Like many doctors across the country, Dr. Paul Caulford breathed a sigh of relief Friday morning when he heard that a judicial ruling had declared the federal government's controversial refugee health-care cuts "cruel and unusual."
"There was so much on the line," said Dr. Caulford, a physician and co-founder of the Toronto-area Community Volunteer Clinic for the Medically Uninsured. "We were a voice, all the people there were voices for people who didn't have one."
Dr. Caulford was one of numerous health-care providers who provided details to the Federal Court on behalf of those who were affected by the 2012 changes that cut off health care for certain refugees and who were too afraid themselves to come forward.
Those stories provided the backbone of the court decision that forcefully questioned Ottawa's cost-cutting arguments behind the reduction in coverage.
On June 30, 2012, Ottawa reduced medical benefits for those who have come here seeking asylum. It left many of these new arrivals with basic, essential health care, but took away the type of vision and dental care given to those on social assistance.
Rejected refugee claimants, who stay on in the hope of winning an appeal, as well as claimants from any of the 37 countries the government deems safe, are only eligible for health care when they pose a public health threat. That eliminated care for heart problems, pregnancy, diabetes and other such ailments that only pose a risk to the individual.
Ontario and Quebec stepped in to fill the void, but other provinces did not, and the withdrawal of public funds proved a huge burden for doctors and volunteer clinics who refused to curtail what they felt was necessary care.
The 268-page Federal Court decision acknowledged that the government has the right to assign priorities and set limits on social benefit plans. But it said that the "intentional targeting of those seeking protection of Canada — an admittedly poor, vulnerable and disadvantaged group" amounts to "cruel and unusual treatment."
The ruling focused heavily on pregnant women and children, detailing cases such as a sick child unable to get a chest X-ray to diagnose what might be life-threatening pneumonia.
"This is a huge effort on behalf of refugees, made by many, many Canadians across the country," said lawyer Lorne Waldman, who represented the group of Canadian doctors who challenged the cuts.
Many refugee claimants refused to share their stories, fearful of their claim being denied. It forced doctors and nurses to speak on their behalf, providing patient stories, sometimes without names or key identifying details.
"The enormity of that responsibility for the most vulnerable segment of society, it dawned on you as you were telling answers to the lawyers," said Dr. Caulford, recalling the day he spent in the Toronto court.
"I came away feeling I hope I didn't do any harm," he said. "For several days afterward, I personally reflected that I could've been stronger in the deposition.So that's why my relief and my joy is so palpable."
About half of the 40 documented cases heard in court came from Dr. Caulford's volunteer-run clinic, located in Scarborough. It opened 15 years ago to provide health care to the most vulnerable groups, essentially a mixture of undocumented migrants, refugee claimants who had lost their federal health benefits under older rules or those who'd become homeless.
After the cutbacks in June 2012, however, a whole new crush of patients turned up at the clinic, nearly half of them pregnant women and children new to Canada, says Dr. Caulford. Evening drop-ins climbed dramatically, with up to 40 patients visiting compared to the 10 to 15 they'd seen before.
The unprecedented rise in patients "just about sunk our ship," he admitted.
Government vows to fight
The Federal Court's ruling on Friday gave Ottawa four months to make changes or the court will reinstate the pre-existing arrangements.
In the decision, Justice Anne Mactavish wrote that the 2012 change puts refugee claimants lives "at risk and perpetuates the stereotypical view that they are cheats and queue-jumpers, that their refugee claims are 'bogus', and that they have come to Canada to abuse the generosity of Canadians.
"It serves to perpetuate the historical disadvantage suffered by members of an admittedly vulnerable, poor and disadvantaged group."
Immigration Minister Chris Alexander said the government will appeal the decision, stressing the financial burden placed on Canadians and stating that $600-million has been saved to date.
"We will vigorously defend the interest of Canadian taxpayers," he said.
Dr. Annalee Coakley, medical director of the Calgary Refugee Health Program, said it's been a struggle ever since the 2012 changes to tell Canadians what is going on with these individuals without violating patient confidentiality.
"The government portrays them as bogus, but if any Canadian met these individuals and heard their stories, they would want to help them, and they wouldn't want to deny them basic health services," said Coakley.
Only a couple refugees agreed to be named for the court case, which presented a unique challenge to the advocacy groups arguing on their behalf.
Government lawyers questioned details of the anonymous cases, calling them hearsay, anecdotal and of little value.
But while the presiding judge acknowledged some "frailties" in some of the evidence, such as gaps in information about immigration status, she determined there was enough reliable detail to make an assessment.
Among the cases she heard was one involving someone named "Saleem Akhtar," not his real name, who sought refugee protection in Canada out of fear of persecution in Pakistan for his Christian faith.
He was diagnosed shortly after his arrival with cancer. Chemotherapy wasn't covered by Ottawa. A Saskatoon hospital ended up paying for the costs, and, later, the province offered to help, calling the federal cuts "unbelievable."
There was also the case of "Sarah," an Iranian woman whose claim is outstanding. She was covered for medical services and products that are urgent, but not for her regular medications. She suffers from angioedema, asthma and severe allergies.
Her Canadian doctor says she may die if she doesn't take medication regularly. Her family can't afford to pay for some of the medications, and tests and follow-up visits not covered.
"Hanif Ayubi" is diabetic, and was a failed refugee claimant. But the government couldn't return him to Afghanistan because it's currently deemed too dangerous. Due to the cuts, he's no longer covered for insulin and other medical supplies. He works as a dishwasher and is unable to pay for medication.
"Daniel Garcia Rodrigues" and his wife came to Canada from Colombia in 2007. His refugee claim was refused but his wife's was accepted. He suffered a retinal detachment and was told a delay in surgery would put his sight at risk, but he couldn't afford the surgery because he wasn't covered. A doctor agreed to help him with the cost.