Toronto Star. Published On Thu Apr 26 2012. Ritika Goel, Baijayanta Mukhopadhyay, Joshua Wales and Mei-ling Wiedmeyer

This winter, Jason Kenney introduced Bill C-31, the Protecting Canada’s Immigration System Act, in Parliament. We have been watching the debate around this bill with some concern. It seems that Kenney believes the system needs protection from migrants. We, on the other hand, believe migrants, particularly refugees, need protection from his bill. We are a group of primary care physicians who support our patients, many of whom are refugees, to live proactively healthy lives. This approach is good medical practice, and yes, it even reduces health-care costs. We also recognize that people’s health status is dependent on their social and political realities. We therefore advocate for policies that support healthy living and condemn those that cause harm. And thus, our contention with the bill.

Take, for example, the case of Ms. J. who could be a patient in any one of our practices. She arrived in Canada on an overcrowded boat with her children, having escaped a war-torn nation where she witnessed the traumatic death of her politically active husband.

She is a poorly controlled diabetic, has flashbacks of her experiences, has difficulty sleeping, and has recently developed suicidal thoughts. Instead of allowing Ms. J. to go through a fair refugee claims process that might allow her protection, Kenney would rather put her in prison for up to a year, separate her from her children, keep her from reuniting with the rest of her family for five years and, even if accepted as a refugee, keep her immigration status in Canada uncertain.

At best, these policies are misguided and driven by ideology. At worst, they are intentionally cruel and inhumane. Bill C-31 proposes automatic detention of refugee claimants for up to one year without review if deemed unilaterally to be an “irregular arrival” by the Minister of Public Safety, currently Vic Toews. In addition to detention, C-31 also fast-tracks refugee claims from certain countries deemed “safe” by the minister, with little regard for the case-by-case nature of refugee claims.

The health consequences of the policies proposed by C-31 cannot be underestimated. In Australia, where the policies that Kenney proposes have been tried and discarded, studies show that detention increases risk of suicidal thoughts, post-traumatic stress disorder and self-harm in refugee claimants. Such findings are not surprising given previous trauma, isolation from social support and an inherent sense of powerlessness when imprisoned in a foreign country. Furthermore, the very nature of incarceration is known to exacerbate conditions such as hypertension, asthma and diabetes while providing an environment ripe for the spread of infectious diseases such as tuberculosis and hepatitis.

Even after release from detention, Bill C-31 would continue to influence the health of refugees. The legislation precludes applications for family reunification for five years after the refugee claim is adjudicated. We do not know what Kenney has against families, but we know from our clinical experience that sick people who have the support of their families fare better than people who are alone.

The bill also includes the possibility that a patient’s refugee status be ceased and permanent residency revoked. Research has demonstrated that refugees denied permanent status are more socially withdrawn, show less improvement of language skills, and have worse mental health compared with those with secure permanent status.

Kenney often points out that the government is only proposing to do what has already been done elsewhere. What he fails to mention in his quest for mediocrity for Canada is that American civil society groups have denounced detention conditions in the U.S. while more than 100 detainees have died in custody there since 2003. He also forgets that several medical organizations in Australia criticized refugee detention after it was initiated in 1992, and in 2008 the Australian government acknowledged the damage detention inflicts on refugees. The criticisms in Britain are no different.

We are not opposed to change. We believe much can be done to improve our collective responsibility to help those in need, efficiently and fairly. But we have grave concerns about the direction Kenney is taking us. Evidence and experience oblige us to speak out against what seems to be ideology and fear-mongering. We speak not only out of professional duty as physicians, but also as Canadians who demand better for our society.

Ritika Goel MD is a Masters candidate at the Johns Hopkins School of Public Health and a family physician in Toronto.

Baijayanta Mukhopadhyay MD is a resident in family medicine at the Northern Ontario School of Medicine in Timmins.

Joshua Wales MD is a resident in family medicine at the University of Toronto.

Mei-ling Wiedmeyer MD is a family physician in Toronto.