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Fraser Health Syrian Refugee
Response Plan
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High Level Summary of the Response Plan
The Government of Canada has committed to the intake of 25,000 Syrian refugees
by the end of February 2016. Between 3,000-4,000 of the incoming Syrian refugees
will arrive in British Columbia (BC) and 80-90% of this population is expected to
settle in the Fraser Health region over time.
The Planning and Oversight Committee was convened to provide a forum for the
coordination of Fraser Health’s preparedness activities related to the arrival of
Syrian refugees and to ensure effective communication within Fraser Health and
with Fraser Health stakeholders, including other health authorities, the Ministry of
Health, local governments, NGOs, and agencies providing refugee support. Among
the objectives of the committee are:
Ensuring the effective use of Fraser Health resources by assigning clear
responsibility for tasks
Developing and implementing a plan to ensure Fraser Health is effectively
providing health services to Syrian refugees
Representing Fraser Health in externally led planning processes and
implement coordination with external partners
The committee provided oversight for the development of this response plan which
addresses the federal government’s initial announcement of 25,000 Syrian refugees
arriving in Canada throughout 2016. The plan will be revised and scaled in the
coming weeks to address any anticipated increases to the refugee numbers in
Fraser Health as a result of subsequent federal announcements.
Furthermore, while this plan is developed to address Fraser Health’s preparation for
the arrival of Syrian refugees, there is a need to ensure that the strategies are
sustained to benefit non-Syrian refugees and other vulnerable populations in the
Fraser Health region.
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Key Elements of the Plan
Key elements of this Fraser Health plan include specific programs and activities
aimed at wrapping health services around the Syrian refugee population.
Specifically, this plan outlines pre-existing and planned augmentations in the
following health and support service areas:
Health Services
Population and Public Health
Primary Health Care
Acute Care
Mental Health and Substance Use
Maternal Infant Child Youth
Support Services
Communication
Finance
Diversity Services
The plans that follow are based on an assumption that approximately 3,000
Government Assisted Refugees will arrive in BC by late February 2016, with 90%
residing in Fraser Health, 50% being children, and 75% of the children being under
12 years of age.
The following sections outline key activities to be undertaken by Fraser Health:
Community Integration Provide linkage between Fraser Health programs and services and the
services/efforts of municipalities, community organizations and interest
groups
Identify information or service gaps and escalate them as appropriate
All refugees landing in BC will meet Community Airport Newcomers Network
(CANN) settlement workers, part of the SUCCESS community agency, for a brief
orientation upon arrival at the Vancouver International Airport. While some may
travel on to their next destination outside of BC, Government Assisted Refugees will
be directed to temporary housing or Welcome House via ISSofBC, while Privately
Sponsored Refugees will go with their host sponsors to their new home.
Various departments and programs within Fraser Health will collaborate internally
to provide a coordinated response to the arriving refugees. This internal Fraser
Health response will be evolved in consultation with external partners. The internal-
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external coordination will happen through already-established partnerships,
relationships and purpose-specific meetings.
Fraser Health’s planning and preparations are focused in Burnaby and Surrey given
the expectation that Syrian refugees are most likely to resettle in these
municipalities based on historical refugee settlement patterns.
There are multiple community service agencies that provide refugees with
programs and services, generally fitting within seven categories: settlement,
language, employment, capacity building, outreach, information, and health. There
is however, variability and complexity in the reach and coverage of these services
across the Fraser Health region. Many organizations offer multiple services at single
sites, and some contract other service providers to deliver similar programs
throughout the region.
Population and Public Health:
Provide public health nurses for initial immunization screening and delivery
Provide ongoing immunization and other Public Health services through
Public Health Units and partners
Partner with Fraser Health Primary Health Care and Vancouver Coastal
Health’s Bridge Clinic to establish space for immunization screening/delivery
and initial medical screening
Population and Public Health services promote, protect and improve the health
and well-being of those living in the Fraser Health region through integrated and
collective actions. Population and Public Health services and programs include:
communicable disease prevention and control; maternal, child and family health;
environmental health; licensing of community care facilities; and healthy
living/healthier community partnerships.
To ensure that activities are evidence-based and meet the needs of the
population, Population and Public Health monitors the health of the population in
the Fraser Health region through a wide range of population health assessment
and surveillance activities. This information is made available to decision-makers,
service providers, communities and the public to inform public health action; and
to prioritize efforts to those at greatest risk.
Population and Public Health is strengthening and expanding partnerships both
internally and externally with community partners across various sectors to
maximize collective impact on population health outcomes.
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Primary Health Care:
Increase capacity at New Canadian Clinics in Burnaby and Surrey to receive
refugees arriving in 2016
Provide Primary Health Care services to 700 refugee clients currently
residing in Fraser Health receiving care through the Bridge Clinic in
Vancouver
Provide nurse practitioner for the Bridge Clinic to perform initial assessment
in Fraser Health (Guildford)
The Primary Health Care team in Fraser Health delivers primary care services
through multiple clinics across the health authority. Primary Health Care services
for refugee populations are provided in three clinics in Fraser Health: two located
in Burnaby and one located in Surrey. The clinics partner with other Fraser Health
programs and physicians to deliver disease-specific interventions and education.
The team works closely with family physicians, nurse practitioners and specialists
throughout the region to deliver services, implement new systems, and organize
learning opportunities.
“Attachment” to quality primary care for Fraser Health residents is key to its
provision. Attachment occurs when a family physician or physician group agrees to
provide longitudinal care for a patient. This means maintaining a longitudinal
patient record and providing and/or coordinating comprehensive medical care with
other health care providers.
To address attachment challenges across the region, Fraser Health and the
Divisions of Family Practice have partnered to establish Rapid Access Clinics focused
on those living with mental health and substance use in every community across
Fraser Health.
Additionally, a number of Primary Health Care clinics have been established in
partnership with the Divisions of Family Practice, such as the Global Family Care
Clinic in Burnaby, Primary Care Seniors Clinic in Chilliwack, and the South Asian
Health Centre in Surrey.
Accelerated Integrated Primary and Community Care services available in Fraser
Health include:
BreatheWell (chronic obstructive pulmonary disease)
Psychosis Treatment Optimization Program (PTOP)
Home First
End of Life Care
Community REDi (Community Reintegration and Rehabilitation Services)
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Mental Health and Substance Use:
Create capacity at New Canadian Clinics by transitioning Mental Health and
Substance Use patients when possible
Review DIVERSEcity's capacity to provide general and trauma counselling,
and explore potential for contracting general and trauma counselling
services with other key community agencies
Inform refugee clients of private resources(IFHP-funded) for trauma
counselling
Ensure Mental Health and Substance Use clinicians are aware of the
provincial refugee mental health coordinator line to access referrals and case
consultation.
Mental health and substance use disorders impact all aspects of an individual’s life
regardless of his or her age, social or economic situation, physical wellbeing and
psychological functioning. The refugee experience which can involve experiences
of profound loss, displacement and trauma may precipitate or exacerbate existing
or underlying mental illness and substance use conditions.
Fraser Health Mental Health and Substance Use services provide a continuum of
care, with services ranging from health promotion, harm prevention and
community-based care to more intensive services, such as inpatient/day treatment,
tertiary care, and housing supports.
Acute Services:
Ensure all relevant Fraser Health and partner information and plans are
shared with Acute Care staff as required
Fraser Health operates 12 acute hospitals, three of which are considered referral
centres: Royal Columbian Hospital Abbotsford Regional Hospital, and Surrey
Memorial Hospital. Each of the hospitals forms part of a network and provides
services to the local community and region. Each hospital has a unique blend of
services complementing and supported by services within the network. Fraser
Health also operates the Jim Pattison Outpatient Care and Surgery Centre, a large
ambulatory care centre offering a broad range of primary, acute and chronic
disease services that do not require an overnight stay.
Among the Acute Care program areas anticipated to be utilized most quickly by
the arriving Syrian refugees are the Emergency departments, maternal and
paediatric services in the communities of Surrey and Burnaby. Each of the Acute
Care centres is positioned within a community and network of community-based
services. Similar to the general population and depending on the health needs of
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the Syrian refugees, services will be provided wherever along the community to
acute spectrum is most appropriate.
Diversity Services:
Provide in-person workshops for Fraser Health employees about culturally
sensitive care for refugees
Provide culturally sensitive care training for Emergency staff
Ensure capacity and provision of translation and interpreter
In the context of this plan, Diversity Services’ role is to increase Fraser Health
employees’ capacity in providing high quality care to diverse populations through
education (training and resources), interpreter services (in-person or on the phone
spoken translation from one language to another using medical interpreters), and
translation services (translation of written material from one language to another).
Background
Currently, Canada has finalized 500 Syrian refugee applications while 17,500 are
still in progress. In December 2015, 6,300 Syrian refugees arrived in Toronto of
which nearly 400 were Government Assisted Refugees (GARs) who carried on their
journey to BC. It is anticipated that over 3,000 refugees will be arriving in BC by
late February 2016. Around 90% or more of these refugees are expected to resettle
in the Fraser Health region.
The exact number of refugees being brought to Canada, BC and Fraser Health in
turn is difficult to confirm. All of the volume-based plans and preparations that
follow are therefore speculative, although they do rely on the best information
available at the time of preparing this document. As new or more accurate
information becomes available, this plan will be adapted and/or scaled.
Immigration, Refugees & Citizenship Canada (IRCC) continues to publish updates
on Privately Sponsored Refugee (PSR) settlement regions and numbers. 1
Information is available on the resettlement communities of GARs on government-
sponsored flights on the IRCC website2.
All Government Assisted Refugees arriving into BC will be oriented by Immigrant
Services Society of BC (ISSofBC). Privately Sponsored Refugee sponsors are
oriented by ISSofBC and will link the people they have sponsored to the necessary
programs and services.
1 http://www.cic.gc.ca/english/refugees/welcome/map.asp.
2 http://www.cic.gc.ca/english/refugees/welcome/milestones/flights.asp
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Information shared with Fraser Health is that the overall health of the refugee
population is assessed as being generally good. Many individuals will have specific
health needs related to having experienced war in their country, and/or the difficult
living conditions of refugee camps. Health needs could be physical (e.g. injury,
chronic illness, nutritional deficits) or mental (e.g. post-traumatic stress,
depression, anxiety). The latest figures indicate that 50% of refugees are children,
of which 75% are under the age of 12.
Information regarding the health screening and coverage process collected from the
Ontario Health System Action Plan includes the following:
Refugees will be given a paper copy of their immigration medical examination
(IME) results prior to departure for Canada, and will bring it with them to
Canada.
As part of the immigration process, refugees will undergo a full immigration
medical examination overseas prior to departure. They will also undergo a
fit-to-fly assessment prior to boarding flights to Canada. Once they land in
Canada, refugees will be screened for symptoms and signs of infectious
disease by Canadian Border Services Agency (CBSA). Individuals who may
be ill will be referred to a Public Health Agency of Canada (PHAC) quarantine
officer. Quarantine officers will assess whether there is a need to apply
measures authorized under the Quarantine Act.
CBSA officers will issue Interim Federal Health Program (IFHP) Certificates,
valid for 12 months, to refugees at the point of entry. Arriving Syrian
refugees will receive type 1 health benefits3 covered under the Interim
Federal Health Program. In addition, the IFHP will also provide Syrian
refugees with coverage for supplemental services and prescription
medications.
All Syrian refugees who settle in BC are eligible for coverage under the Medical
Services Plan (MSP) and the waiting period is waived. Enrolment and coverage in
MSP is not automatic. Individuals must complete the MSP Application for Enrolment
form and provide copies of their immigration documentation confirming their
immigrant status. Once a refugee is eligible for coverage under the MSP, basic
health care coverage under the IFHP, will cease. However, the Supplemental and
Prescription Drug Coverage will continue for up to one year.
This Fraser Health Syrian Refugee Response Plan is prepared by the Planning and
Oversight Committee under the leadership of the Vice President Population and
Public Health and Chief Medical Health Officer.
3 http://www.ifhp-pfsi.ca
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Fertility rates are higher among Syrian refugees than the general population. About
50% of the refugee population is comprised of children and 75% of these children
are under 12 years of age. At this time, Maternal Infant Child and Youth
services have not been informed of any significant needs of pregnant and expecting
moms.