Table 2.

The negative impact of lack of access to care

Negative impact of lack of access to care	Case vignettes	Quotes
Potential for adverse health outcomes	Fatima, who immigrated from West Africa, tries to consult a clinic with her daughter Issa, who is known for difficult-to-treat constipation.	[Translation] ‘...For our little daughter who has a bad case of constipation. Once she almost had an intestinal blockage. So I went … there (to a clinic)… she was sick and they told me no straight out … (in the end) they hospitalized us for 13 days.’
	Mariam is on welfare. Her 5-year-old son Ali has advanced caries with a dental abscess. At one point, she was told that dental services were not covered for refugee children anymore.	[Translation] ‘Me... [and my son] do not have the right to have dental care and I do not have the money, that is why I only get one filling [for him] done every 6 month, just until [I] have collected more money’
Psychological distress	Mariam endures stress when taking her 5- year-old son Ali to the hospital.	[Translation] ‘Every time we go to the hospital, it’s stress, because I wait, I bring my son, and in the last minute we have a negative answer: “You cannot have access to this service because you are not covered.”’
	Paola struggles to have her 11-year-old daughter Dalia seen in a clinic for her allergies.	[Translation] ‘Certainly at that very moment there is a lot of stress because there is nothing I can do. We do not have the money to go to a private clinic. If we get refused, it creates stress.’
Financial burden	Cynthia, a single mother in her mid-thirties from the Caribbean, was charged for an emergency ophthalmology consultation for her son Philip.	‘I broke down in tears ‘cause […] his eyes […] he couldn’t see, his eyes was getting so bad that I end up and paid the 120 $. I wanted that money so bad to pay the rent.’
Social stigma	Fatima, mother of Issa and Amina, returns to the same optometrist where her daughters had been seen free of charge for her glasses before the 2012 cuts. She is now asked to pay and tells us how the receptionist got very agitated upon her questioning about the reason.	[Translation] ‘That day I was very frustrated, I felt humiliated in my dignity.’
	Cynthia and other friends who are refugees feel stigmatized about using the IFHP document.	‘A lot of people are ashamed to use this paper.’
	Mariam is waiting to see a doctor for her daughter in a local clinic. When she is finally turned away at the desk, she lies to other parents in the waiting room, stating that her own doctor was not available that day and that she would return another time.	[Translation] ‘I was embarrassed. I didn’t want to tell her “Because we don’t have papers like you do, we’re not covered.” I was embarrassed, I left. I couldn’t go home. I walked and walked and walked. My daughter said “Mummy, I’m tired.” “I didn’t even know what I was going to do.”’

IFHP Interim Federal Health Program