MONTREAL -- On Jan. 24, 2021, Mr. W. passed away in a Montreal-area hospital. Originally from Saint Vincent and the Grenadines, this 62-year-old man, well-liked by all who knew him, was illiterate and without access to Quebec’s health insurance plan owing to his precarious migratory status.

In July 2018, after over ten years living in Quebec, a lawyer and community workers helped him apply for permanent residence on humanitarian and compassionate grounds based on his fragile state of health.

Mr. W. had suffered from heart disease and complex diabetes for many years, which had led to infections, an amputation and significant loss of vision. He had been to the emergency room several times but without any possibility of medical follow-up.

It was not until December 2020 that a healthcare team finally took charge of his case, only to find that his condition had deteriorated to such an extent that only palliative care could be envisaged.

Shortly after this diagnosis, he tested positive for COVID-19.

Despite the progress in his immigration procedures and the fact that he had obtained discretionary access to Quebec's health insurance board, the Régie de l'assurance maladie du Québec (RAMQ), a month before his death, it was already far too late for Mr. W. and he could not be saved.

Mr. W.'s story is one case among thousands of others. According to an estimate made by the SHERPA University Institute, between 40,000 and 70,000 people in Quebec do not have health insurance.

However, the situation is quite different in the province of Ontario, which from March 23, 2020, extended its health insurance coverage to all individuals living on its territory, regardless of their migratory status. In Quebec, people awaiting permanent residence or regularization of their status, some temporary workers and international students are still excluded from provincial health insurance.

While it is true that since March 31, 2020, these people have access to screening tests and health care strictly related to COVID-19, this is far from sufficient in a health emergency. Indeed, this technical distinction between health-care services directly related to COVID-19 and other general health-care services impedes the work of front-line health care teams and puts health professionals in a very difficult position.

In the context of a health crisis and a lack of resources, such overly burdensome administrative procedures not only result in significant and unacceptable inequities but also have an impact on the health of the population and public health efforts.

After over a year of pandemic, it is time for the Quebec government to ensure that no one falls through the cracks!

The current crisis exacerbates the vulnerability of people with a precarious migratory status and multiplies the obstacles they face in accessing health care: delays in immigration procedures; loss of employment; ineligibility for government assistance programs; employment in key sectors exposing them to COVID-19, etc. Indeed, their fear of the authorities and the financial implications of health care prevent them from using the available services.

Did you know that people who do not have health insurance are billed for health care services with a 200 per cent surcharge? Or that, with the curfew, many avoid travel to access health care or sleep at work for fear of being intercepted by the police? The crisis context we are living through calls for a more humanistic approach, especially towards these vulnerable people who make a real contribution to our society.

We, therefore, call on the Government of Quebec to take a humanistic approach and guarantee, without further delay, access to health coverage for all people living in Quebec, regardless of their migratory status. 

LIST OF CO-SIGNATORIES OF THE LETTER

As an institution

Alliance des communautés culturelles pour l’égalité dans la santé et les services sociaux (ACCÉSSS)
L'Anonyme
Association des spécialistes en médecine préventive du Québec (ASMPQ)
Association des intervenants en dépendance du Québec (AIDQ)
Association québécoise des avocats et avocates en droit de l’immigration (AQAADI)
Association pour la santé publique du Québec (ASPQ) 
Centre des femmes d’ici et d’ailleurs
Just Solutions Clinic
Clinique médicale l’Actuel
Collectif Ensemble avec les personnes migrantes contre le racisme
Montreal Diet Dispensary
Fédération du Québec pour le planning des naissances (FQPN)
Ligue des droits et libertés
Regroupement intersectoriel des organismes communautaires de Montréal (RIOCM)
SHERPA University Institute
Table de concertation des organismes au service des personnes réfugiées et immigrantes (TCRI)
Table des organismes communautaires montréalais de lutte contre le SIDA (TOMS) 

On a personal basis

May Chiu (Lawyer)
Janet Cleveland Ph.D. (Researcher)
François Crépeau (Professor, Faculty of Law, McGill University)
Marie-Andrée Fogg (Lawyer)
Julius Grey (Lawyer)
Marianne Léaune-Welt (Social Worker)
Robert Leckey (Professor and Samuel Gale Chair, Faculty of Law, McGill University)
Claude Provencher (Lawyer)
Cory Verbauwhede (Lawyer)