Canada has committed to accepting 25 000 refugees from the ongoing civil war in Syria. BC is expecting to welcome up to 3500 by the end of February 2016. A portion will already be in the province by the time you read this letter.
Many physicians will have also read my related blog posting on the BCMJ website. Some will have signed on to Medavie and will already be engaged with individual sponsors, Immigrant Settlement Services of BC, or the Bridge Clinic in Vancouver to provide care or advice to these newcomers to BC. What these physicians will know is that every refugee will have undergone a comprehensive medical assessment prior to entering Canada. Although the physical health of many will have deteriorated from the relatively good health enjoyed by Syrians prior to the onset of civil war, these new arrivals will pose no threat to the health of Canadians. According to the World Health Organization, the incidence of TB in Syria was low (17 cases per 100 000 population), and refugees examined in Europe have shown low levels of infection. Any cases contracted in refugee camps will be identified during the medical examination and treated prior to entry into Canada. Syria also had high levels of coverage of routine childhood vaccination—reaching an estimated 90%. However, since the onset of the civil war, reductions in health infrastructure and lack of access to health care as refugees travel to safer havens means that many children will be undervaccinated or not vaccinated at all. You can expect more information regarding the refugees’ overall health status and gaps as we gain more experience.
The demographic profile that we expect to see is one of younger families. Many of the health issues they face will reflect the hardships they have endured. We will need to ensure that systems are in place to address health issues over time, including physical trauma, malnutrition, psychosocial trauma, and dental problems. We also need to be prepared to provide treatment for chronic diseases such as cardiovascular disease, hypertension, and diabetes. Once the refugees have recovered physically and are becoming integrated into Canadian society, it is possible that the focus of care and support will need to shift to the lasting psychological effects of their experiences.
These refugees will, by and large, already have access to immediate Medical Services Plan coverage and will not have to wait to access provincially covered care in BC. They will also be eligible for supplemental coverage through the Interim Federal Health Program (IFHP). The IFHP will cover services such as dental care, mental health, and additional medications, over and above what is covered through MSP.
To access primary care if they do not have immediate MSP coverage or require additional health services, refugees must be treated by physicians or health professionals who have signed up with Medavie Blue Cross, which is the IFHP claims administrator. Once you have signed up with that program, potential patients are able to find you through a list of eligible providers.
To sign up with Medavie, visit www.cic.gc.ca/english/refugees/outside/arriving-healthcare/practitioners.asp.
If you’d like to help, here is how to get involved. I encourage you to contact the Immigrant Services Society of BC to let them know that you are able and willing to accept refugee patients (both those with MSP coverage and without). If you are worried about a language barrier—many of the refugees will likely not speak English (at least not fluently)—the Provincial Language Service has stepped up efforts to hire additional Arabic-speaking interpreters who can provide health-related translation services. Thank you for helping.
—Perry Kendall, OBC, MBBS, MSc, FRCPC
Provincial Health Officer
Postscript: Doctors of BC has created a webpage to keep members informed of resources and information available to provide medical care for Syrian refugees. Check the page regularly as it will be continually updated: www.doctorsofbc.ca/caring-syrian-refugees.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org