Medical Care Accessibility for Refugee Children in Vancouver

Group Members: Khafiya Mangut, Jessica Dhaliwal Title: Medical Care Access to Refugee Children in Vancouver, BC Introduction (259 words): Although Vancouver carries a vivid image, the daunting issue of healthcare accessibility for refugee children remains a critical issue. This project aims to highlight the system of inequality- access to healthcare that remains in place and can be arguably directly linked to the well-being of refugee children and their communities. The goal of this research is to help peers and those of the audience to engage with the current ongoing critical issue, and provide an outline for steps that can make a considerable impact within the ongoing issue. The lack of access to medical care for refugee children and families shows that healthcare access is restricted, and is in dire need of dismantling and rebuilding. It is important to note that access to healthcare is not only limited to the physical, but also to the hierarchies that the system of inequality creates to the disenfranchisement, one of which can be considered as trauma, both physical and emotional. This group of equity-deserving experiences unearned disadvantages as a result of their disenfranchisement in various ways, which also includes the trauma they face. As the trauma from migration, and the uncertainty of living can pile up, it can cause the individuals and community to experience a mental health challenge. This mental challenge impacts the wellness of the refugees, as it can become a burden and a challenge to overcome these mental hurdles. Furthermore, this impact on well-being can then also impact the community and family of the individual, which in turn can cause additional stress and anxiety when navigating the healthcare system. Learning Resources: 1) A systematic review on Primary Health Care Interventions to improve quality of care for refugees (Journal Article) https://doi.org/10.1111/hex.13365 (Addresses solutions per the perspectives of the equity-deserving group) This article provides primary healthcare interventions targeted at raising the standard of care for refugees and asylum seekers and is compiled in this systematic review. This article draws

attention to the fact that these refugee groups encounter major obstacles when attempting to obtain healthcare services, including issues with the appropriateness and quality of care. This resource includes a synopsis of interventions with an emphasis on communication services, system integration models, healthcare worker training, and individual skill development. A better knowledge of how primary care can be tailored to meet the specific needs of the refugee community can contribute to the discussion on health equity for underrepresented populations. 2) Vancouver’s Refugee Health (Youtube Video 5 minutes) https://www.youtube.com/watch?v=SnDVTtJ0bfs (Addresses structural issues) This video looks at the lives of refugee children receiving medical care in Vancouver. This video focuses on a geographic context and offers a human perspective on the problem, which improves comprehension of the particular challenges faced by refugee children in Vancouver while trying to receive healthcare. It introduces the topic of healthcare amongst the refugee community. Moreover, it discusses the Interim Federal Health Program (IFHP), which provides coverage for a limited number of health benefits to certain groups of individuals and resettled refugees, refugee claimants, and a few other groups. 3) History of Refugee Health Care in Vancouver (Article 3 pages) f ile:///C:/Users/Admin/Downloads/uwomj-chief,+6212+Roseborough+EIC%20(1).pdf (Anchors the topic in a particular time and place (including important historical, political, and social context) This article gives a summary of the history behind medical care provided to refugees in Canada while talking about specific policies that have influenced how health services are provided to refugees. It also talks about how refugee health services have changed over time, including the Interim Federal Health Plan (IFHP) being introduced. In addition, this article looks at other persistent problems that some groups of refugees, such as women and illegal immigrants, face and it explores possible solutions to deal with these problems. The article ultimately wants the audience to know how critical it is to guarantee health fairness for refugees and support. 4) Refugees: Health Needs and Vulnerabilities (WHO Article) https://www.who.int/news-room/fact-sheets/detail/refugee-and-migrant-health

(Highlights the voices and perspectives of the equity-deserving community). This article offers a thorough summary of the health requirements and vulnerabilities of migrants and refugees, as well as the effects of their migration experience on their mental and physical well-being. It focuses on common health concerns that refugees go through including mental health problems and other diseases. The data sheet also covers obstacles to receiving healthcare, such as prejudice, restricted service availability, and low health literacy. This article helps people realize that it is crucial to discuss the health issues that refugees go through, and how it's important to solve these issues as well. 5) Refugee Health Care in Canada: Examining Policy Tools (Journal Article) https://doi.org/10.12927/hcpol.2017.25099 (Addresses solutions per the perspectives of the equity-deserving group) This article talks about how the government of Canada’s decision in 2012 to change the criteria to the Interim Federal Health Program (IFHP) doesn’t provide health care coverage to all migrants in Canada and so this resulted in refugees being placed into categories that either reduced their access to healthcare coverage. So if we want to eliminate these hierarchies and challenges, policy changes would need to be considered to include reinstating comprehensive healthcare coverage for all refugees. The article also talks about community engagement playing an important role in advocating for refugee healthcare rights and challenging the IFHP changes. So it's important if we can continue to include community engagement to make it a central policy-making process, ensuring that refugee voices are heard and considered. 6) Voices of the Displaced: Refugee Experiences (Poem) https://www.umrelief.org/refugees-are-crying-alone/ (Highlight the voices and perspectives of the equity-deserving community). This poem written by Ahmed Ibsais, talks about refugees facing several difficulties, such as limited access to healthcare, education, and basic infrastructure. With over 70 million people displaced worldwide, many refugees are left to suffer in silence. These refugees have a variety of origins and have all suffered a terrible loss and have been through a lot of trauma..

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Many of these refugees are having a difficult time getting access to healthcare, and so this poem shows us that there needs to be justice done for these refugees who are struggling to get proper access to healthcare. The title itself “Around the world, refugees are crying alone.. in silence" discusses the millions of refugees who are internally displaced, and it's a global refugee crisis. This poem makes this situation more of a human rights issue rather than a political or economic one. 7) Access to Healthcare:Refugee Community (UNHCR Website) https://www.unhcr.org/what-we-do/protect-human-rights/public-health/access-healthcare (Addresses solutions per the perspectives of the equity-deserving group) Access to healthcare for refugees around the world is greatly aided by the UNHCR. They offer financial support, infrastructure, and advice for medical services. This covers prevention and treatment of both communicable and non-communicable diseases, as well as primary healthcare and community health activities. UNHCR also makes sure that necessary medications and medical supplies are available, and it concentrates on vaccines. UNHCR works to ensure that every refugee has access to health care through these initiatives. 8) Elements Affecting Refugee Resettlement in Vancouver (Article) https://www.sciencedirect.com/science/article/abs/pii/S0277953620304627 (Highlight the voices and perspectives of the equity-deserving community). This specific article goes over a qualitative study that explores the experiences of refugees in Vancouver who are sponsored by the government and those who are not, which emphasizes the nature of resettlement. Through a comparative analysis of the viewpoints of key informants and both temporary and permanent refugees, the study pinpoints important resilience variables such as cultural identification, social support, personal strengths, and resource accessibility. The article highlights these elements in fostering refugee resilience and provides support and guidance to those policy makers involved in refugee resettlement. 9) A Review of Refugees Housing Access in Canada (Article 22 pages)

https://www.jstor.org/stable/44320598 (Addresses structural issues) This article discusses that the accessibility of housing for immigrants is further restricted by discriminatory actions by the real estate, especially against specific ethnic groups. Immigration-related housing barriers in Canada are usually classified into three different categories, they are gender, skin color, and also cultural practices that affect housing access. So this article reviews what housing is like in the refugee community and how we can change that and make it accessible for all people living in Canada, or anywhere to be exact. 10) Understanding Healthcare Access in British Columbia: (Report) https://www.sciencedirect.com/science/article/abs/pii/027795369400345T (Addresses structural issues) The article talks about the accessibility for refugees in Victoria, British Columbia using the healthcare system. Twenty healthcare professionals and twenty Vietnamese refugees were interviewed. The study discovered that the incorrect interpretation of patient symptoms and healthcare practitioner suggestions was a significant concern noted by both groups. Access to healthcare has also been hampered by healthcare professionals' ignorance of conventional treatments for common illnesses. Potential remedies are suggested by the report, such as client advocates based in the municipality and specialized translation training for current hospital employees. Actions You Can Take: There are various structural changes that could help eliminate hierarchies that are creating unearned disadvantages and challenges to wellness in the equity-deserving group, one of which

can be categorized as language services. A change that can occur within language services’ is to ensure that interpreters, and languages that are globally spoken are provided. This will help eliminate hierarchies as it will dismantle the current language barrier and provide a safe and welcoming place for the refugees. Another main action taken to address the language barrier can be raising awareness, which in turn, can prompt those who are bilingual to join the cause, and further push the issue into a global context. - Promoting and advocating for cultural competency in health care setting - This is considered a direct action, as advocating and promoting cultural competency in health care can be done by joining protests, or by engaging in social media posts - Collaborating with support groups - This is a direct action as can take place on campus, and with refugees in mind, this support group can offer different services and programs to the refugee peers - Promoting and advocating for mental health resources - This is a direct action that can take place, as it can be to advocate for mental health resources, that are offered within the language that the refugee community speaks Define Your Topic What is the particular system of inequality or structural determinant of inequities that your topic is focused on? Our system of inequality is access to healthcare for those in need. What equity deserving group are you focusing on? We are focusing on specifically refugee individuals and communities.

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What location are you focusing on? Vancouver, BC What legal, policy, or social context makes this the appropriate level (of governance) to examine your topic? Vancouver has one of the highest populations of refugees, which is why we thought it appropriate to examine this topic. What is the hierarchy that the system of inequality or structural determinant has created? Language Barriers are seen as a hierarchy, as those that are not not proficient in English, will have a difficult time accessing resources and the healthcare system. What are some unearned disadvantages that this equity-deserving group experiences as a result of their disenfranchisement? There are many unearned disadvantages for this equality-deserving group, and one of the most important ones may be the trauma that can follow when healthcare resources are inaccessible. How have these unearned disadvantages impacted the wellness of the group? With the trauma that develops from the unearned disadvantage, can mean that the individuals are then faced with mental health challenges, which can be an issue if they lack the resources to obtain mental health support. Strategize Our Document Describe your key purpose. In other words, what exactly do you want your audience to do Our key purpose is to raise awareness, and hopefully provide enough information and

to support health equity after reviewing your document? evidence to promote the need for policy change. How much do you think your audience knows about this topic already? How will their prior knowledge level shape your key message and choice of resources? We do not believe that the audience is too aware of the current situation, as it is not a situation that is displayed in media, however, we are also aware that our audience comes from a wide background, so likely, they do have some knowledge about the issue. We picked resources that were easy to read, and intriguing while also encapsulating the issue. How much do you think they know about equity already? How will their prior knowledge level shape your key message and choice of resources? We think our audience knows a far bit about equity, considering that they have taken prior classes that covered the topic. Our choice of resources helped neatly enclose the need to take action and advocate for equity. How will you structure your list of resources to best support your key purpose? What needs to come first? What should come later? To structure our list of resources to help support our key purpose of spreading awareness, we will start with the quality of life provided to refugees, and end off with an article that provides resources and examples on how to take action.

Actions What structural changes (including legal and policy changes) could help eliminate hierarchies creating unearned disadvantages and challenges to wellness in the equity deserving group? There are many structural changes that could help eliminate hierarchies creating unearned disadvantages and challenges to the wellness in equity-deserving groups, in this case, healthcare practices that are trauma-informed and culturally competent. Are there current political initiatives in your location that your audience should know about? There are currently political initiatives, but these are web pages that can sometimes be difficult to find and do not gain much attraction. One of them can be found here: https://find.healthlink bc.ca/ResourceView2.

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aspx?org=53965&age ncynum=17676144 What are some of the main solutions or actions that the equity-deserving group promotes to address this topic? The main solution and actions that will help address this topic can be done as a community. With community effort and initiative, there can be access to different support groups. Actions Evaluation Table Action #1 : Volunteer with Organizations Describe Action #1 Capabilities Time management and ability to efficiently complete the task at hand, along with empathy and awareness of cultural differences

Motivation Making a positive impact within the community, which can lead to a sense of personal fulfillment and pride Opportunity There need to be volunteer programs that help address the issue at hand, and maybe a charity fundraiser which can be used to bring like-minded people together and network Impact The more actions that align with this, the more demand there might be for structural change Action #2: Support for Language Barriers Describe Action #2 Capabilities Bilingual and knowledge in the language of the refugee community Motivation Will directly make a positive impact in the community, while also providing knowledge of cultural understanding Opportunity Having the organization bring in collaboration with other organizations that provide language support Impact This action is more so individual based, the individual can take what they learned and

apply it to their daily life ie: if they see someone that has a language barrier issue, they can help resolve it Action #3: Healthcare Education Workshop Describe action #3 Capabilities Presentation and teaching skills to help communicate the healthcare system and other relevant information to the audience Motivation Promoting education about healthcare- Demotivating: challenge with language barrier if there is no presenter that shares the language as the refugees Opportunity Having organizations fund and create areas where presentations can take place, as this will have to be a place that is accessible Impact This action will encourage the individual to change behavior in their day to day life, as they will be

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knowledgeable about the current issue Action #4: Policy change advocate Describe Action #4 Capabilities Understanding of current policies and effectively create evidence-based arguments to convey message Motivation Will feel satisfaction knowing that the change is at a systemic level, and will create a positive outcome - Demotivating: it can be a slow process when changing policies Opportunity Organization and groups that are in collaboration with policymakers Impact This can create change in the external world, as it is directly working with policymakers Action #5: Raise Awareness Describe Action #5 Capabilities Ability to effectively convey

the current information about refugee healthcare issues Motivation Providing a sense of fulfillment for creating awareness for a topic that is critical Opportunity Collaborating with a large social media platform to help spread the message to a larger audience Impact This action will encourage the individual to change behavior in their day to day life, as they will be knowledgeable about the current issue, however, this can also fall between 1 and 2, as with enough knowledge, it can help change the external world and policymakers can become more informed and prompted to make change 1) Which actions give the best combination of feasibility and impact? - Action #5 2) Explain your reasoning. - Action number 5, raising awareness via social media, seems to give the best combination of feasibility, as anyone is able to run a social media account, and the impact it can have can be extensive, as social media is able to gain attraction and support globally

Resources List resource(s) that are produced by members of the equity-deserving community. Voices of the Displaced: Refugee Experiences by Ahmed Ibsais List resource(s) that explain or highlight the voices and perspectives of the equity-deserving community. Vancouver’s Refugee Health YouTube Video List resource(s) that explain the system of inequality or structural determinant of inequities that are creating issues for this equity-deserving group A Review of Refugees Housing Access in Canada Article.

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List resource(s) that explain the hierarchy created by the system of inequality or structural determinant of inequity Refugee Health Care in Canada: Examining Policy Tools (Journal Article) List resource(s) that document unearned disadvantages that this equity-deserving group experiences as a result of their disenfranchisement The History of Refugee Health Care in Vancouver (Article) List resource(s) that document impacts on wellness resulting from unearned disadvantages Refugees: Health Needs and Vulnerabilities (WHO Article) Resource(s) that relate to recommended actions for your audience to take Helpful Links and Resources For Medical Care Accessibility for Refugees and

Immigrants (Website)

References ● P Iqbal, M., Walpola, R., Harris-Roxas, B., Li, J., Mears, S., Hall, J., & Harrison, R. (2022). Improving primary health care quality for refugees and asylum seekers: A systematic review of interventional approaches. Health expectations : an international journal of public participation in health care and health policy , 25 (5), 2065–2094. https://doi.org/10.1111/hex.13365 ● Journeyman Pictures. (2017, February 6). Refugee Health: Vancouver [Video]. YouTube. https://www.youtube.com/watch?v=SnDVTtJ0bfs ● Roseborough, A., & Hudson, R. (n.d.). The history of refugee and newcomer health care in Canada. University of Western Ontario Medical Journal . Retrieved from [URL] ● World Health Organization. (n.d.). Refugee and migrant health. Retrieved February 24, 2024, from https://www.who.int/news-room/fact-sheets/detail/refugee-and-migrant-health

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● Holtzer, E., Moore-Dean, A., Srikanthan, A., & Kuluski, K. (2017). Reforming Refugee Healthcare in Canada: Exploring the Use of Policy Tools. Réforme des services de santé pour les réfugiés au Canada : examen de l'utilisation des outils stratégiques. Healthcare policy = Politiques de sante , 12 (4), 46–55. https://doi.org/10.12927/hcpol.2017.25099 ● Van Os, E. C. C., Zijlstra, A. E., Knorth, E. J., Post, W. J., & Kalverboer, M. E. (2020). Finding keys: A systematic review of barriers and facilitators for refugee children’s disclosure of their life stories. Trauma, Violence, & Abuse , 21 (2), 242-260. ● Ahmed Ibsais UMRelief. (n.d.). Refugees are crying alone [Poem]. Retrieved from https://www.umrelief.org/refugees-are-crying-alone/ ● United Nations High Commissioner for Refugees. (n.d.). Access to healthcare. Retrieved fromhttps://www.unhcr.org/what-we-do/protect-human-rights/public-health/access-health care ● Liu, J., Mansoor, Y., Johar, J., Kim, S., Sidiqi, A., & Kapoor, V. (2020). Strengths-based inquiry of resiliency factors among refugees in Metro Vancouver: A comparison of newly-arrived and settled refugees. Social Science & Medicine , 263 , 113243. ● Miraftab, F. (2000). Sheltering refugees: the housing experience of refugees in Metropolitan Vancouver, Canada. Canadian Journal of Urban Research , 42-63. ● Stephenson, P. H. (1995). Vietnamese refugees in Victoria, BC: an overview of immigrant and refugee health care in a medium-sized Canadian urban centre. Social Science & Medicine , 40 (12), 1631-1642.

● Canadian Civil Liberties Association. (n.d.). Useful links and resources: Healthcare for immigrants, refugees, and non-status individuals. Retrieved from https://ccla.org/get-informed/talk-rights/useful-links-and-resources-healthcare-for-immigr ants-refugees-and/

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