Canada's Non-status Immigrants: Negotiating Access to Health Care and Citizenship

Abstract

Illegal immigration in Canada is characterized mainly by non-status immigrants who legally enter Canada and stay after their legal status expires and by failed refugee claimants. For these persons, immigration status or its absence plays an important role in determining the degree of access to Canadian health care. This article situates the clinical setting as a site of contention and negotiation of citizenship and care in social networks as well as pragmatic and discursive strategies. Drawing on the case of a patient who faced imminent deportation and became suicidal, in this article I depict how psychiatrists and other health practitioners embrace “bearing witness” as an ethical practice, which intersects the medical and legal spheres.

Key Words:

• bearing witness
• citizenship
• mental health
• non-status immigrants
• social movements

ACKNOWLEDGMENTS

This research has been supported by the McGill-CIHR Grant in Strategic Training Program in Culture and Mental Health Services Research. I am deeply grateful to all discussants (clinicians, non-status immigrants, and lawyers) who graciously offered me their busy time, and to my colleagues who provided me encouragement and feedback in previous drafts of this article. In particular, I would like to express my appreciation to Janet Childerhose, Suparna Choudhury, Cristiana Giordano, Kelly McKinney, Eugene Raikhel, Ana Schaller de la Cova, and Nha-Thy Vo. I thank the anonymous reviewers at Medical Anthropology for their relevant and insightful comments. Earlier versions of this article were presented at the annual meeting of the Canadian Anthropological Association (CASCA) and at the biennial meeting of the European Association of Social Anthropologists (EASA).

Notes

Marcel Mauss (1985) defined “persona” as a fixed position and role within a society. It embodies a set of social relationships “on which hinge questions of moral agency, responsibility, and blame” (Kirmayer 2007:239).

I draw on the difference between tactic and strategy as highlighted by De Certeau (1984): “strategies” are linked to institutions and structures of power; “tactics” are utilized by individuals to create space for themselves in environments defined by strategies, e.g., strategies of the strong and tactics as “the art of the weak.”

The IRB is a quasi-judicial tribunal in which the refugee claimant must sustain a hearing in front of a sole commissioner. The Immigration and Refugee Protection Act created the Refugee Appeal Division (RAD) as a means for the failed refugee claimant to appeal the sole commissioner's decision. At the time of writing, the bill to implement the RAD has not yet become law. I suggest that this state of affairs has contributed to the rising percentage of failed refugee claimants who as non-status citizens merge into the category of illegal immigrants.

At the turn of the century and in the interwar period, psychiatrists forcibly supported the passing of restrictive immigration laws, which prevented the influx of immigrants whose race was deemed “inferior.” Enmeshing purity of race and eugenics with the desired character of Canadian society, psychiatrists were at the frontline in the screening and deportation of those immigrants with mental illness (Comeau Duerden and Allahar 2009; Dowbiggin 1995; McLaren 1990).

To protect Nouredinne's anonymity, I decided not to provide many details of the episode.

A refused refugee claimant can apply to the Federal Court, but only with leave (or permission) from the Court and only on technical legal matters. The leave is infrequently granted; he or she can also apply for the Pre-Removal Risk Assessment in which new evidence can be raised by showing the risks involved in being deported to the home country (such as persecutions, torture, lack of medical care for a present health condition such as HIV-AIDS).

There is a discrepancy in the data regarding the rate of acceptance of these applications. According to Khandor and colleagues (2004) and Goldring and associates (2007), immigration lawyers and advocates agree that the clause accounts for a success rate of between 2.5 and 5 percent. In a recent article published in The Toronto Star in 2008, Citizenship and Immigration Canada stated that applications have an approval rate of more than 50 percent and that the application process takes one to four years. In addition, the amount of backlog is unclear; unofficial data point to an estimated 35,000 applicants (Keung 2008).

Additional information

Notes on contributors

Alessandra Miklavcic

ALESSANDRA MIKLAVCIC, PhD, is a medical anthropologist and sociolinguist. She was a postdoctoral fellow in the Division of Social and Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada (2006–2009), where she conducted research on intercultural communication in clinical encounters. Her research lies at the intersection of anthropology, linguistics, history, and psychiatry.