UniversityHamiltonCanada
  2. 2.School of NursingMcMaster UniversityHamiltonCanada
  3. 3.PaediatricsMcMaster UniversityHamiltonCanada
  4. 4.School of MedicineMcMaster UniversityHamiltonCanada

Personalised recommendations