Procedures that take place after the interview and prior to making a final decision:
Issuing medical instructions
Where the International Organization for Migration (IOM) organizes transportation, IOM doctors may also perform a medical examination, or the IOM may arrange for the medical examination to be performed by a Panel Physician (PP) and reimburse the PP for their service. The IOM absorbs the examination costs of unsuccessful refugee applicants. The officer should therefore stage processing to keep the number of applicants who have a medical examination, but do not proceed to Canada, as small as possible.
Refugees who have the means to do so may, of course, pay for their own medical examination. Otherwise, the officer may authorize a loan.
Sharing medical information
Under the federal Privacy Act, medical history is considered protected “personal information.” The Act states that such information cannot be collected “unless it relates directly to an operating program or activity of the institution” and cannot be used except for the “purpose for which the information was obtained or compiled by the institution or for a use consistent with that purpose.” Further, it cannot be disclosed without consent except in prescribed circumstances including “for the purpose for which the information was obtained or compiled by the institution or for a use consistent with that purpose.”
Regarding the release of medical information to potential sponsors and resettlement workers, it should be noted that detailed medical information, descriptions of trauma, physical or mental abuse, should be protected to the greatest extent possible. In many instances, it might be necessary to inform settlement workers or private sponsors of the symptoms or objective signs, but not the specific diagnosis. For example, it is important that a settlement worker or sponsor be prepared to assist an applicant who is in need of counselling, a wheelchair or who is partially blind, but it is not necessarily essential that the settlement worker be made known of the disease or trauma/injury behind the condition.
Sharing information on HIV
Under current guidelines, HIV positive clients are counselled by the PPs on the implications of being HIV-positive and are instructed to seek medical care upon arrival in Canada.
As there is no conjugal relationship between the client and the service-providing organization (SPO) or the private sponsor, the sharing of a client’s HIV status is not legally defensible. Information on medical conditions resulting from the disease that are pertinent to the applicant’s resettlement needs, i.e., bronchial asthma and the need for a pump, etc., may be released, but not information on HIV itself.
The applicants with HIV, including those without any obvious symptoms present at the time of arrival, may require regular infectious-disease support. They will also likely require more extensive care and settlement needs in the long term and as such, they should be in a larger centre where these facilities might be available.
Medical information may be released in the following circumstances:
- Directly to the applicant. The applicant may be given a copy of the medical officer's diagnosis and narrative description of the medical condition.
- To reception centres to ensure adequate arrangements on arrival, so long as the diagnosis (e.g., HIV) is not released.
- With the applicant's permission (signature in the IMM 5475E Authority to release to designated persons), officers may release information to authorized representatives, sponsors, employers, provincial public health or medical personnel.
If an applicant desires additional medical information, they should be advised to have their doctor contact Immigration, Refugees and Citizenship Canada (IRCC) medical staff. Only medical staff may release information from a medical file.
Note: Should non-accompanying spouses being processed under the OYW be HIV positive, please refer to the Policy for Automatic Partner Notification of Family and Dependant Refugee Class Applicants who Test Positive for HIV. While the policy is specific for family and dependant refugee class applicants, it also applies to OYW cases.
Resettlement Needs Assessment Form (IMM 5544)
The Resettlement Needs Assessment Form (IMM 5544) is a tool developed to help private sponsors and resettlement workers in Canada plan appropriate reception and make resettlement arrangements for refugees. It facilitates the collection and distribution of pertinent information on significant medical conditions that would impact on the ability of newcomers to successfully resettle in Canada.
For each refugee to be resettled in Canada, the visa office will issue an IMM 5544B “Resettlement Needs Assessment Form” together with the IMM 1017 “Medical Report: Client Biodata and Summary form. The Panel Physician will complete the IMM 5544 and provide functional assessment and special requirements of the refugee during travel to Canada and post-arrival.
Before preparing a destination matching request (DMR) and Notice of Arrival Transmission (NAT) for a particular refugee, the visa officer will verify for any specific resettlement needs information provided in the IMM 5544. Visa officers should click off the “special needs” field in GCMS when requesting a destination (or in the case of a PSR, click off the “special needs” when completing the fields for the NAT) when and if specific needs have been identified in the IMM 5544. This will facilitate the Resettlement Operations Centre in Ottawa (ROC-O) to communicate any specific resettlement needs information to service provider organizations and sponsors in Canada.
For further information on the IMM 5544, refer to Health Branch’s operational instructions to Panel Physicians.
Occasionally a refugee will have a medical condition that requires a medical escort to accompany them during their travel to Canada. The costs for the medical escort have to be added to the refugee’s transportation loan. IOM must have IRCC NHQ approval to add these costs to the warrant and therefore it is important that IRCC NHQ is advised of the request for the medical escort.
Procedures for medical escorts:
- A Panel Physician (PP) makes a recommendation for a medical escort. This recommendation goes to the Regional Medical Officer (RMO) for their review and recommendation;
- The RMO reviews the case, liaises with the PP for more information if required, and advises the visa office if a medical escort is recommended;
- The visa officer contacts the manager of Refugee Resettlement Program Delivery (RRPD) unit at IRCC NHQ to advise of the recommendation for the medical escort;
- RRPD reviews the case and consults with the RMO if needed. Once the need for the escort is verified, RRPD advises the visa office and IOM-Ottawa that a medical escort can be arranged. RRPD also gives IOM authority to add the costs of the escort to the refugee’s transportation warrant.
The requirement for the medical escort should be entered into CAIPS/GCMS notes. The refugee requiring the escort, as well as the person who signed the loan (if other than the refugee) must be advised of the need for the escort and of the additional costs that will be incurred. Once this has taken place it must be recorded in CAIPS/GCMS notes.
The Resettlement Needs Assessment Form (IMM 5544) should be completed. It should indicate the type of escort (doctor/nurse/family member) as well as any special travel requirements.
As mentioned, the costs for the medical escort are added to the refugee’s transportation loan. These costs are generally $3,000 to $5,000 (or more) and therefore careful consideration must be given to the need for the escort, in order to avoid unnecessarily burdening the refugee with this additional debt.
In some cases the costs of the medical escort may be covered by a contribution from IRCC. However, this must be decided on a case-by-case basis. If the visa office wishes to ask for a contribution the request must be made via email to the ROC-O.
Special considerations for privately sponsored refugees (PSRs):
If client is privately sponsored, the sponsor needs to be notified of the medical escort and the estimated cost prior to approval being given. The ROC-O will ask the sponsor to provide confirmation in writing that they have been notified of the additional costs that will be incurred.
Request to add dependants
When a request is received to add dependants to an application, visa officers must:
- notify the ROC-O of the request to add a new family member;
- add “Refugee Operations Centre in Ottawa” as a secondary office in GCMS; and
- place final processing on hold.
The ROC-O will:
- correspond with the sponsor and ask them to submit a completed Request to Add Dependent(s) to a Private Sponsorship Undertaking form along with any necessary supporting documents to the ROC-O by a certain deadline;
- advise the visa office that the request to add dependants has been approved or refused, or that the entire sponsorship undertaking has been withdrawn.
If the request is approved, the ROC-O will inform the visa office, who will update the information in GCMS and continue processing.
Note: A completed Request to Add Dependant(s) form is acceptable proof of sponsor support. A new undertaking is not necessary.
If the request is refused and/or if the sponsorship undertaking is withdrawn, the ROC-O will instruct the visa office to continue to place the overseas processing on hold and, if required, will request the sponsor to attempt to locate a new sponsoring group to take over the case by a certain deadline.
If a sponsor is located:
- the ROC-O will enter the new sponsorship information into GCMS and notify the visa office that the request to add dependants has been approved;
- the visa office will add the dependant to GCMS and continue processing.
If no sponsor can be located:
- the visa officer will send a procedural fairness letter indicating that the applicant has 90 days to secure another sponsorship before their case will be refused under paragraph R139(1)(f)– Read more on procedural fairness;
- at the end of 90 days, if no new sponsorship is submitted, the visa officer will send a refusal letter to the applicant, code the case as “withdrawn” and close it in GCMS.
Reviewing admissibility results:
If the application has been furthered for criminal or security reasons, the officer will review the case at this point.
For criminally furthered cases, the RCMP Liaison Officer may be able to provide input for consideration before the final decision is made. Once the input has been reviewed, the officer may choose to refuse or continue processing the case. For information on exceptions to criminal inadmissibility, please see below.
For security furthered cases, the SLO may require an interview. Following the interview, the SLO will provide the officer with input for consideration before the final decision is made. Once the input has been reviewed, the officer may choose to refuse or continue processing the case.
It is strongly recommended that the officer consult the IC manual chapters on Security and Criminality and review the correct procedures.
Exceptions to medical inadmissibility
Officers may not issue a visa or authorization to anyone who is deemed to be a risk to public health or safety. A24 gives the officer the authority to issue a temporary resident permit if the officer is of the opinion that the circumstances justify the issuance of a temporary resident permit. If such a case should arise, officers should be aware that special travel and public health protection procedures may be necessary. Advice should be sought from the medical officer responsible for the area. Please refer to the procedures on temporary resident permits for more information.
Note: A38(2)(b) exempts refugees from medical inadmissibility on the grounds that the applicant will place excessive demand on the health care system.
Exceptions to criminal inadmissibility
Refugees found to be inadmissible on criminal grounds would normally be refused. If, however, there is reason to believe that the prosecution was the result of persecution, the refugee may be admissible. It should also be noted that Article 31 of the 1951 Convention stipulates that refugees should not be found criminally inadmissible for a criminal conviction relating to illegal entry or use of false documents in an effort to reach safety from persecution.
There may be public policy, national interest or humanitarian and compassionate considerations that exist in such a case.
If the criminal and security checks as well as the medical results have not revealed any problems, the officer should:
- Accept the refugee applicant(s); and
- enter final decision in GCMS;
For government-assisted refugees, refer to the procedures for Destining government-assisted refugees (GARs).
For privately sponsored refugees and self-supporting refugees, refer to the procedures for Visa issuance and travel documents.
If the criminal and security checks as well as the medical results have revealed concerns:
- Date Modified: