1. Médecins du Monde
Migrants with precarious status:
challenges accessing health and social services

2. MÉDECINS DU MONDE
• Mission: Offer and promote access to healthcare for
vulnerable and excluded people, here and elsewhere.
• Vision: A world where health is recognized as a real
human right.
• 14 delegation around the world: in Canada since 1999.
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3. MÉDECINS DU MONDE
• Our approach:
– Meet people in their own environment
– Most vulnerable of the vulnerable
– Basic quality health services within a context of limited resources
– Complementary to the public healthcare system
– Understanding root causes of precarious situations
– Advocacy
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4. MÉDECINS DU MONDE
• Our projects in Montreal:
– Psychological support for community workers
– Mobile clinic
– Clinic for migrants with precarious status
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5. MÉDECINS DU MONDE
• Medical clinic for migrants with precarious status
without medical coverage :
– Why? Immigration status must not be an obstacle to access
health care.
– For whom? Women, men and children (0-12) who have an
immigration background and do not have access to medical
coverage.
– How and by whom?
– 2 clinics without appointment/week
– 2 to 3 clinics with appointment/week
– Professionals involved: nurses, social workers,
volunteer doctors and psychologists
– Partnerships
– Outreach
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6. MÉDECINS DU MONDE
• Some tables and figures
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YEAR N of
appointements
N of people N seen by
doctors
N seen by
nurses
2013-2014 665 537 451 372
2014-2015 865 681 528 509
2015-2016 1002 795 639 555

7. MÉDECINS DU MONDE
• Some tables and figures from 2015-2016
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SEX %
Women 74
Man 26
AGE %
14 and - 3
15-18 1
19-25 7
26-30 19
31-40 31
41-50 13
51-64 18
65 and + 9

8. MÉDECINS DU MONDE
• Some tables and figures from 2015-2016
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IMMIGRATION STATUS %
Canadian citizen or permanent resident 3
Temporary residency visa 45
Particular situations giving a right to stay 15
Refugee claimants 1
Non status 36
Doesn’t know 0,6

9. MÉDECINS DU MONDE
• Some tables and figures from 2015-2016
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CONSULTATIONS MOTIVES N
Pregnancy 255
Osteo-articular 121
Cardiovascular 118
Eyes 102
STBI 91
Digestive system 84
Metabolic, nutritional or endocrine 76
Mental health 38
General health 34
Neurology 34
Respiratory 29
Vaccination for VHA and VHB 24
Blood, system haematological/ immunological 22

10. MÉDECINS DU MONDE
• Other numbers from 2015-2016
– Total number of people who have benefitted from the clinic: 3290
– Total number of people met at the clinic: 393
– Total number of nurses follow-ups: 1875
– Total number of STBI screening: 409
– Total number of people who received social support: 403
– Total number of hours given by the psychologist intern: 104
– Total number of people reached through our outreach program: 2216
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11. The Challenges
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• When we opened the clinic
– How to find migrants with precarious statuses in Montréal?
– How are they going to find us?
– How to promote our services?
– Are authorities a risk for our patients?
• Now:
– MdM specialities: front line health care services
– But how to deal with chronic deseases?
– Access to labs/special exams/speciality care

12. More challenges…
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• Ethics: can we give partial care?
– Pregnant women
– Children
– People who need investigations/surgeries
– People with cancer/chronic deseases
– Need of expensive treatments
• Medication:
– We can prescribe, but they canno’t afford it
– They take half the prescription/one day out of two/stop when
they have no more money/etc.

13. And more challenges…
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• Elaborate partnerships
– Laboratories
– Imaging centers
– Other clinics
– Hospitals
– Specialists (physio./ostéo./psychiatry, …)
• Work with volunteers
– Doctors
– Nurses
– Social workers
– Students
– Population

14. All this without recognization
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• The population with whom we work don’t exist…
• If your situation isn’t recognized, you have no services and there
is no money for appropriate services…
• THAT IS Médecins du Monde’s reality!!!
– We have to knock on foundations doors
– Our founding is not recurent
– We depend on donations and voluntary work
– Rigth now, we have to cut services…and staff…

15. REEMA
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• 28-year-old woman from North Africa
• Sponsored by her husband who has is a permanent resident
in Canada, currently awaiting approval of the sponsorship
claim.
• Arrived here 4 months ago with a visitor visa.
• No RAMQ, very few financial means
• 3 months pregnant
– Presents to ER for severe symptoms related to pregnancy
– Needs pregnancy follow-up

16. AMANTINE
Amantine is 65 years old. Born in St-Vincent, she has been
living in Montreal for the past 25 years. At the time, she
had come at the border as a tourist. No immigration
process was ever started. She has been living in the same
appartment for 20 years and working as a housekeeper.
She makes approximately 600$ per month. She has a 14
year old daughter who was born in Canada. Amantine
raised her daughter as a single mother. She comes to
Médecins du Monde because she has been feeling dizzy and
having very intense headaches.
– No access to medical coverage
– No access to social benefits or public services
– No access to medical coverage for her daughter
– Difficult access to community services (food banks, etc.)
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17. SOCIAL BARRIERS
• No or difficult access to social benefits and public services
– Social welfare
– Child care benefits
– CSST
– RAMQ: care and medication
– ETC.
• Difficult access to community services
– Food banks
– French or English classes
– Help with employement search
– ETC.
• Governemental subsidized daycare: depends on the parent’s immigration
status
• Right to work: depends on your immigration status
• Regularisation of immigration situation: $$$
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18. JOSÉ
José is 37 years old. Born in Columbia, he has been living
in Montreal for the past 10 years. After his refugee claim
was refused, he decided not to leave the country because
he considered that going back to Columbia was worse than
staying underground in Canada. Since then, José has been
working in a factory. Paid 6$ per hour, he can sometimes
work for 30 hours straight. In the past few months, José
has been feeling extremly tired and unwell. Unable to
identify the problem, he decides to come at Médecins du
Monde where he meets a volunteer doctor and a nurse.
After a STBI screening test, he is diagnosted as HIV +.
– Limits of Médecins du Monde
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19. OUR LIMITS
• Volunteer doctors
• Limited staff
• Complex medical situations needing medical equipement
for appropriate diagnosis that we do not have
• Very serious medical situations needing very expensive
medication or interventions (EX: HIV, HVC, cancer, etc.)
• Little support from general population
• No governmental funding for the clinic
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20. CONCLUSION
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• Complex
• Multidisciplinary team
• Advocacy efforts

21. Questions ?
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