Publications

Scoping review methodology was used to rapidly assess a broad range of literature while at the same time identify key knowledge strengths and gaps. A total of 241 publications included in this scoping review, with 56 from Canada, 74 from the US, 50 from elsewhere in the Global North and 61 from the Global South. LGBTQI people living in the Global South: Homophobic and transphobic violence faced by LGBTQI people living in the Global South is always situated within particular geo-political and regional contexts that are shaped by neo-liberalism, gender inequalities, colonial legacies, nationalisms, armed conflict, police violence, corruption, religious extremism, etc. LGBTQI migrants living in Canada: Most focused on LGBTQI refugees. Since 2014 there has been a shift in focus from refugee to precarious status, newcomers and immigrants and exploring how LGBTQI migrants navigated community belonging and structural barriers. LGBTQI migrants living in the US: Exploration of well-being especially with respect to HIV risk and prevention. For LGBTQI migrants, chosen families broke social isolation and fostered belonging. LGBTQI migrants also encounter multiple identity-based discriminations that blocked access to housing and health and social services, along with a fear, especially for those undocumented, of being profiled and detained by immigration officials. LGBTQI migrants living elsewhere in the Global North: Two areas of focus include SOGIE-based refugee claims and multiple discriminations by LGBTQI migrants, such as family / community rejection and barriers to access housing, employment, health and social services. Detention centres have a detrimental impact on the mental health of LGBTQI refugees, and increases their exposure to homophobic and transphobic violence. Key research methodologies and theories used: Qualitative research methods used include semi-structured interviews, focus groups, mixed methods and refugee case decisions. Some applied intervention, community-based and/or participatory research methodologies. Theories applied include ecological systems theory, minority stress model, multicultural feminist framework, the social determinants of health and especially intersectionality. Knowledge strengths and gaps: Researcher use of critical and participatory research methodologies as well as intersectionality theory are knowledge strengths. The IRB has implemented SOGIE-based guidelines for decision makers. There remains little knowledge about the realities of LGBTQI immigrants and migrants with precarious status. Need to develop anti-racist, anti-heterosexist and anti-cissexist service delivery and specialized services for LGBTQI migrants. Service providers should engage in trauma-informed and anti-oppressive practice that attends to the intersectional realities of LGBTQI migrants. Policy makers involved in developing Canada’s international role in LGBTQI human rights, should consider the complexities of LGBTQI realities in the Global South.

Lorsqu’on donne des soins et que la personne que l’on tente d’aider ne parle pas la même langue que nous, il est parfois difficile de comprendre l’autre et de se faire comprendre. Et si on pouvait utiliser des images pour s’aider? C’est le pari qu’a fait Juliana Alvarez, designer industrielle et cofondatrice d’IDE3S. Avec l’aide des professionnels de la santé et des services sociaux travaillant dans une ressource intermédiaire hébergeant des personnes âgées, elle a conçu une gamme d’outils visuels ayant pour but de faciliter la communication entre les intervenants et les personnes âgées allophones

This study assessed the prevalence, continuation, and identification of maternal depressive symptomatology over the first 16 weeks postpartum among refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women. A sample of 1125 women (143 refugees, 369 asylum-seekers, 303 non-refugee immigrant, and 310 Canadian-born) completed the Edinburgh Postnatal Depression Scale (EPDS) at 1 and 16 weeks postpartum. The sensitivity, specificity, and predictive power of the 1-week EPDS to identify women with elevated EPDS scores at 16 weeks were determined. The total number of women with EPDS scores >9 for each group at 1 and 16 weeks, respectively, was 26.6 and 18.2 % for refugees; 25.2 and 24.1 % for asylum-seekers; 22.4 and 14.2 % for non-refugee immigrants, and 14.8 and 7.4 % for Canadian-born. Using the cut-off score of 9/10, the 1-week EPDS accurately classified 77.6 % refugee, 73.4 % asylum-seeking, 76.6 % non-refugee immigrant, and 85.5 % Canadian-born women at 16 weeks with or without postpartum depressive symptomatology. The 1-week EPDS was significantly correlated to the 16-week EPDS (r = 0.46, p < 0.01). All groups were significantly more likely to exhibit depressive symptomatology at 16 weeks if they had EPDS scores >9 at 1 week postpartum: refugees (OR = 6.9, 95 % CI = 2.8–17.3), asylum-seekers (OR = 4.0, 95 % CI = 2.4–6.7), non-refugee immigrants (OR = 3.8, 95 % CI = 2.0–7.6), and Canadian-born women (OR = 8.0, 95 % CI = 3.3–19.8). Our findings suggest that refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women at risk of postpartum depression may be identified early in the postpartum period such that secondary preventive interventions may be implemented.

Highlights

This article maps the global governance processes on migration and assesses whether the human rights of migrants are effectively included and mainstreamed therein. It is argued that the lack of a comprehensive framework for migration governance and the insufficient focus on the human rights dimension in migration management have led to serious human rights violations in the treatment of migrants and asylum seekers, and to a lack of oversight and accountability when these violations occur. The article commences with an examination of the legal and normative framework related to the three areas that have been the main objects of global migration governance: the refugee regime, international labour standards and transnational criminal law regarding human trafficking. It goes on to explore the complex institutional framework of global migration governance and how it has been mostly informal, ad hoc, non-binding and State-led. The article concludes with a discussion on the future perspectives for a human rights-centred approach in global migration governance. It is contended that there is a need to bring the migration dialogue inside the United Nations, as it already plays a key role in international cooperation, with human rights as one of its pillars.

Migration towards Europe has surged over the past few years, overwhelming government authorities at the national and EU levels, and fuelling a xenophobic, nationalist, populist discourse linking migrants to security threats. Despite positive advances in the courts and worthy national initiatives (such as Italy’s Operation Mare Nostrum), the EU’s governance of migration and borders has had disastrous effects on the human rights of migrants. These effects stem from the criminalisation of migrants, which pushes them towards more precarious migration routes, the widespread use of administrative detention and the processing of asylum claims under the Dublin system, and now the EU–Turkey agreement. Yet, this paper finds that with the right political leadership, the EU could adopt different policies in order to develop and implement a human rights-based approach to migration that would seek to reconcile security concerns with the human rights of migrants. Such an approach would enable member states to fully reap the rewards of a stable, cohesive, long-term migration plan that facilitates and governs mobility rather than restricts it at immense cost to the EU, the member states and individual migrants.

La question des rapports entre groupes ethniques définis par différents marqueurs, dont celui de la religion, s’impose aujourd’hui plus que jamais au sein de nos sociétés plurielles. Cet ouvrage original s’intéresse au rôle de l’éducation dans la dynamique des relations entre la communauté juive et leurs concitoyens de toutes origines au Québec, au Canada et dans d’autres pays. En effet, alors que les communautés juives sont souvent bien implantées dans leurs sociétés d’accueil, elles demeurent souvent mal connues de la population et plus particulièrement des groupes majoritaires. 

Les auteurs se penchent sur trois enjeux susceptibles d’interpeller les intervenants des milieux scolaire et communautaire, mais aussi le grand public intéressé au « vivre ensemble » et à ses défis :

– L’enseignement sur les communautés juives à l’école publique 

– L’éducation sur l’Holocauste et les pratiques novatrices à cet égard 

– Le vécu des écoles juives et leur impact.

Since 2011, the war in Syria has resulted in mass displacement of its population both inside and outside the country. 

Although neighbouring countries have hosted most of the refugees, since the summer of 2015 a surge of Syrian citizens have crossed through Turkey into Greece, with the ultimate aim of reaching western Europe. Thousands of Syrians are being subjected to harsh natural and manmade obstacles on their journey, while receiving poor medical care along the way

AIMS:

This paper is based on a report commissioned by the United Nations High Commissioner for Refugees, which aims to provide information on cultural aspects of mental health and psychosocial wellbeing relevant to care and support for Syrians affected by the crisis. This paper aims to inform mental health and psychosocial support (MHPSS) staff of the mental health and psychosocial wellbeing issues facing Syrians who are internally displaced and Syrian refugees.

METHODS:

We conducted a systematic literature search designed to capture clinical, social science and general literature examining the mental health of the Syrian population. The main medical, psychological and social sciences databases (e.g. Medline, PubMed, PsycInfo) were searched (until July 2015) in Arabic, English and French language sources. This search was supplemented with web-based searches in Arabic, English and French media, and in assessment reports and evaluations, by nongovernmental organisations, intergovernmental organisations and agencies of the United Nations. This search strategy should not be taken as a comprehensive review of all issues related to MHPSS of Syrians as some unpublished reports and evaluations were not reviewed.

RESULTS:

Conflict affected Syrians may experience a wide range of mental health problems including (1) exacerbations of pre-existing mental disorders; (2) new problems caused by conflict related violence, displacement and multiple losses; as well as (3) issues related to adaptation to the post-emergency context, for example living conditions in the countries of refuge. Some populations are particularly vulnerable such as men and women survivors of sexual or gender based violence, children who have experienced violence and exploitation and Syrians who are lesbian, gay, bisexual, transgender or intersex. Several factors influence access to MHPSS services including language barriers, stigma associated with seeking mental health care and the power dynamics of the helping relationship. Trust and collaboration can be maximised by ensuring a culturally safe environment, respectful of diversity and based on mutual respect, in which the perspectives of clients and their families can be carefully explored.

CONCLUSIONS:

Sociocultural knowledge and cultural competency can improve the design and delivery of interventions to promote mental health and psychosocial wellbeing of Syrians affected by armed conflict and displacement, both within Syria and in countries hosting refugees from Syria.

The current study aims to identify what newly arrived migrant women do, in the early months post-birth, to respond to abuse associated with pregnancy. Textual data from 59 migrant women were analyzed thematically to identify common responses to abuses. The most common response was to physically leave their countries of origin and move to Canada, or to move out of the shared dwelling. Other responses included taking legal action, remaining silent, reporting the abuse, seeking counseling, isolating themselves, and supporting anger management for the abuser. These results enhance our understanding of the decisions, including inaction, made by migrant women.

Background
Poverty is known as an important determinant of health, but empirical data are still missing on the relationships between poverty, other adverse living conditions, and psychological distress, particularly in low-income countries.

This study aimed to assess mental health needs and psychological distress among the poorest in rural settings in Burkina Faso where food security and access to water, electricity, schooling, and healthcare are limited.

Methods
We randomly selected 2000 individuals previously identified as indigents by a community-targeting process. Interviewers visited participants (n = 1652) in their homes and completed a questionnaire on mental health variables that included presence and intensity of anxious, depressive, psychotic, and aggressive symptoms, as well as level of psychological distress. Descriptive statistics, Spearman correlations, and logistic regressions were performed.

Results
In all, 40.2% of the sample reported 10 or more anxious/depressive symptoms in the past 30 days, and 25.5% reported having experienced at least one psychotic symptom over their lifetime, 65.6% of whom had had those symptoms for many years. The number of anxious and depressive symptoms was significantly associated with the level of psychological distress (r = 0.423, p < .001). Predictors of distress level included: poor health condition (F(1) = 23.743, p <. 001), being a woman (F(1) = 43.926, p < .001), not having any income (F(1) = 16.185, p < .001), having begged for food in the past 30 days (F(1) = 12.387, p < .001), being illiterate, and being older (F(1) = 21.487, p < .001). Approximately one third of respondents reporting anxious/depressive or psychotic symptoms (28.2 and 30.0%, respectively) had not talked about their symptoms to anyone in their social network.

Conclusions
These results suggest alarmingly high levels of psychological distress and reported symptoms among the poorest in rural settings in Burkina Faso, which can be explained by their difficult living conditions. However, these results must be interpreted from a transcultural perspective to avoid decontextualized misinterpretations. Ethnographic works are needed to document the larger context within which these distress results can be analyzed.

The Canadian government’s recent cuts to healthcare coverage for refugee claimants has rekindled the debate in Canada about what medical services should be provided to individuals with precarious immigration status, and who should pay for these services. This article further explores this debate, focussing on the perceptions of healthcare workers in Montreal, a large multiethnic Canadian city. In April-June 2010, an online survey was conducted to assess how clinicians, administrators, and support staff in Montreal contend with the ethical and professional dilemmas raised by the issue of access to healthcare services for pregnant women and children who are partially or completely uninsured. Drawing on qualitative analysis of answers (n = 237) to three open-ended survey questions, we identify the discursive frameworks that our respondents mobilized when arguing for, or against, universal access to healthcare for uninsured patients. In doing so, we highlight how their positions relate to their self-evaluations of Canada’s socioeconomic situation, as well as their ideological representations of, and sense of social connection to, precarious status immigrants. Interestingly, while abstract values lead some healthcare workers to perceive uninsured immigrants as “deserving” of universal access to healthcare, negative perceptions of these migrants, coupled with pragmatic considerations, pushed most workers to view the uninsured as “underserving” of free care. For a majority of our respondents, the right to healthcare of precarious status immigrants has become a “privilege”, that as taxpayers, they are increasingly less willing to contribute to. We conclude by arguing for a reconsideration of access to healthcare as a right, and offer recommendations to move in this direction.

The objective of this study was to explore housing insecurity among women newcomers to Montreal, Canada. Semi-structured interviews were conducted with 26 newcomer women who had experienced housing insecurity and five women’s shelter service providers. The primary cause of housing insecurity for newcomer women was inadequate income in the face of rapidly rising housing costs, coupled with unfamiliarity with the dominant culture and the local housing system. Specific events often served as tipping points for immigrant women—incidents that forced women into less secure housing. To avoid absolute homelessness, most women stayed with family, couch surfed, used women’s or educational residences, shared a room or an apartment, lived in hotels, single rented rooms, or transitional housing. These arrangements were often problematic, as crowded conditions, financial dependency, differing expectations and interpersonal conflicts made for stressful or exploitive relationships, which sometimes ended abruptly. Only two of the 26 women interviewed described their current living situation as stable. Based on the findings on the study, we recommend training for housing and immigration service providers, wrap-around services in terms of health, housing and immigration settlement programs that take into account a broad range of immigration statuses and transitional housing that caters to the specific needs of migrant women.

La santé mondiale est un vaste champ de savoirs et d’interventions dont l’intérêt porte sur des grands enjeux comme les inégalités sociales transnationales qui affectent toutes les populations dans le monde. La constitution d’un savoir issu de pratiques comparatives entre groupes sociodémographiques est un moyen d’informer l’intervention destinée à ce qui est communément qualifié de communautés. Selon une certaine littérature, les disparités raciales et ethniques sanitaires sont un problème de santé mondiale. Malgré la controverse qui entoure l’usage de la catégorie de race, à laquelle sont souvent associées voire préférées celles d’ethnicité ou encore de culture, certains auteurs jugent que leur mobilisation comme cadre d’analyse reste pertinente pour discuter et rendre compte des iniquités sociales dans le monde. En d’autres mots, ces catégories permettraient d’identifier des groupes et des individus désavantagés sur le plan médico-sanitaire.

Objectifs

Cahier REALISME n°11 : L’équité en santé mondiale : qu’en est-il de la fabrique, de la circulation et des conséquences des stéréotypes sur les populations ? vise à discuter la manière dont ces trois catégories sont instrumentalisées par les pratiques sanitaires qui constituent, ensemble, comme cela avait déjà été proposé dans un autre contexte, un système d’opposition et de différence. En d’autres mots, la construction de cette forme de savoir relève de pratiques dans le champ sanitaire qui en viennent à reproduire, renforcer et donner un nouveau sens à la différence dans l’opposition. C’est un ensemble d’opérations qui aboutissent éventuellement à la constitution de stéréotypes à connotation raciale, ethnique voire culturelle.

Méthodes

Nos propos s’appuient sur deux recherches ayant été menées aux États-Unis et au Burkina Faso. La première a procédé à une déconstruction du discours de la santé publique américaine et plus précisément des pratiques et des représentations à propos de la catégorie de race. Elle la situe dans son contexte historique et politique. La seconde a observé la circulation de stéréotypes à propos de certaines populations locales au sein des discours de professionnels de santé au Burkina Faso. Elle a aussi permis de discuter des conséquences potentielles de ces stéréotypes sur une politique sanitaire.

Résultats

Plus globalement, dans ce commentaire, nous discutons des conséquences potentielles des stéréotypes sur la santé des populations visées et sur leurs conduites. Enfin, nous cherchons à dégager des moyens de sortir d’un discours qui a tendance à naturaliser la différence et à donner beaucoup de place à la question de la diversité tout en omettant, dans une certaine mesure, la question du racisme et des inégalités sociales et économiques partout présentes.

Aujourd’hui comme hier, dans la vie publique comme dans la vie privée, le mensonge et son contraire, la vérité, occupent une place ambivalente.

En politique, le rêve d’une société transparente a abouti au cauchemar totalitaire. Le mensonge est à première vue incompatible avec l’idéal démocratique, qu’il pervertit. Pourtant, il semble devenu inhérent à l’activité politique, même s’il est rendu plus difficile qu’avant avec les technologies nouvelles de communication qui, elles-mêmes, favorisent le succès des théories du complot.

Le mensonge et le secret sont associés parfois à des valeurs supérieures : ne faut-il pas accepter l’existence de secrets d’État, ou de secrets de familles, pour rendre possible le vivre ensemble ? Mensonges et secrets permettent aussi de résister à un pouvoir ou une domination, ménagent l’espace privé, toujours menacé d’intrusion.

Cet ouvrage offre une réflexion sur les conditions qui permettraient de renforcer la démocratie, le vivre ensemble en réduisant la part du mensonge (et celle du secret) à ce qui serait un strict minimum. Mais lequel ?

Inuit in Canada currently suffer from one of the highest rates of suicide in the world. The objective of this study was to explore the prevalence of suicide ideations and attempts among 15–24 year olds living in Nunavik, Québec, and to explore risk and protective factors of suicide attempts as a function of gender. A cross‐sectional survey was conducted in 2004 across Nunavik. Univariate and multivariate logistic regressions were conducted. A total of 22% of young males and 39% of females adults reported past suicidal attempts. Gender differences were observed in relation to associated risk and protective factors as well as degree of exposure to risk factors. Suicide prevention must include alcohol and drug prevention programs and rehabilitation services, interventions to reduce physical and sexual violence and their long‐term impacts on Inuit youth, as well as exposure to culturally meaningful activities.

Background and Purpose

Migrant-sensitive care provision has been identified as a priority in the World Health Assembly Resolution, ‘Health of Migrants’. Little research has been done on the extent to which migrant-sensitive (‘friendly’) maternity care (MFMC) is currently being provided, factors that support or inhibit provision of such care, and whether specific components of MFMC may be more important than others. We sought to determine: (1) to what extent recommended components of MFMC are being provided to recently-arrived international migrant women giving birth in an urban Canadian city; and (2) what contextual factors support the implementation of MFMC.

Methodology

We conducted a mixed quantitative-qualitative study of 2400 women recently giving birth, speaking any language, in Canada <8 years, and from non-Western countries; and 63 health professionals. Medical records and unit documents were reviewed. The Migrant Friendly Maternity Care Questionnaire was administered and open-ended interviews were completed.

Results

Women from over 97 countries, speaking any of 79 languages reported on their perceptions of how the health system responded to their needs including communication facilitation, promotion of social support, education for healthy weight, treatment of pre-pregnancy/perinatal/maternal illnesses, early access to prenatal care, and responsiveness to preferences for care, among other indicators of MFMC. A range of professionals reported on challenges to care provision and how these were met.

Conclusions and Discussion

Empirical data on migrant-sensitive maternity care, contextual factors supportive of that care, and associated reproductive health outcomes offer baseline data for programming and to permit benchmarking nationally and internationally.

Key messages

• Empirical data on migrant-sensitive maternity care offer baseline data for health programming

• Migrant-friendly maternity care data allow for benchmarking for the future

At the end of 2011, 34 million people worldwide were living with HIV/AIDS (PLWHA), 68% of these in Sub-Saharan Africa (UNAIDS, 2012). HIV and AIDS remain a major public health challenge that continues to affect the lives of millions of people globally. Gender inequality has been recognised as a key factor to understand the dynamic and impact of the epidemic, particularly in Sub-Saharan Africa (Niëns & Lowery, 2009; Steinitz & Ashton, 2007; UNAIDS, 2012).

From 2011 until 2012, members of the Canadian parliament debated three iterations of legislation relating to the detention of asylum seekers. The final bill, unlike its predecessors, exempted children under the age of 16 from mandatory year-long detention, opening the door to children’s prolonged separation from parents or invisible detention as guests alongside mandatorily detained parents. Using a critical discourse analysis approach, we examine parliamentary debates and seek to determine how speech acts within the Canadian parliament construct a (detained) migrant child. Our results suggest that parliamentarians invoke logics of human rights and humanitarianism and that a reconfiguration of these paradigms places the state rather than the refugee in need of protection, thus introducing a hierarchy of compassion. Within this discourse, children are rendered so vulnerable as to be voiceless, enforcing the corollary image of the threatening adult refugee, which ultimately allows detention of children to be framed as a protective measure. We hypothesize mechanisms that make such constructions possible and discuss the implications for advocacy efforts.

OBJECTIVES: Study results on child maltreatment based on general population samples cannot be extrapolated with confidence to vulnerable immigrant or
refugee families because of the specific characteristics and needs of these families. The aims of this paper are 1) to conduct an evidence review of the
prevalence, risk factors and protective factors for child maltreatment in immigrant and refugee populations, and 2) to integrate the evidence in an analytical
ecosystemic framework that would guide future research.
METHODS: We used a 14-step process based on guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Canadian
Collaboration for Immigrant and Refugee Health. We searched major databases from “the oldest date available to July 2014”. The eligibility criteria for paper
selection included qualitative or quantitative methodologies; papers written in English or French; papers that describe, assess or review prevalence, risk and
protection factors for child maltreatment; and a studied population of immigrants or refugees.
SYNTHESIS: Twenty-four articles met the criteria for eligibility. The results do not provide evidence that immigrant or refugee children are at higher risk of
child maltreatment. However, recently settled immigrants and refugees experience specific risk factors related to their immigration status and to the
challenges of settlement in a new country, which may result in high risk of maltreatment.
CONCLUSION: Future research must incorporate more immigrant and refugee samples as well as examine, within an ecosystemic framework, the interaction
between migratory and cultural factors with regard to the prevalence, consequences and treatment of child maltreatment for the targeted groups.

International adoption is a relatively recent phenomenon and research in this field is emerging, particularly on issues of ethnic identity development and its implications for psychological adjustment and well-being. This article presents a critical review of the literature on ethnic identity in transracial adoptees as it relates to discrimination and psychological well-being. The review results show no clear evidence on the relation between a strong ethnic identity of origin, racial socialization efforts by parents and psychological adjustment in transracial adoptees. Studies investigating the effects of discrimination are too scarce to be conclusive. Results are discussed in light of future research and clinical recommendations

À l’adolescence, les enfants adoptés à l’international sont confrontés à un double défi identitaire : celui de l’adoption et celui de la négociation du statut minoritaire. S’ajoute à cette tâche complexe la possibilité que certains d’entre eux soient victimes de discrimination. Le but de la présente étude est de documenter les processus en jeu dans la négociation identitaire des adolescents adoptés à l’international en portant une attention particulière aux enjeux culturels et de discrimination. Des entrevues semi-structurées ont été menées auprès de 13 participants âgés entre 12 et 17 ans et adoptés de pays d’Asie. Une analyse par théorisation ancrée révèle l’existence d’une variation dans les stratégies identitaires bien que la majorité privilégie l’assimilation. Les expériences de discrimination poussent certains à surinvestir leur culture d’accueil au détriment de leurs origines ou, à l’inverse, rend impossible leur intégration. Les implications cliniques sont discutées en lien avec les bénéfices possibles de la socialisation culturelle.