Chapter 3: Migration-Related Trauma and Refugee Mental Health in the Canadian Resettlement Sector
The Canadian government has international commitments through the United Nations to resettle a certain number of refugees each year. Under Canada’s immigration law, the Immigration Refugee Protection Act (IRPA), people forced to migrate and who qualify for international protection may have a path for resettlement in Canada either as asylum seekers or as refugees. In both cases, a person must fit the definition of a refugee, thereby being considered part of a vulnerable population. In addition, Canada has resettlement programs designed to provide increased social support to people who are identified as having higher support needs and who are referred by the UNHCR. Furthermore, although a medical exam is an admissibility requirement for any resettlement program, a person eligible as a refugee will not be refused resettlement to Canada based on any medical condition (IRPA, Part 1, Div. 4, Section 38 (1)(2)) (Government of Canada, 2019).
Asylum Seekers and Refugee Claimants
Those who arrive to Canada requesting asylum arrive to a land border and claim asylum. Once they have made their claim, they become Refugee Claimants. They may apply for a work permit and/or an education permit. Their family members may also apply for work or education permits as long as they are in Canada and have also made asylum claims. Refugee Claimants have access to health care in Canada through the Interim Federal Health Program (IFHP). The IFHP provides limited, temporary health care benefits to Refugee Claimants while they are not eligible for provincial or territorial health insurance.
Refugee claimants’ legal status in Canada is connected to their official asylum claim or refugee protection claim. That official claim is considered through the Immigration Refugee Board (IRB) of Canada, which was created in 1989. Through a formal hearing, the person’s asylum claim is reviewed. If their claim is recognized by the IRB, the person gains official refugee status and can immediately apply for permanent residence in Canada. As a permanent resident, that person can access settlement support services through settlement agencies, obtain health care through provincial or territorial healthcare systems using provincial or territorial health insurance, and be legally employed without any other permits.
For many refugee claimants, life remains somewhat precarious until they receive official recognition of their claim and can proceed with life in Canada as permanent residents. This means some refugee claimants do not reach a post-migration stage until they obtain permanent residence in Canada. In terms of healing from migration trauma, the asylum claim and IRB hearing process in Canada may still be seen as part of migration. The post-migration period can be seen to begin once a person receives their permanent resident status and legal access to health care, education, and employment.
As part of Canada’s international commitment to resettle refugees from abroad, Canada provides resettlement opportunities through the Refugee and Humanitarian Resettlement Program. People who are experiencing forced migration whose refugee claims have been recognized abroad by either the UNHCR or the government of a country of first asylum may be resettled in Canada through one of the following programs:
- Government Assisted Refugees (GAR) Program
- Blended Visa Office Referred (BVOR) Program
- Joint Assistance (JAS) Program
- Privately Sponsored Refugees (PSR) Program
- Collective Sponsorship (in Quebec)
All recognized refugees are considered vulnerable migrants. However, the refugees resettled through the BVOR and JAS programs come from higher-risk situations and are identified as requiring greater support needs than those who are resettled through the GAR and PSR programs.
Refugees who are resettled in Canada through the PSR program or the Collective Sponsorship Program (Quebec) are nominated or identified by the Canadians who would like to sponsor them.
Refugees resettled through the GAR, BVOR, and JAS programs are referred to Canada by the UNHCR. All refugees referred by the UNHCR “fall under UNHCR’s Resettlement Submission Categories: Legal and/or Physical Protection Needs, Survivors of Torture and/or Violence, Medical Needs, Women and Girls at Risk, Family Reunification, Children and Adolescents at Risk, and Lack of Foreseeable Alternative Durable Solutions.” (UNHCR, 2021).
Stakeholders in Private Sponsorship
In private sponsorship programs, a group of Canadians or an organization choose to sponsor a refugee or refugee family. Although GARs come to Canada through the support of the Canadian government, BVOR and JAS cases have the added benefit of the social and network connections of sponsors. The presence of sponsors grows the number of stakeholders invested in a newcomer’s well-being. It can also increase social dynamics among stakeholders.
Stakeholders supporting a newcomer may include the following:
- Government officers
- Settlement agency workers
- Private sponsors
- Family members and friends already in Canada
- Local organizations and program delivery staff
- School staff
- Doctors, dentists, and other healthcare workers
- Other more casual community connections
For GARs, financial support is distributed by the government directly to the newcomers and housing is organized through a settlement agency. Newcomers receive community support through settlement agency services. For privately sponsored newcomers, financial support, housing, connection with a settlement agency, and other supports are provided by the private sponsors.
We have seen that migrant resilience is strongly correlated with social connections and the protective factors that those connections can bring. For the stakeholders themselves, collaborating to provide those social resources to newcomers can be a challenge.
Learning Activity 5: Case Study – Marjana
Marjana, 36, a refugee identified by the UNHCR as a woman at risk and a victim of gender-based violence and torture was resettled in Canada through the BVOR program and the support of a Sponsorship Agreement Holder (SAH) organization.
Marjana was greeted at the airport by the SAH coordinator, Miriam; the SAH communications person, Guy; and three volunteers (sisters) who were going to be directly involved in helping Marjana with social and tangible support needs such as budgeting, shopping, opening a bank account, and so on.
Within the first two weeks, the sisters helped Marjana connect with settlement agency staff in an organization within walking distance of where she was staying. After the intake process, a settlement worker named Gail helped Marjana enroll in the orientation program and schedule her language assessment. Gail seemed to put Marjana at ease because Marjana nervously confided in Gail about wanting to talk to a medical doctor about an issue. Marjana had not confided anything to the sisters who were supporting her through the SAH.
The SAH coordinator and the three sisters knew very little about Marjana’s personal or medical situation, having received only a brief written profile with a short overview of her support needs.
It was the formal responsibility of the SAH and SAH volunteers to help Marjana find a family doctor. Gail was bound by confidentiality and could not share Marjana’s personal information with any of the SAH contacts. Marjana was afraid of telling the sisters or SAH staff about her medical needs. She was afraid of what they would think of her. It would likely need to be the sisters who would help Marjana travel to meet a doctor for the first time.
Case Study Questions
Use the questions below to consider how collaborating stakeholders can be part of a newcomer’s resources for resilience or additional stressors. Discuss your responses with others working through this chapter.
- What stressors do you think Marjana was experiencing in her early post-migration period?
- What resources did Marjana have that might be sources of resilience?
- What dynamics between Gail and the sisters might increase the stressors on Marjana?
- Is there anything Gail could do to strengthen the collaboration among the people supporting Marjana while still respecting and maintaining Marjana’s right to privacy?
- How would you feel if you were in Gail’s situation?
- How would you feel if you were in Marjana’s situation?