A/HRC/41/34/Add.2 V. Additional remaining challenges A. Other groups in vulnerable situations 85. The Interim Federal Health Program in Canada provides limited, temporary healthcare coverage to asylum seekers. The programme was restricted in 2012 but reinstated in 2014 with some changes, pursuant to a decision by the federal court that ruled the cut had been “cruel and unusual” and therefore unconstitutional; the programme was fully restored in 2016. The reinstatement brought confusion among individuals looking for health-care coverage under the programme and among providers, including pharmacies, which continued mistakenly to believe that goods and services were either not covered under the programme or could only be obtained through a complex process. 86. By law, no person in Canada can be denied emergency and life-saving medical services. While asylum seekers for the most part can gain access to health care in Canada, persons with no immigration status cannot. As a common rule, provinces and territories require that identification documents be shown in order to gain access to health care. In Montreal, the Special Rapporteur visited a migrant clinic of the organization Doctors of the World that offers a wide-range of health-care services to migrants in precarious situations who have neither public or private health insurance nor the financial means to gain access to health care. The clinic has increasingly provided health care to children who were born in Quebecand are therefore Canadian citizens but who have no public health coverage owing to obstacles in obtaining a health insurance card. 87. Access to the Interim Federal Health Program should be ensured without discrimination based on immigration status.34 At the very minimum, Canada should ensure public health care to all migrants in cases of infectious diseases, including access to screening, diagnosis, treatment and follow-up. Moreover, all girls and women, regardless of their migration status, should have access to complete perinatal care and to sexual and reproductive services, including voluntary interruption of pregnancy, and all children born in Canada and abroad should have free access to health care regardless of their parent’s immigration status. 88. In Quebec, the Special Rapporteur collected many testimonies of persons in situations of poverty who faced barriers in gaining access to health care owing to communication gaps and difficulties in interacting with health-care personnel because of their different contexts and life experiences and the tendency of health-care personnel to use expert medical language. This led to prejudice, social distance and miscommunication, which discourages persons in situations of poverty from seeking health care or following medical advice and pushes health-care personnel to diagnose and indicate treatment quickly without full consideration of the barriers that persons in situation of poverty face. 89. The health care of incarcerated women remains a challenge. Overall, health care is the most common complaint before the Office of the Correctional Investigator, the ombudsman for federal offenders. Regarding women, the Special Rapporteur was informed that some prisons lacked sex-specific health care, including hormonal contraception, abortion, prenatal care and breastfeeding support, clinical care and supplies while menstruating. The experience of incarcerated pregnant women had not been documented and there was a lack of disaggregated data by race or gender about health-related experiences and outcomes of incarceration. Furthermore, with the exception of Quebec,35 there were no provincial monitoring bodies similar to the Office of the Correctional Investigator, and some provinces, including Nova Scotia, had no requirements for a public inquiry when a prisoner died in provincial custody. All prisons should ensure health care for women and data collection to monitor the progression of incarcerated women’s health. 34 35 See E/C.12/CAN/CO/6, para. 50. The Protecteur du citoyen is the correctional Ombudsman for incarcerated persons in 1 of the 18 operating correctional facilities under the responsibility of the QuebecDepartment of Public Security. See https://protecteurducitoyen.qc.ca/en/about-us/role-and-mandates. 17