‘Denial of care’: Doctors worry about refugees as payment requirements take effect

TORONTO – Refugees now have to pay out of pocket for part of their drug prescriptions, mental health counselling, dental services, vision care and health equipment — including wheelchairs — as changes to a federal program take effect.

For decades, Canada’s Interim Federal Health Program has provided complete health coverage to refugees and refugee claimants until they are eligible for provincial health plans and benefits.

But starting Friday, they must pay $4 for every prescription and 30 per cent of the cost of supplemental health products and services.

More than a dozen medical, nursing, social work and refugee organizations, including the Canadian Medical Association, the Canadian Paediatric Society, the Canadian Psychiatric Association and the Canadian Nurses Association, have warned that refugees can’t afford those co-payments and their physical and mental health will suffer.

They also say the changes will end up costing the health-care system as people who can’t afford their medication or mental health services will deteriorate and end up in emergency departments.

The Interim Federal Health Program will continue to pay the full cost of doctor’s appointments and hospital visits for refugees and refugee claimants.

Dr. Vanessa Redditt, a family physician at Women’s College Hospital’s refugee clinic in Toronto, said refugees are already living in poverty and making the co-payments will be impossible for many.

“It is a denial of care,” said Redditt, who is also a founding member of the Canadian Refugee Health Network.

“I know patients who are grappling with suicidality because of the torture that they have endured or the sexual violence that they have endured and their precarious immigration status,” she said.

“They’re still living in shelters and they don’t have a sense of safety and now they will not have the trauma therapy that they need to be safe.”

The Canadian Press has reached out to the office of Immigration Minister Lena Metlege Diab for comment but has not heard back.

Health Minister Marjorie Michel said on Thursday that the government will “monitor” the effects of the program change, including whether or not it shifts health-care costs to the provinces through more emergency department visits.

Dr. Parisa Rezaiefar, physician lead of the Ottawa Newcomer Health Centre, said investment in the health of refugees — many of whom arrive in Canada ill or injured — will allow them to integrate into the community and contribute to the economy.

“The faster we deal with people’s medical condition(s), the faster we enrol them in language training and vocational training (and) the faster we get them off supplemental care,” said Rezaiefar, who came to Canada as a refugee from Iran in the 1990s.

Redditt said most refugees “want to work right away,” and often end up in low-paying jobs, even though many are highly educated and were professionals in their home countries.

“Once they get a job, the jobs that they can get are cleaning, construction, and personal support workers, usually.  Maybe working in kitchens as well. That’s the majority,” Redditt said.

The federal government announced the introduction of the co-payments in its budget last year and said it is a necessary cost-saving measure.

In 2012, the Conservative government under Prime Minister Stephen Harper made drastic cuts to the Interim Federal Health Program, which were challenged in court by a coalition called Canadian Doctors for Refugee Care.

Those cuts were much deeper than those that came into effect on Friday, fully eliminating dental, vision and pharmacy coverage for refugees, except for immunization and medications “in cases where there is a risk to public health or public safety,” according to government news release on April 25, 2012.

The program also funded health-care coverage overall “of an urgent or essential nature.”

In July 2014, a federal judge ruled in favour of the coalition, concluding that the cuts amounted to “cruel and unusual” treatment under the Canadian Charter of Rights and Freedoms, “particularly, but not exclusively so as it affects children who have been brought to this country by their parents.”

In 2016, the Liberal government restored full health-care coverage under the program.

Although they are less drastic than those made in 2012, the current cuts are still cruel, doctors argue.

“It’s already so hard (for refugees). They are living in poverty,” Redditt said.

Redditt said being unable to afford a $4 co-payment on multiple medications means people with diabetes may stop taking them and end up in hospital with serious complications, including possible limb amputation. There could be similarly dire consequences for patients who can’t pay 30 per cent of the cost of dental care, she said.

Ali Abdiwahab Adan arrived in Canada with his family in June 2024 after fleeing Somalia where he said his life was repeatedly threatened while working as a journalist.

He and his family lived in Uganda as refugees for several years while waiting to come to Canada under the resettlement assistance program.

Abdiwahab Adan and one of his daughters have a genetic condition called osteogenesis imperfecta, also known as “brittle bone disease,” which has caused permanent disability.

“When I and my family arrived in Canada, we depended on the Interim Federal Health Program, IFH program, during our first year,” he said.

The program paid for medications, occupational therapy and an electric wheelchair. Abdiwahab Adan said he couldn’t have afforded the 30 per cent co-pay that’s now come into effect.

“Without (the) IFH program, I believe we couldn’t have survived and settled in this country,” he said.

Abdiwahab Adan is now off the interim health program and is on the Ontario Disability Support Program while he volunteers at a YMCA in Toronto, hoping it will lead to a job.

Although the changes won’t affect him or his family, he’s deeply concerned.

“I’m worried about the people like me who are facing these this cuts.”

—With files from Hannah Alberga

This report by The Canadian Press was first published May 1, 2026.

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