French translation - https://bit.ly/2ytj4SN

TO: The Right Honourable Justin Trudeau, Prime Minister of Canada
       The Honourable Patty Hajdu, Minister of Health
       The Honourable Marco Mendicino, Minister of Immigration, Refugees, and Citizenship

CC: Premiers and Ministers of Health of all provinces & territories

The COVID-19 pandemic has highlighted long-standing gaps in the Canadian healthcare system that continue to disproportionately and negatively impact vulnerable communities. Despite Canada’s proclaimed universal healthcare system, migrant workers, individuals without status, rejected refugee claimants, and others, are left uninsured, facing fear of deportation and insurmountable debt in accessing healthcare. Healthcare is a human right, yet it is not guaranteed for hundreds of thousands of individuals in Canada. The COVID-19 pandemic has highlighted that our community wellbeing is highly interconnected, and we place our entire society at risk by failing to guarantee health care to all people. As members of the health and migrant communities, we call on Canada’s federal government to work closely with provincial and territorial governments, health institutions, and public health leaders to ensure and support access to healthcare for all people living in Canada, including those currently living in detention, regardless of immigration and citizenship status.

In response to the pandemic, some provinces have begun acknowledging the harms of limiting access to healthcare for uninsured communities by temporarily expanding some types of coverage, largely through making an artificial distinction between COVID-19 related services and others (see https://bit.ly/2WLVhqw). This is not enough. There is significant variability in how COVID-19 presents, making it difficult for healthcare providers to know what constitutes a COVID-19 related service - this false distinction is harmful as it may lead to missed testing and treatment and increased community transmission. Full and comprehensive coverage of all services will also ease the administrative burden on frontline healthcare providers working to control this pandemic, rather than having them waste time with bureaucratic gatekeeping. To effectively “flatten the curve”, policy must ensure universal access to all essential health services.

The national response on this issue has also been fragmented, with only some provinces beginning to provide care for some uninsured individuals, and policy implementation being incomplete in healthcare institutions. Patients are still being forced to navigate complicated pathways to access care, and many continue to be denied access to essential healthcare services, both COVID-19 related and otherwise. Uninsured individuals across Canada require universal access to healthcare that is effectively implemented from the level of policy to the patient experience - inconsistency only serves to create further inequity and confusion within an existing patchwork-system.

The threat of detention and deportation faced by undocumented individuals who seek essential healthcare services at all times, but particularly during this pandemic, must be addressed. Though deportation has been temporarily halted at the policy level, with some exceptions, there is an ongoing fear that access to health care services could result in detention and deportation by the Canada Border Services Agency (CBSA) in the future. This fear results in many uninsured individuals regularly avoiding or delaying seeking care. It is important that health care institutions affirm in their patient privacy policies that they will not share information with the CBSA, and that the CBSA affirm that attempting to access healthcare will not result in detention or deportation.

Finally, these changes have been announced as temporary measures for the COVID-19 crisis. This is in direct opposition to what healthcare professionals, international human rights bodies, and community organizations have repeatedly said: denying healthcare on the basis of immigration status is a human rights violation and threat to public health. Ensuring access to health care for migrants improves the health and safety for all communities in Canada; it leads to reduced health care costs and improved health outcomes.The United Nations Human Rights Committee has condemned Canada in the past for denying access to essential healthcare on the basis of immigration status, based on the case of Nell Toussaint. We must not be short-sighted - equitable access to healthcare is always essential, not only during crises such as COVID-19.

We demand that the Canadian federal government work closely with provincial and territorial governments, health institutions, and public health leaders to immediately ensure comprehensive healthcare coverage to all. This can only be achieved when:
        1. Healthcare coverage is comprehensive, covering all medically-necessary services, and does not make the artificial and harmful distinction between COVID-19 related services and others;
        2. All healthcare institutions are informed of the policy details and how they will be implemented, including coverage changes, the application of billing codes, and confidentiality policies that prevent sharing personal health information or collaborating with the Canadian Border Services Agency (CBSA). This messaging must reach all workers interacting with patients in addition to healthcare providers;
        3. An explicit public messaging campaign informing all uninsured communities and the broader public that all healthcare services are available at no charge regardless of immigration status;
        4. The CBSA guarantees that accessing healthcare will not result in detention or deportation;
        5. Healthcare coverage is permanent, carrying on beyond the COVID-19 pandemic, as a human rights and public health measure.

Sincerely,
1. Migrant Rights Network
2. Canadian Doctors for Medicare
3. OHIP for All
4. Sanctuary Health Vancouver
5. Canadian Health Coalition (CHC)
6. Canadian Medical Association (CMA)
7. College of Family Physicians of Canada (CFPC)
8. Médecins Québécois pour le régime public (MQRP)
9. Collaborative Network to End Exploitation
10. Ontario Psychiatric Association
11. Canadian Pediatric Society (CPS)
12. Action Canada for Sexual Health and Rights
13. Canadian Labour Congress
14. Radical Action with Migrants in Agriculture (RAMA) - Okanagan
15. Médecins du Monde Canada / Doctors of the World Canada
16. Canadian Federation of Nurses Unions (CFNU)
17. Collectif Ensemble avec les personnes migrantes contre le racisme-Sherbrooke
18. Broadbent Institute
19. Caregivers Action Centre
20. Hamilton Social Medicine Response Team (HAMSMaRT)
21. Canadian Federation of Medical Students (CFMS)
22. Canadian Centre for Victims of Torture (CCVT)
23. Regency Nannies Inc.
24. Carrefour d'éducation populaire de Pointe-Saint-Charles
25. People's Health Movement Canada/Mouvement populaire pour la santé au Canada
26. Canadian Civil Liberties Association (CCLA)
27. Northumberland Community Legal Centre
28. Centre ressources pour femmes de Beauport
29. Butterfly (Asian and Migrant Sex Workers Support Network)
30. Parkdale Community Legal Services
31. Workers' Action Centre (WAC)
32. $15 and Fairness Campaign
33. Langs Community Health Centre
34. Conseil Migrant
35. Migrant Workers Centre
36. Mouvement d'éducation populaire et d'action communautaire du Québec (MÉPACQ)
37. ACCÉSSS
38. Health Providers Against Poverty (HPAP)
39. Soignons la justice sociale/Caring for social justice
40. Concertation itinérance Beauharnois-Salaberry Suroit
41. Migrant Workers Alliance - Niagara
42. Regroupement intersectoriel des organismes communautaires de Montréal (RIOCM)
43. No One Is Illegal - Toronto
44. Planned Parenthood NL Sexual Health Centre
45. FCJ Refugee Centre
46. Vancouver Committee for Domestic and Caregivers Rights
47. Au coeur de l’enfance
48. GLOMHI - Global Migration and Health Initiative
49. Decent Work and Health Network
50. Solidarity Across Borders / Solidarité sans frontières
51. Mouvement PHAS (Personnes handicapées pour l'accès aux services)
52. Migrante Alberta
53. Migrante Canada
54. Alberta Healthcare For All
55. Vancouver and District Labour Council
56. Colectif Contre la Brutalité Policière (COBP)
57. UNIFOR Canada
58. Office for Systemic Justice, Federation of Sisters of St. Joseph of Canada
59. SWAN Vancouver Society
60. Association for the Rights of Household and Farm Workers (ARHW - ADDPD)
61. Coalition des organismes communautaires québécois de lutte contre le sida (COCQ-SIDA)
62. Migrants Resource Centre Canada
63. Fédération interprofessionnelle de la santé du Québec-FIQ
64. Canadian Union of Public Employees (CUPE)
65. Table de concertation des organismes au service des personnes réfugiées et immigrantes (TCRI)
66. Ottawa Sanctuary City Network
67. Regroupement québécois des intervenantes et intervenants en action communautaire en CISSS et en CIUSSS (RQIIAC)
68. Réseau des Tables régionales de groupes de femmes du Québec
69. Overdose Prevention Ottawa
70. CAMS Ottawa (Coalition Against More Surveillance)
71. University of Ottawa Aesculapian Society
72. Women's Health in Women's Hands CHC
73. Industrial Accident Victims Group of Ontario (IAVGO) Community Legal Clinic
74. The Canadian Centre for Refugee and Immigrant Health Care (CCRIH)
75. Ontario Medical Student Association (OMSA)
76. South Asian Legal Clinic of Ontario (SALCO)
77. Canadian Council for Refugees | Conseil canadien pour les réfugiés
78. Canadian Centre on Statelessness
79. The Refugee Centre
80. Ontario Council of Agencies Serving Immigrants (OCASI)
81. Front d'action populaire en réaménagement urbain (FRAPRU)
82. Coalition solidarité santé
83. Ligue des droits et libertés
84. Council of Agencies Serving South Asians (CASSA)
85. Regroupement des aidantes et aidants naturels de Montréal
86. Institute of the Blessed Virgin Mary (Loretto Sisters, Canada)
87. United Nurses of Alberta
88. Migrant Workers Alliance for Change
89. Ontario Coalition Against Poverty (OCAP)
90. SINGA Québec
91. RÉCIFS
92. No One Is Illegal - Halifax/K'jipuktuk
93. First Call: BC Child and Youth Advocacy Coalition
94. Moelle épinière et motricité Québec
95. Alliance for Healthier Communities
96. Association des groupes d'intervention en défense des droits en santé mentale du Québec (AGIDD-SMQ)
97. Migrante Ontario
98. Keeping Six- Hamilton Harm Reduction Action League
99. Action santé Outaouais en partenariat avec la Table de développement social de la Vallée de la Gatineau
100. Table des organismes communautaires montréalais de lutte contre le sida (TOMS)
101. KAIROS: Canadian Ecumenical Justice Initiatives
102. Fédération des maisons d'hébergement pour femmes
103. Service jésuite des réfugiés Canada
104. FIQ Syndicat des professionnelles en soins de Montérégie Ouest
105. 411 Seniors Centre Society
106. Centre d'Action Sida Montréal
107. Medical Student Society of McGill University
108. British Columbia Civil Liberties Association
109. Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital
110. International Retinoblastoma Consortium
111. Femmes du monde à Côte-des-Neiges
112. REFUGE Centre for Newcomer Health
113. Canadian Association of Community Health Centres (CACHC)
114. Centre des femmes solidaires et engagées
115. Centre for Gender and Sexual Health Equity (CGSHE)
116. Northern Connections
117. Compassionate Kenora
118. Saskatchewan Association of Immigrant Settlement and Integration Agencies (SAISIA)
119. Alliance du personnel professionnel et technique de la santé
120. Oxford Coalition for Social Justice
121. KAIROS BC-Yukon
122. Collaboration Interprofessionnelle Montréalaise Étudiante (CIME)
123. Coalition des Tables régionales d'organismes communautaires
124. SWITCH - Student Wellness Initiative Toward Community Health
125. Street CCRED (Community Capacity in: Research, Education and Development)
126. Kenora Seniors Coalition
127. Criminalization and Punishment Education Project
128. Association of University Professors University of Ottawa (APUO)
129. Edmonton & District Labour Council
130. Pivot Legal Society
131. BC Health Coalition
132. Umbrella Multicultural Health Co-op
133. Judy Waldman Counselling and Consulting
134. Immigrant Workers Centre
135. Shelter Health Network
136. Student Medical Society of Saskatchewan (SMSS)
137. Ottawa Coalition to End Violence Against Women  (OCTEVAW) / Coalition d'Ottawa contre la violence faite aux femmes (COCVFF)
138. Micah House Refugee Reception
139. Welcome Collective
140. Table des regroupements provinciaux d’organismes communautaires et bénévoles
141. Justicia for Migrant Workers (J4MW)
142. Pinecrest--Queensway Community Health Centre
143. Chatham-Kent Community Health Centres
144. The Obstetric Justice Project
145. Halifax Refugee Clinic
146. Association of Mexicans in Calgary
147. FSSS-CSN - Fédération de la santé et des services sociaux
148. Rainbow Refugee Society
149. Rainbow New Beginnings
150. City for All Women Initiative (CAWI), Ottawa
151. Hope Centre Health Care Inc.,
152. Rainbow Refugee Society (Vancouver)
153. PEI Action Team for Migrant Workers (Cooper Institute)
154. MCC Toronto's LGBTQ+ Refugee Programs
155. Hamilton Community Legal Clinic
156. Millennial Womxn In Policy
157. PINAY Quebec
158. DIVERSEcity Community Resources Society
159. Nova Scotia Association of Community Health Centres
160. WazanaLaw
161. Mouvement Santé mentale Québec
162. PEI Working Group for a Livable Income
163. Wellfort Community Health Services
164. Seaway Valley Community Health Centre
165. House of Friendship
166. London InterCommunity Health Centre
167 .Canadian Association of Occupational Therapists
168. Maison d'Haïti
169. Les Oblates Franciscaines de Saint-Joseph
170. La Maisonnée
171. Immigration Partnership Winnipeg
172. Ontario Health Coalition
173. Manitoba Association of Newcomer Serving Organizations (MANSO)
174. Cabinet Laval Avocate
175. United Steelworkers
176. Accueille et outille les personnes immigrantes (ALAC)
177. International Migrants Alliance (IMA) - Canada
178. Solidarité Ethnique Régionale de la Yamaska (SERY)
179. Jeunes médecins pour la santé publique (JMPSP)
180. Comité d'aide aux réfugiés
181. Quaker Refugee Committee of Toronto Monthly Meeting of the Society of Friends
182. Capital Rainbow Refuge
183. Ometz: Community Services, Employment and Immigration
184. Canadian Union of Public Employees Local 2424
185. Centre multiethnique de Québec
186. Association québécoise des avocates et avocats en droit de l’Immigration (AQAADI)
187. Centre Francophone du Grand Toronto
188. Casa C.A.F.I. (centre d'aide aux familles immigrantes)
189. Association québécoise des organismes de coopération internationale
190. Service d'accueil des nouveaux arrivants de La Matanie (SANAM)
191. Pediatric Chairs of Canada
192. Children's Healthcare Canada
193. Vision Inter-Cultures
195. Maison Multiehtnique Myosotis
196. Carranza LLP
197. East End CHC
198. Caregiver Connections, Education, and Support Organization
199. Interagency Coalition on AIDS and Development (ICAD)
200. Project Accompaniement Solidarity with Colombia
201. Vancouver Island Counselling Centre for Immigrants and Refugees Association
202. Table de concertation du mouvement des femmes de la Mauricie
203. Canadian Association of Muslim Women in Law
204. Nova Scotia Health Coalition
205. Chaudhary Law office
206. Canadian Association of Nurses in HIV/AIDS Care (CANAC/ACIIS)
207. Toronto Political Advocacy Committee
208. Association for Ontario Midwives
209. Friends of Medicare
210. North End Sponsorship Team
211. Community Legal Services of Ottawa / Services juridiques communautaires d'Ottawa
212. Amnistie internationale Canada francophone
213. Disability Justice Network of Ontario
214. Comité des Femmes Immigrants de Québec
215. Rainbow Refugee Association of Nova Scotia
216. OPSEU Provincial Human Rights Committee
217. Canadian Federation of Students
218. Working Women Community Centre
219. Canadian Association of Physicians for the Environment
220. Working Women Community Centre