In the Name of Humanitarianism: The Interim Federal Health Program and the Irregularization of Refugee Claimants.

Author:Connoy, Laura
 
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Abstract

Since 1957 Canada's Interim Federal Health Program (IFHP) has provided health-care coverage to refugee populations. However, from June 2012 to April 2016 the program was drastically revised in ways that restricted or denied access to health-care coverage, specifically to refugee claimants--persons who have fled their country and made an asylum claim in another country. One of the main intentions of the revision was to protect the integrity of Canada's humanitarian refugee determination system. However, this had a major unintended consequence: within everyday healthcare places like walk-in clinics, doctor's offices, and hospitals, IFHP recipients were denied access to services, regardless of actual levels of coverage. In this article I analyze how these program restrictions were experienced within Toronto's everyday health-care places through the concept of irregularization. I discuss how the IFHP, as a humanitarian health-care program, problematizes the presence of refugee claimants in ways that created experiences of vulnerability, insecurity, and anxiety. Building on this view, I conclude with a discussion of how activists who sought to draw attention to the experiences of refugee claimants in the aftermath of the IFHP revisions closed off truly transformative pathways toward social justice.

Resume

De juin 2012 a avril 2016, les demandeurs d'asile ont ete confrontes au Canada a une restriction d'acces a la couverture sanitaire par le Programme federal de sante interimaire (PFSI). Ces restrictions visaient a proteger l'integrite du systeme humanitaire du pays. J'analyse dans cet article la maniere dont ont fonctionne ces restrictions et dont elles ont ete vecues au quotidien a Toronto dans des lieux fournissant des soins de sante, j'etudie aussi comment le programme humanitaire pfsi peut etre compris comme un assemblage favorisant la non-regularite des situations, qui cible et interroge de diverses manieres la presence de demandeurs d'asile, et genere ainsi une vulnerabilite, une insecurite et une anxiete. Je conclus ensuite en examinant comment les activistes qui cherchaient a degager les demandeurs d'asile de toute irregularite au sein des etablissements de sante ont en realite ferme de veritables voies de transformation sur la route de la justice sociale.

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Humanitarianism is typically associated with ideas and practices that aim to alleviate suffering and injustice. However, as Fassin notes, humanitarianism is also founded on difference and inequality. (2) 'The actors, policies, practices, documents, and knowledges that constitute humanitarianism work to differentiate and categorize persons seeking access to humanitarian assistance and protection. In this article I analyze how Canada's humanitarian refugee system, and specifically its Interim Federal Health Program (IFHP), works to differentiate and problematize the presence and claims of refugee claimants.

Since 1957 Canada has offered health-care coverage to refugee populations through the IFHP. In 2012 the program was drastically revised in ways that aimed to protect the integrity of Canada's humanitarian refugee determination system, as well as ensure fairness to Canadians and contain financial costs. (3) Here the goal was to deny access to essential healthcare coverage in order to deter refugee claimants from making a claim within the country and/or to force those within the country to leave more quickly. (4) The IFHP revision represented one of many moves adopted by the federal Conservative government to regulate refugee claimants. For example, in 2009 visa requirements for Mexican nationals were introduced in order to "reduce the burden" of Mexican claims on the refugee system, (5) and in 2010 the Designated Countries of Origin (DCO) list was introduced, which defines certain countries (including Mexico and Hungary) as respecting human rights, offering state protection, and therefore as less likely to produce refugees. Through this measure, persons claiming asylum from a DCO face stricter asylum measures (6) and an erosion of their rights. (7)

In order to justify the restrictive revisions to the IFHP, government officials relied upon a construction of refugee claimants as "different" subjects within the context of humanitarian assistance and refugee protection. Offering refugee protection is inherently humanitarian, however, as Casas-Cortes et al. note, protection and support is provided to those who "obey and behave as demanded by the protection regime." (8) One important behaviour is passivity or helplessness. According to Ticktin, "Humanitarianism often requires the suffering person to be represented in the passivity of their suffering," (9) which effectively makes the act of seeking asylum problematic. To make a refugee claim requires moving (and claiming) on one's own volition rather than waiting to be resettled, which positions refugee claimants as practising an "unsavoury" and "dangerous" form of agency, (10) one that occurs outside regulated refugee pathways. As a result, and as I discuss below, refugee claimants were targeted as greedy and rule-breaking "bogus" "queue jumpers" who were undeserving of accessing important finite health-care resources. I approach this targeting of presence (i.e., of "being here," or one's concrete locality within space (11)) and rights through the concept of irregularization.

Irregularization targets and questions the presence of certain persons as abnormal, out of place, or in other words irregular, regardless of legal status. (12) In this light, to be irregular, or to be attributed the status of irregularity, is not a legal (i.e., juridical) status, but a standing or positioning (13) that shapes lived experience by effecting one's ability to make claims, which produces insecurity, vulnerability, and anxiety. Here status (as standing or positioning) alerts us to the processes that hierarchically position persons/groups and attribute identities; it attends to the ways persons are (re)shaped/(re)fashioned in space that exceed the focus simply on law and policy. Irregularization emerges through a complex assemblage of heterogeneous elements (i.e., policies, practices, documents, actors, knowledges, encounters, etc.) that come together in unpredictable, inconsistent, and contradictory ways to problematize the presence of certain individuals/groups as irregular (14) and to effectively regulate movement and access to services.

As stated by O'Connor and Ilcan, assemblages "create events and the possibility of events" and "make a difference or disclose different futures or the possibility of things being other than what they were" within "local sites and social settings." (15) As a status that emerges out of irregularizing assemblages, irregularity can be understood as constituted within everyday encounters and relations; it is contingently configured and enforced by state and nonstate actors to limit access to social resources and to rights. To view irregularization as an assemblage captures well the messiness of the everyday and alerts us to the labour that goes into irregularization, and to the importance of how one's presence within space is encountered and (re)negotiated. As noted by Rygiel, presence is intricately connected with rights, which means targeting and questioning presence interrupts rights and claims to them. (16) Problematizing presence therefore challenges one's connections with and contributions to the surrounding community as well as their occupation and use of space, which work as foundations to rights and rights claiming. (17) This is a key element of irregularization.

Analyzing the IFHP through the concept of irregularization draws attention to how refugee claimants were restricted or denied access to health-care coverage as a result of their irregularized status within the broader humanitarian realm and within the state. This irregularity was then interpreted, (re)produced, and experienced in contradictory and unpredictable ways within everyday health-care places, such as in Toronto's walk-in clinics, doctor's offices, and hospitals. Here, health-care professionals were actively involved in the irregularization of refugee claimants, which in practice restricted or denied access to essential health-care services, regardless of actual levels of coverage. Perhaps the most affected were refugee claimant women, specifically pregnant women, because the IFHP revisions targeted prenatal and postnatal coverage. Women were also affected beyond the health-care context; as detailed below, their asylum claims do not reflect the existing definition of refugee, which compounds their irregularity. In this regard, I illustrate how refugee claimant women experience a gendered form of irregularity within and outside of health care.

In light of the above, I show how Canada's refugee system can be thought of as an irregularizing humanitarian assemblage. In addition to this analysis of regulation and restriction, I also draw attention to the friction and messiness that defines this assemblage (18) as evident in the forms of resistance that emerged in light of the IFHP cuts. Although this resistance is well-intentioned, I shed critical light on how it closed off transformative pathways to a more socially just healthcare system. In light of the above, the key guiding question of this article is: how is Canada's refugee system irregularizing, and are there gendered effects? In addition, I also ask how are resistance strategies implicated in the maintenance of irregularity? Drawing on critical migration and humanitarianism literature, (19) this article calls more attention to how refugee claimants are irregularized in Canada and how this affects access to essential health-care services.

This article is organized into four sections. Following a brief explanation of the research methods deployed in this study, I offer an overview of my conceptual framework that connects...

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