RESEARCH SUMMARY REPORT REFUGEE HEALTH AND RESETTLEMENT: LESSONS LEARNED FROM THE SYRIAN RESPONSE
INTRODUCTION plan was to accomplish this ambitious commitment by the end of 2015. e e Syrian Civil War, according to the UN deadline was later extended to early spring Human Rights Commissioner Zeid Ra’ad of 2016. Advocacy groups and community al Hussein, has become “the worst agencies continued to rally the Canadian [human-made] disaster the world has seen government to increase the Syrian resettle- since World War II” (United Nations News ment numbers. By mid-2017, a total of Services, 2017). Over 6.5 million people 40,000 Syrian refugees have been resettled have been internally displaced within Syria in Canada (Government of Canada, 2017). (UNHCR, 2016), and 5 million have ed Syria and are living as refugees in Turkey, Resettling this large cohort of Syrian Egypt, Iraq, Jordan, Lebanon, and other refugees to Canada within a short amount North African countries (UNHCR, 2017b). of time was an extraordinary and complex Almost one million Syrians have requested undertaking. e last time Canada under- asylum in European countries (UNHCR, took such a rapid and large scale refugee 2017a). resettlement was in 1979, when we resettled 60,000 refugees from South East Asia In line with our humanitarian tradition, (Vietnam, Cambodia, and Laos) within a Canadian government and Canadian period of two years. In the case of Syrian citizens stepped in with a nationwide refugee resettlement process, several inter- commitment to resettle Syrian refugees. e national organizations and all levels of widely shared story of the tragic loss of government in Canada were involved. e young Aylan Kurdi, and the fact that his federal and provincial governments provid- family had considered seeking refuge to ed additional funding to support this pro- Canada, further galvanized our response to cess (see Figure 1). Moreover, hundreds of resettle Syrian refugee families (Withnall, community agencies and many community 2015; e Canadian Press, 2015). e groups (sponsor groups, faith based groups, Liberal Party won the 2015 federal elec- volunteer groups etc.) across Canada came tions on the promise that they would reset- together to provide services and supports to tle 25,000 Syrian refugees. Initially, the Syrian families arriving daily in large
FEDERAL FUNDING 2016-2017 PROVINCIAL FUNDING - ONTARIO 2015-2017 Newcomer Settlement and Integration: $10.5 million for immediate and future support: $153.6 million Immediate settlement needs for UNHCR and UN World Food Program: Health Protection (includes screening, $2 million medical surveillance and IFH): $14.5 million For organizations that support private refugee sponsors: Internal Services (administrative): $1.8 million $8.1 million Boost community-based supports: $3.7 million
Orientation, training, and public education: $626.000
Figure 1: Additional Funding Allocated to Syrian Refugee Resettlement at Federal and Provincial Levels 2 numbers (Hansen & Huston, 2016). cross-sector collaborations and organizational innovations that were Ontario resettled more than 16,000 Syrian mobilized to meet the unique demands of refugees (Government of Ontario, 2015). rapid, large-scale delivery of services for Of this, a third (5345 Syrian refugees) came hundreds of Syrian families arriving on a to the City of Toronto. Region of Peel and weekly basis. e study has captured the key Region of Waterloo resettled 1066 and success factors that facilitated these 1495 Syrian refugees respectively. Figure 2 collaborations and innovations including shows a breakdown of arrivals to these engagement of senior leaders, public areas. goodwill, and relationships based on trust. Study ndings also shed light on the many With funding from United Way Toronto challenges faced along the way including and York Region, Access Alliance funding and communication gaps, conducted an environmental scan study to coordination challenges, fairness and equity concerns, and meeting needs speci c to Syrian newcomer families. Results from this CITY OF TORONTO study have important best practice (INCLUDES TORONTO, SCARBOROUGH, ETOBICOKE, NORTH YORK) implications for refugee health and settlement, particularly in terms of planning GAR – 2241 PSR – 2613 services and supports for future large-scale BVOR – 491 arrivals of refugees to Canada. Total: 5345
REGIONAL OF PEEL METHODOLOGY (INCLUDES MISSISSAUGA, BRAMPTON, CALEDON) e key goal of the study was to document GAR – 434 how we responded to the arrival of large PSR – 558 BVOR – 74 cohort of Syrian refugees within a short Total: 1066 time frame in order to identify best practices to inform future response e orts REGION OF WATERLOO to similar situations. In particular, we (INCLUDES CAMBRIDGE, KITCHENER, wanted to understand (i) the nature and WATERLOO) scale of cross-sector collaborations and GAR – 1086 system navigation supports that were PSR – 249 mobilized with attention to the BVOR – 160 Total: 1495 institutional factors that enabled these collaborations and successes, (ii) and document challenges faced, and how Figure 2: Breakdown of Syrian Refugee Arrivals by Region agencies responded to these challenges. To *GAR - Government-assisted refugees provide a comparative context on how PSR - Privately-sponsored refugees variations in regional/urban contexts a ect BVOR - Blended Visa Office-Referred service planning, our study focused on three urban centres/regions in Ontario: City of document how service provider agencies Toronto, Region of Peel, and Region of planned and delivered settlement, health Waterloo. and other services in response to the arrival of large number of Syrian refugee families e study was grounded in Community within a short span of time. Interviews with Based Research (CBR) principles. We key informants capture the exemplary 3 trained and meaningfully engaged two KEY FINDINGS recently arrived Syrian Canadians, Tarek Kadan and Iman Malandi, in leadership 1. Setting the Context - capacity as “peer researchers” in research An Extraordinary design, data collection, analysis, writing, Response and knowledge translation activities. Tarek and Iman came to Canada as refugees (Tarek as privately sponsored and Iman e urgency and the extraordinary through the government assisted refugee situation of large scale resettlement of stream) and brought their lived experience Syrian refugees within a few months expertise to this study. activated an “emergency” operational response (P3, P7) and was met with an We conducted key informant interviews extraordinary response from agencies and (n=22) with senior-level leaders as well as groups involved. e scale of this response front-line service providers/mobilizers was unique and impressive and involved from healthcare, settlement, government, dozens of agencies from many di erent community development, and faith & sectors including those that "would not non-faith-based organizations/groups. have been involved in the past" (P10). For Study participants were recruited using example, even municipalities were at the purposive sampling to ensure (i) diversity table and as one participant mentioned, of representation from di erent sectors this was "the rst time for us to deal and regions; and (ii) t and relevance to closely with the cities" (P4). study goals (participants who played direct and active role in the Syrian refugee Settlement Healthcare Education response were targeted and prioritized). e interviews were conducted between Community, Sponsor Children’s Civic Participation December 28, 2016 till March 15, 2017. Groups Services & Leadership e interviews were transcribed verbatim and coded and analyzed using NVIVO 8 Community & Nonprofit Faith-based Research software using grounded theory Organizations framework (Glaser, 1998; Martin and Food Gynnild, 2011; Braun & Clarke, 2006; Housing Government Robson, 2006) that allows for capturing Assistance emergent and latent patterns/ ndings Language Police & through “constant comparison” and Employment Supports Safety seamless bridging of inductive and deductive analytical frameworks. We analyzed data using collaborative data Figure 3: Sectors and Areas of Support in Syrian analysis (CDA) framework developed by Refugee Response Access Alliance, and in line with the DEPICT analysis model put forth by Interviews with key informants show that Flicker and Nixon (2015). Research and agencies and groups from 15 di erent ethical protocols were reviewed and sectors were involved in some capacity in approved by Access Alliance's Senior providing services and supports for the Research Scientist to ensure the study met large groups of Syrian refugee families the agency's research and ethical policies. arriving in their respective cities/regions. e sectors involved during the response can be seen in Figure 3. In addition to Government-assisted Refugees usually stay Senior leaders and front-line providers for a couple of weeks after arrival to from health, settlement and other commu- Canada in temporary accommodations in nity agencies worked together to create “reception centres” provided by the desig- spaces, coordination framework, decision nated resettlement assistance program making process, and information manage- (RAP) agencies for the particular city/re- ment system to provide these multiple gion. In response to the mass arrivals of services within the hotels. For example, Syrian refugees, government agencies and collaborating agencies created dedicated designated RAP agencies had to arrange for rooms in the hotels for particular services, other temporary accommodation sites and triage systems were set in place to (primarily hotels) that could house a large prioritize urgent needs for primary care. number of refugee families. Refugee fami- lies stayed in these temporary accommoda- Moreover, study results highlight that these tion sites for several weeks or months until temporary accommodation sites helped to more permanent housing was arranged. strengthen a sense of belonging and com- Interviews with key informants highlight munity among Syrian newcomer families, that these rst sites of resettlement served as it became a place to build rapport and as innovative service hubs and platforms for trust with fellow newcomers, service pro- community-building. viders, volunteers, and other community members. Many of the services for refugees that typically are accessed externally, were operationally centralized at temporary accommodation sites. For example, in Toronto, these temporary accommodation sites included onsite primary care clinics, public health and dental screening services, midwifery services, as well as spaces for volunteer and other community agen- cies/groups. Similar collaborative response 4. Innovations in Service models were also set up in Region of Peel Planning and Delivery and Region of Waterloo. e on-site service collaboration model is shown in Figure 4. Many innovative partnerships, programs &
4 settlement and healthcare sector, decision aexemplary and innovative models of makers and front-line workers from the cross-sector collaborations were mobilized education sector (e.g. School Boards), in order to provide timely and integrated housing sector (including private landlords services and supports for Syrian refugee who helped to create housing registry), families. police, and children’s services were directly and indirectly involved in delivering di er- Beginning in September 2015, service ent services and supports to the newly providers recognized that the imminent arrived Syrian refugee families. Importantly, arrival of this large cohort of Syrian an impressive number of private sponsor refugees was a critical time to set up groups, faith based organizations/groups, collaborations between agencies and among and existing and newly established volun- sectors. Within three months, diverse teer groups put in thousands of hours of systems of collaboration were set up to their time to help with big and “little support the immediate needs of Syrian things” like connecting Syrian refugee refugees arriving in the City of Toronto, families to services, helping with interpre- Region of Peel, and Region of Waterloo. tation/translation, accompanying them to their appointments etc. Hundreds of Forming good partnerships to collaborate specialists (for example, ophthalmologists, e ectively with agencies across sectors plastic surgeons) and general public also enabled many service providers to share dropped by on a regular basis to o er their resources, information, expertise and skills help. in timely and optimal ways. Moreover, it also enabled them to overcome challenges e scale of involvement and the diversity and constrains along the way through a and number of agencies and groups shared model of responsibility. involved was unprecedented in recent history of Canada. is large scale response As one study participant (P8) put it, from multiple sectors and agencies/groups services across sectors were never "as brought many opportunities and resources, collaborative as it has recently been," with and also catalyzed organizational innova- providers "coming together" without tions and cross-sector collaborations that "competing of funding for a client base", continue to have lasting positive impacts; at but rather "what can I support you, I can the same time, this resulted in many chal- take care of this piece...". For example, in lenges, including challenges related to Toronto, a network of 32 di erent coordination, communication, navigation healthcare provider agencies came together and equity. e rest of this report discusses to establish a system of coordinated care for successes, challenges and best practices Syrian newcomers arriving to the region, in from this extraordinary response. order to ensure that the provision of care during the response was shared across 2. Collaborations: From agencies (P16). Sector leaders in each Regional Roundtables city/region organized community meetings to mobilize partnerships and gather to Interagency Networks knowledge and resources. ese meetings then led to the creation of dozens of A large cohort of Syrian refugees arriving collaborative working groups that took on within such a short timeframe was initially di erent shared responsibilities. In the chaotic and confusing for service providers Region of Peel for example, a large to plan and successfully support. However, community meeting was convened: through this chaos and confusion, interventions were mobilized to respond to the needs of Syrian refugee families. New stang positions were created by agencies to help manage coordination e orts. One example of a position created was the Stakeholder Engagement Manager in Toronto, a role exclusively aimed at scheduling and coordinating people. Other stang positions were also created and shared between collaborating agencies. For example, two positions were created for Syrian mental health workers and two positions were created for settlement agency workers which wee shared amongst settlement agencies in the Region of Peel. e uncertainty about what the actual need was and the stang requirements to meet Senior leaders and front-line providers this need made this shared stang model from health, settlement and other commu- an e ective use of resources. nity agencies worked together to create spaces, coordination framework, decision Similarly, to help coordinate the process of making process, and information manage- connecting families with housing, one ment system to provide these multiple agency established a centralized housing services within the hotels. For example, registry. Landlords and other housing collaborating agencies created dedicated partners were able to register their rooms in the hotels for particular services, vacancies on the registry and this and triage systems were set in place to information was then shared with prioritize urgent needs for primary care. community agencies serving GARs as well as privately sponsorship groups. is Moreover, study results highlight that these represented a unique moment when private temporary accommodation sites helped to landlords were working closely and strengthen a sense of belonging and com- collaboratively with settlement agencies to munity among Syrian newcomer families, meet the housing needs of refugee families; as it became a place to build rapport and the creation of the centralized housing trust with fellow newcomers, service pro- registry fostered this collaboration between viders, volunteers, and other community private and non-pro t sector. members. In particular, front-line providers working at the hotels mobilized unique partnerships onsite to reach vulnerable families and proactively overcome linguistic and other barriers to services. For example, a key informant described the relationship established between a midwife and a professional interpreter to jointly build 4. Innovations in Service trust with Syrian refugee families staying at the hotels and communicate about services Planning and Delivery that midwives can provide to pregnant women. Initially no woman had come Many innovative partnerships, programs & forward as pregnant.
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“...with all community partners, about cross-sector collaboration initiatives 200 people showed up sort of asking, between di erent levels of government and what is it that we need to do? How community agencies. For example, sta can we do this? So we started develop- from Ontario Ministry of Children and ing methodologies or ways of having Youth Services worked closely with other information sessions, etc, but the government agencies (including IRCC) and working group became the crux of stakeholders from Peel Children’s Aid, Peel this" - P3, Senior-level Government Newcomer Strategy Group and other RAP Ocial and community agencies to deliver over 50 public education workshops on positive Speci cally, these interdisciplinary working parenting and child welfare services that groups and collaborative partnerships reached over 1100 Syrian refugees. Sta became e ective platforms for mobilizing have noticed marked reduction in negative resources and communicating information experiences with police and child welfare cross-sectorally. For example, the special services among Syrian families because of working group in Region of Peel helped to these workshops. facilitate stronger and seamless collaboration between mental health To ensure language barriers were addressed workers and settlement workers in ways during the provision of care, a local health that resulted in an integrated model of integration network in Toronto "opened up settlement and mental health services for the spectrum of interpretation services" to Syrian refugee families from the rst weeks providers who did not traditionally have of coming to Canada (P3). access (P16). is meant that many more "clinics could have access to telephone In the Region of Waterloo, sector leaders interpretation services" (P16). built on the successes of a previously existing backbone network of di erent ese cross-sector partnerships and organizations. is interdisciplinary collaborations also served as a site for network "took the lead in probably a way knowledge distillation and sharing about that had never been done before" and refugee health and resettlement, particularly became the "designated agency" that would among new stakeholders and partners (for communicate information to all the example, school boards, police services). In partners within the network (P12). is the words of another participant: "we've collaboratively-led structure that included seen the re nement of knowledge that one municipal and community partners "was needs to take care of the refugee patients. really important for the engagement of all For all of us... It’s most striking in of the community organizations which have organizations that don't traditionally work been carrying the heavy weights, in terms with refugees" (P10). is re nement and of, refugee and immigrant resettlements in sharing of knowledge about refugees and the past" (P7). services for refugees between and across old and new partners will continue to have In both Region of Peel and Region of lasting positive impacts in refugee Waterloo, regional government ocials resettlement. were actively involved in organizing and co-leading these collaborative networks. 3. Temporary e Syrian refugee response team Accomodation Sites as established by the Ontario government Community Service provided another platform for many Hubs
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INITIAL PLANNING PHASE: Lead Community Health Centre Public Health GARs ACROSS SECTORS
Hospitals and Specialists
TEMPORARY LODGE SITES RUN BY LEAD SETTLEMENT Faith based communities Hotel/Temporary Shelter (RAP) AGENCY
Volunteers Schools
PRIMARY CARE RESPONSE BY CHCS AND FHT PSRs Primary Care Hubs
Community Primary LHIN Care Providers Figure 4: CHC Collaborative Response Model
Government-assisted Refugees usually stay Senior leaders and front-line providers for a couple of weeks after arrival to from health, settlement and other commu- Canada in temporary accommodations in nity agencies worked together to create “reception centres” provided by the desig- spaces, coordination framework, decision nated resettlement assistance program making process, and information manage- (RAP) agencies for the particular city/re- ment system to provide these multiple gion. In response to the mass arrivals of services within the hotels. For example, Syrian refugees, government agencies and collaborating agencies created dedicated designated RAP agencies had to arrange for rooms in the hotels for particular services, other temporary accommodation sites and triage systems were set in place to (primarily hotels) that could house a large prioritize urgent needs for primary care. number of refugee families. Refugee fami- lies stayed in these temporary accommoda- Moreover, study results highlight that these tion sites for several weeks or months until temporary accommodation sites helped to more permanent housing was arranged. strengthen a sense of belonging and com- Interviews with key informants highlight munity among Syrian newcomer families, that these rst sites of resettlement served as it became a place to build rapport and as innovative service hubs and platforms for trust with fellow newcomers, service pro- community-building. viders, volunteers, and other community members. Many of the services for refugees that typically are accessed externally, were "And one of the things about the operationally centralized at temporary hotel, because it was the largest receiv- accommodation sites. For example, in ing hotel, and this I think is much Toronto, these temporary accommodation more bene cial than we think, is you sites included onsite primary care clinics, land, but you land with your commu- public health and dental screening services, nity." - P13, Frontline Primary Care midwifery services, as well as spaces for Provider volunteer and other community agen- cies/groups. Similar collaborative response 4. Innovations in Service models were also set up in Region of Peel Planning and Delivery and Region of Waterloo. e on-site service collaboration model is shown in Figure 4. Many innovative partnerships, programs & 7 interventions were mobilized to respond to However, once the refugee families learnt the needs of Syrian refugee families. New more about midwife services and developed stang positions were created by agencies trust with the midwife-interpreter team to help manage coordination e orts. One many women disclosed their pregnancies example of a position created was the and were provided with necessary support Stakeholder Engagement Manager in services on site. Toronto, a role exclusively aimed at scheduling and coordinating people. Other 5. Reasons for Success stang positions were also created and shared between collaborating agencies. For example, two positions were created for Results from our study show that there Syrian mental health workers and two were multiple “success factors” that positions were created for settlement facilitated positive cross-sector agency workers which wee shared amongst collaborations, organizational innovations, settlement agencies in the Region of Peel. and e ective planning and delivery of e uncertainty about what the actual need services for the large number of Syrian was and the stang requirements to meet refugee families that arrived from fall of this need made this shared stang model 2015 to end of 2016. In this report, we an e ective use of resources. highlight three key success factors mentioned by most of the study Similarly, to help coordinate the process of participants: connecting families with housing, one A. HUMANITARIANISM AND agency established a centralized housing GOODWILL registry. Landlords and other housing partners were able to register their vacancies on the registry and this e tremendous sense of humanitarianism information was then shared with and goodwill exhibited by members of the community agencies serving GARs as well public, service providers, and volunteers as privately sponsorship groups. is made a signi cant impression on study represented a unique moment when private participants, and was mentioned as one of landlords were working closely and the key reasons for success during this collaboratively with settlement agencies to refugee resettlement response. Goodwill meet the housing needs of refugee families; and enthusiasm was displayed across the the creation of the centralized housing general public during the Syrian refugee registry fostered this collaboration between response (P9, P10, P22), where everyone private and non-pro t sector. had an interest "in making this work and actually caring about the results" (P22). In particular, front-line providers working Service providers who have worked with at the hotels mobilized unique partnerships refugees and immigrants for years have onsite to reach vulnerable families and "never seen this type of outreach and good proactively overcome linguistic and other will... to a time where, really, we couldn't barriers to services. For example, a key keep up with the phone calls from doctors informant described the relationship who wanted to help. And that, it's a phe- established between a midwife and a nomenal thing" (P10). professional interpreter to jointly build trust with Syrian refugee families staying at Crucially, the goodwill and humanitarian the hotels and communicate about services commitment from hundreds of people who that midwives can provide to pregnant wanted to volunteer allowed for immediate women. Initially no woman had come resettlement needs to be addressed in forward as pregnant. timely and personalized manner. For exam 8 ple, volunteers provided transportation to resources in a timely manner. Participants support refugees at their own will, taking referenced accessibility (P15, P22), willing- clients in their own cars or accompanying ness (P15, P22), and supportive leadership newcomers using public transit. One in the collaborative response (P6, P12) as participant described how volunteers took key aspects of senior-level engagement. care of the little things that providers One participant based in the City of "couldn't catch up" at the temporary Toronto described how having senior-level accommodation site (P2). leaders from the local school board at a collaborative ministry organized roundtable ‘Cause there’s there’s little things like a facilitated the process of registering Syrian mom would come and she’s like – I refugee children for school. e fact that need a hair tie for my kids, I don’t school board sta came to the temporary know how to tie their hair. She had accommodation sites (i.e. hotels) at their (number of) girls, all with long hair own costs ensured that Syrian children were and she was like I need to tie their registered to relevant schools right away. hair, and I’m like oh go to the dollar store. Because there was a dollar store "School boards actually came at their close by. But she couldn’t – she just she own cost with school buses. Came, got went to the dollar store she came back consents from the parents. ey she’s like I couldn’t nd anything or brought Arabic speaking sta to the know how to ask. So it was it was hotel to get particulars down. ey volunteers, they’re the ones who’re like hired school buses, they send sta to you know what? I’ll follow up with the hotels to organize kids getting on that piece. So there’s a lot of little the school buses and took them to the things in the moment that start to local schools. And took them to local come up, and that was all volunteers. schools like, every day. And it came And I think they continued to do from one of the roundtables with the that" - P2, Frontline Healthcare ministries. Someone from the school Provider boards were at the table. And I was describing the scenario we had at the Positive Canadian values such as hotels. And she came to me after the compassion and care were mentioned by meeting said, why aren’t those kids in participants as motivation for the goodwill schools? I said, I don’t know. Can they displayed by people assisting to support be in schools? She said, absolutely. Syrian refugees. As one study participant And she pulled it together within two noted, the tipping point to this strong days. And both school boards came on national emotional response was the picture behalf. Again, high level people from of young Aylan Kurdi who died while the department of directors and made trying to ee Syria.Prior to that, there was that whole thing happened in a ash. "faint public awareness that there was a So, that’s just an example of the value crisis" (P8). of those collaborative relationships." - P22, Senior-level Ocial, B. BENDING ROPE: ENGAGEMENT OF Settlement Agency SENIOR-LEVEL LEADERS A similar experience was shared in the Kitchener-Waterloo region, where Many study participants suggested that senior-level leaders were "bending rope" to access to, and engagement of senior-level make it easier to deliver services: leaders in planning and collaboration processes signi cantly helped to mobilize B. BENDING ROPE: ENGAGEMENT OF SENIOR-LEVEL LEADERS A similar experience was shared in the Kitchener-Waterloo region, where Many study participants suggested that senior-level leaders were "bending rope" to access to, and engagement of senior-level make it easier to deliver services: leaders in planning and collaboration processes signi cantly helped to mobilize
9 C. RELATIONSHIPS BASED ON TRUST "We have very senior community leaders, as at other steering committee. And that was important to enabling Many study participants noted that one of very fast decision making about deliv- the key elements of success was building ering services. And in ways that they and sustaining relationship based on trust hadn’t necessarily been delivered in the and shared responsibility. . In particular, past. Or you know, if we needed to having previous or existing relationships bend rope. Because it’s a normal way enhanced leveraging of support when of working with newcomers was not coordinating with partners to deliver going to be enough with this volume services to Syrian refugees. Study of people. Like, our school boards participants conveyed that their having a history of only registering connections with partners such as medical refugee and immigrant children, once specialists and other service agencies that they are living in at their permanent they had worked with previously made it address. You know, this was causing easier to make last minute referrals (P6, problems because we had 100s and P13, P18). 100s of children in temporary accom- modation and needed supervision. One participant's existing connections with And our settlement agencies were not RAP agency, community health centre, and able to do the works that they were mosque created "familiarity" which in turn able to do with their families to sup- led to greater comfort for partnering port their settlement. So we asked organizations to share and utilize di erent school boards, you know, are you able sources of funds. (P14). is participant to just put them into schools? Why do described that because of these positive we have to wait? You know, they are, existing connections things could move fast they may wait 2 to 3 months to go based on trust, "there was never formal into school. And I would be better for MOUs or. It was never any formal them to start now. e next day they organizational meetings with [RAP]. It was had people down at the hotels doing all me discussing with [RAP], coming back registration and the children were in to the mosque and say, listen, they do the school by the end of that week." - P7, check. So this familiarity, people knowing Senior-level Government Ocial and understanding that there was no hidden agenda, right" (P14). In both examples, the positive outcome was that children were registered and in school Participants also mentioned how previous without much delay. Study participants connections with landlords (P22), shared many other examples of how direct settlement agencies and RAPs (P9), and proactive involvement of senior-level volunteers (P6), networks of university leaders from other sectors/agencies (for e.g., hospitals (P10), and food banks (P18) public health, housing) resulted in early, motivated collaborations and mobilized timely delivery of services to Syrian refugee timely access to di erent kinds of services families. Engaging senior-level leaders for Syrian refugee newcomers. Overall, including executive directors, managers, and trust was important among collaborating government representatives (at federal, partners across sectors. Having common provincial, and regional levels) at planning goals and outcomes during the response tables rede ned "how they deliver services facilitated trust among partners (P3, P4), to refugees in this response in a very fast and "everyone was very respectful for what way" (P7) and made it "much easier to it was they were sharing" (P3). bring about change" (P15). 10
Building trust was also key to forming With regards to information sharing, positive relationships between clients and participants mentioned the lack of sucient service partners, alike. Proactively reaching data about the arrivals of Syrian refugee out and connecting with clients on a newcomers as a major challenge to plan- personal level (e.g. smiling, making jokes), ning for the initial resettlement response. letting them know why you are there, and is led to confusion and lack of prepara- ensuring good ow of information (by tion among services, and increased unantic- overcoming language and other barriers) ipated challenges as a result. were steps that study key informants identi- ed as ingredients that built trust with e number of individuals and families clients. For example, P13 (midwife), shared arriving was "vague" and although target about the "importance of [Syrian refugee numbers were provided initially, "it seemed families] seeing your face, right, seeing you to be very dicult process to really have an smile at them, seeing you make a joke about accurate number of incoming [refugee midwives and pregnancy and like that made families]" (P21). In the case of government a huge di erence." is personal connection assisted refugees, although there was regu- that the midwife helped to establish (with lar ongoing planning that was done in the help of a professional interpreter to conjunction with Immigration, Refugee and overcome language barriers) was signi cant, Citizenship Canada (IRCC), the actual as P13 recalled that "within half an hour I number of arrivals was provided just "more had 9 people who were like okay I'm preg- than a couple of day’s notice." One partici- nant, oh I should go talk to that woman pant described how arrivals "just hit us, you over there." Another participant also men- know, on December 24th in a blast" (P22). tioned how consistent presence of sta Another participant described that the onsite at temporary accommodations built information on the volume of refugees relationships between service providers and arriving seemed to be timed "week to week" Syrian refugee families in the hotels, as and vary considerably (P18). Having little newcomers "began to trust us that we were knowledge about the "pattern of arrival" providing supports and meeting their a ected the ability of service providers to needs" (P18). plan services and supports including ade- quate accommodation in temporary accom- 6. Key Challenges modation sites, adequate interpretation services, and to meet medical and accessi- bility needs (P12, P21, P22). e unique and extraordinary situation of providing services to large groups of Syrian In particular, there were gaps in informa- refugee families who arrived within a short tion about privately sponsored refugees in time frame also brought with it terms of their expected arrival dates and extraordinary and unique challenges. ese also the total numbers arriving in speci c challenges transpired at macro/system level cities and communities. As one participant (such as funding gaps, coordination and described: "...so many of the refugees were communication gaps, equity concerns) as made available for sponsorship, but yet the well as at micro/community level (such as papers were not completed. So it took a lot challenges speci c to the needs of Syrian longer for some of them to be processed refugee families). Some of the main and created a lot of frustration among our challenges are documented in this summary sponsoring groups" (P6). is confusion report: resulted in private sponsor groups losing money because they had secured housing A. INFORMATION / COMMUNICATION for arriving refugees in advance. ere was GAPS also lack of clarity in terms of how many 11 privately sponsored refugees arrived, and "Interpretation is not something that’s where they would be settled in the commu- cover under OHIP and largely not nity, because agencies "were more focused something covered under IFH, either. on the government sponsored families" ere are exceptions under IFH. But (P3). Participants stressed that timely and typically for typical primary care or regular information about how many specialist care appointment, interpre- privately sponsored refugees were arriving tation is not covered. A lot of agencies in the community would have been helpful, have a policy of, you know, if you want particularly for connecting them healthcare, an interpreter, you bring it yourself, settlement and other social services as you bring them yourself. Which is needed (P18). problematic for refugees. ey may not have the ability to nd an interpreter, B. FUNDING AND RESOURCES or partial interpreter, or interpreter, at all, to help out with as assessment. So, While the federal and provincial yeah, I mean, I think, it’s a function of governments did put in additional funding, the larger health system, as well as, there were major gaps in funding and individual policies by healthcare resources that hindered collaboration, agencies" - P15, Frontline Healthcare coordination and delivery of services to C. “BURNOUT Syrian refugee families. .. Some participants described how government bodies such as IRCC allocated additional Many participants also noted challenges in funding to larger agencies including those terms of capacity and being stretched in that were already funded by IRCC, and terms of time, hours of work and overall neglected to fund smaller agencies that e ort. Sta onsite at temporary were involved in this extraordinary Syrian accommodation sites were overwhelmed, refugee response (P20). shocked, and experienced mental and physical exhaustion, as well as burnout and Other participants mentioned funding gaps isolation (P2, P3, P8, P13). It was dicult for speci c kinds of services and supports; for sta when hearing sad stories from for example, inadequate funding to hire refugees and trying to be there for refugees enough interpreters, service coordinators, on a personal level. ere was limited space, and additional sta to meet the higher time and support to debrief about these demands for services and supports. Due to challenges or to address vicarious trauma limited funding and resources, agencies that sta may have experienced (P2). were pressed to rely more on volunteers. During the response, many providers were While this was somewhat helpful, agencies also working overtime and not practicing could only expect so much support from adequate self-care as a result (P8). volunteers, as they also had jobs and family responsibilities that they had to attend to For some participants, being dedicated to (P5, P19). support Syrian refugee newcomers during the response also meant that they were In some instances, refugees were arriving stretched in their capacity to provide before government funding dollars were services. In many cases, service providers received by the agencies. Nonetheless, had to shift away from their existing agencies continued to provide services to practice and clients (P11). refugees upon arrival by leveraging resources and “processes that were already Many participants echoed that several in place" (P21) or by using grants and agencies, especially small agencies, did not one-time funds from other sources. (P15, have the capacity to deal with the large P19). 12 volume of people that arrived during the Prime Minister and some didn't even response (P7, P10, P12, P20). One partici- have a real people to pick them up." pant described that "number one, nobody's - P6, Frontline Provider, Faith-based got the capacity to deal with this on our own" (P20). Another participant described With regards to the transportation loan, the how one settlement agency can be stretched federal government waived the loan repay- in capacity: ment for Syrian refugee families that arrived between X and X. e Syrian refu- "when you have one agency that is, gee families that came before and after kind of, the key, the central hub for these dates are stuck with having to repay the reception of such a large group of their transportation loan, just like other people, they needed to be involved sponsored refugees. While the decision to everywhere. So their capacities were waive the transportation loan may have really stretched...focusing on serving been well intentioned (relieve economic the people who were arriving, as they stress for Syrian refugee families), study were supposed to" - P7, Senior-level, participants recommended that the federal Government & Policy government should have taken fairness and Several study participants highlighted how equity into account and waived the trans- some key agencies were a bit territorial and portation loan repayment for all sponsored non-collaborative. is led to burnout of refugees. Several studies have documented sta within those agencies and hindered the adverse economic and health impacts service delivery. Study participants empha- on refugee families from the burden of this sized that in such mass resettlement pro- transportation loan. Community agencies cess, "one agency cannot do it on their and researchers have been calling the own." government to waive the transportation loan for sponsored refugees, and cover D. FAIRNESS AND EQUITY transportation costs to Canada as part of resettlement assistance program. Many study participants raised concerns about fairness and equity. e targeted Study participants raised concerns about focus on Syrian refugees, particularly those di erential access to services and bene ts that arrived between September 2015 and between privately sponsored refugees and February 2016, resulted in unequal levels government assisted refugees of Syrian and types of services and supports between origin. For example, government-assisted di erent groups Syrian refugees, and refugees were receiving tickets/tokens to between refugees from Syria and from other cover public transportation, while privately countries. sponsored refugees were not eligible: “Now, try to explain to two refugees from the Within Syrian refugees, one participant same war and program why X is getting a described the wide variations in types of bus ticket and the other doesn’t” (P4). services and supports depending on when they arrived: Furthermore, service providers and commu- nity/faith-based organizations faced ethical "...two di erent classes of refugees dilemmas on how to use donation money in were created. Some refugees who an equitable manner. Due to the targeted arrived in Canada with loan and some focus on Syrian crisis, most of the dona- refugees who arrived [to] Canada tions coming in were directed at supporting without. Not only that, other refugees Syrian refugee resettlement. Study partici- arrive[d] in Canada and received all pants shared about their moral dilemmas these out ts. And others arrived and and operational challenges in not being able got nothing. at were received by the 13 to use these donations for refugee families and I know they were overwhelmed too, from other countries who were equally in they’re like well, it’s transportation to a need. medical appointment. So it’s your piece” (P2). E. COORDINATION Participants also described that there was Poor coordination between agencies and a an overwhelming response from volunteer lack of a central coordinating group was groups but because there was no designated described as a signi cant challenge for stang to coordinate volunteers, they were participants. In the words of one “not necessarily being well received and this participant (P10), “there were a lot of pieces led to more chaos.” (P13) Furthermore, but who was responsible for putting those despite a large number of volunteers pieces together?” Some participants showing interest, most were available for described that there was not enough limited time and hours. . For example, one resources and time put into coordinating participant recalled “but then when it came and in some cases “every organization was down to it and we’re like ‘I need you Friday preparing on their own” (P10 and P11). morning at 9.’ Out of a hundred people Poor coordination between agencies led to [volunteers], three people would show up some agencies taking on a signi cant load sometimes" (P2). ere was a strong need while other agencies were underutilized. for a dedicated volunteer coordinator sta is was “to the detriment of the people who could e ectively manage the large coming in. ere should have been that number of volunteers with varied recognition that nobody’s got the capacity availability, skills and interest. to deal with this on their own" (P20). F, MEETING COMMUNITY-SPECIFIC Participants also described that managing NEEDS the large volumes of information being received from other agencies and di erent ere were certain challenges in terms for levels of government was challenging and planning services to meet needs unique and that the lack of consistent information to speci c to Syrian refugees. is included support planning was a barrier: “Our their preference for where to settle, chal- biggest challenge was guring out our lenges related to large family sizes, and system for how we took all of that meeting complex health and other needs as information in and put it all together in a a result of severity of war and con ict in consistent way” (P7). Syria.
Participants described that there was poor Initially refugees arriving in Toronto were coordination of roles and a lack of clarity being settled in regions such as Scarbor- about the scope of individual roles and the ough and Etobicoke. However, service roles of other agencies. is was mentioned providers noticed many families were then as a major hurdle when connecting refugees moving to Mississauga. is took place due with services they needed such as primary to the large Syrian population, restaurants care. For example, participants described and Arab grocery stores in Mississauga. the challenge of arranging medical Study participants noted the challenges appointments along with other supports nding a ordable rental units and transpor- such as childcare, transportation and tation in Mississauga. Families also wanted interpretation: “Transportation is a to move into buildings where other families settlement piece for (local settlement were located and preferred to cluster agency). But then when I would approach together. However, arranging housing close (local settlement agency) 14 to each other was also challenging: “A lot of not prepared for the “overwhelming families wanted to live together in the same numbers,” which simply made things feel building. You know they had already made like they were “moving too slowly” (P19). friends with others living at the hotel. And One participant on-site indicated that so to nd them housing close to each other “there were people with really urgent in the same building, it was a challenge” medical needs and they [were] not being (P22). seen fast enough.” is led to CHCs coming onsite and opening clinics at the Many of the Syrian refugee families had hotels. In spite of this service providers large families, including up to 11 - 12 noted that “there was still a lot of chaos” as family members. e large family size “there were people that didn’t know there presented a set of unique challenges for was a clinic onsite. Or they didn’t know service provider agencies: “ e families’ what kind of help they can get” (P19). given size was completely neglected. Syrian Arab families are not the 2.2 children that One service provider expressed how we have in North America. We had families refugees would go to walk-in clinics come in who had 5, 6, 7 kids” (P14). because of their immediate medical needs, Arranging a ordable housing for families and “going to walk-in clinics could take 6 of this size was dicult, and led to families hours of waiting. So then you need a staying for longer than was expected in volunteer to go and sit for hours at a hotels. walk-in clinic. Or, if it wasn’t a walk-in clinic then we end up at emergency at (local Coordinating transportation was also hospital)” (P22). logistically dicult and costly. When arranging transportation by car for these large families to get to healthcare appoint- • SPECIAL DIET ment, front line service providers needed to • DIALYSIS spend extra time guring out the right • WILSON’S DISEASE – RARE combination of cars and car seats. DISEASE INVOLVING LACK OF COPPER METABOLIZATION Large family size also created challenges in • NEED FOR ASSISTIVE DEVICES terms of managing length of appointment. FOR MOBILITY For example, a participant shared the case • REGULAR BLOOD of a family of 13 that was supposed to be TRANSFUSIONS seen at a local CHC but the CHC’s client onboarding policy required a 1-hour visit for each individual. Seeing this family was Service providers were heavily involved in logistically impossible and the CHC ended liaising with other service providers such as up seeing none of the refugees that the specialists and caregivers, so that referrals participant had been working with. could be made successfully (P13). However, liaising became more complicated agencies G. NAVIGATING THE HEALTH SYSTEM located in the city centre because of the WHILE MEETING COMPLEX NEEDS movement of Syrian newcomers to secondary locations of resettlement, Navigating the health system was a central particularly in the outskirts of GTA. challenge mentioned by participants in our Healthcare provision was good for “acute” study, particularly in reference to refugees care (P9, P13) but not for chronic or with complex or speci c health needs. Early longer-term care needs, as it made on in the resettlement response, providers “following up… challenging, because those at the temporary accommodation sites were individuals had to basically transfer care to 15 a clinic closer to where they go resettled, have the phone service. But you know right?” (P9). According to healthcare you need somebody with you. So, same providers in Toronto who conducted initial thing, we would have to have volun- medical assessments, maintaining transfer teers that were seeing each other after of care once newcomers had settled in 3 or 4 hours. ‘Cause you can be at the places like Scarborough or Mississauga was emerg’ for 12 hours, 15 hours before dicult, as it “caused…some breakdown in you get out or in. So, those were terms of communicating ndings, repeating challenging. ose were very frequent. of tasks, things that were already done, once I mean, a kid has a fever at 2 o’clock in they got into contact with their new the morning. What do you tell them? providers…” (P9). Re ecting on this ey wanted go somewhere. And challenge, one participant mentioned that somebody was saying, you know, “…we’ve lost a lot of dollars as like our maybe you wait or. Even take a deci- healthcare system with that because I know sion of whether you know, you can a lot of people probably just went, found a actually nd a volunteer and go over to new doctor, repeated everything again” (P2). emerge. Or whether you are gonna recommend they stay in the hotel. And H. INTERPRETATION AS A they weren’t doctors either. But I call it STRUCTURAL BARRIER TO those soft medical things; were pretty HEALTHCARE hard to handle that we were like, for everybody. It’s not unique to refugees. Interpretation remains an existing It’s just when you got 600 of them in structural barrier within the healthcare one place it becomes insurmountable.” system, and this was expressed as a key - P22, Senior-level, Settlement issue, particularly in the case of hospitals and private clinics. e health system Here, it is clear that the use of volunteer “wasn’t prepared for the newcomers” as shifts was implemented to support refugees described by one participant: in hospitals to overcome barriers to inter- pretation. “So for example, hospitals are sup- I. ACCESS TO PREGNANCY AND posed to have translation services. But REPRODUCTIVE CARE they didn’t. Every time we’d get phone calls from there and like, nobody’s understanding what we were saying. Another key health need that was And hospitals [don’t] have translation overlooked in planning for Syrian refugee services, even for emergencies. You resettlement was pregnancy and know, which was messed up. So it’s reproductive care. ere was not enough kind of like, the system failing.” - P19, recognition of the fact that “people are Senior-level, Community Agency sexually active, regardless of whether they are eeing or living in a camp” (P13). A Partners relied on Arabic-speaking physi- participant described how another cians, but “when they nd them they are “…practitioner said, ‘well how many overwhelmed as one doctor isn’t enough for pregnant women do you think there will our community, that could speak Arabic” be?’” which highlighted the “lack of (P3). Another participant expressed that understanding of both how many pregnant lack of access to interpretation was one of people [there] might be, the urgency of that the “soft medical things” that made it care, what that means to settlement, and dicult to navigate the health system: also that people are sexually active” (P13). Furthermore, women’s health exams such as “ e interpretation services at the pap tests and breast exams were not hospitals is not ideal. And they do prioritized as part of the healthcare 16 response.
Disclosure of pregnancies was also another issue that arose. Although it later was learned that for women who were pregnant ahead of time, many had “received care at the camp they were at” including ultrasounds, blood work, and paperwork documenting physical examinations, “it became very clear to them in talking to people and getting to know them” that women did not have paperwork about their pregnancy (P13). According to a service provider, this was “deliberate, they didn’t want anyone to know they were pregnant because they were really afraid that would prevent them from being able to come” (P13). Birth control was also a “huge need that was missed” which providers later had provided counselling for during the response.
Systemically, “…one of the big hindrances” to providing “basic-well-women care” is that “midwifery as a profession is not recognized at a federal level” - P13, Frontline Primary Care Provider 17
7 BEST PRACTICES funding is only for certain organiza- tion but there needs to be stronger RECOMMENDATIONS communications with other ministries and other level of government about Key informants re ected on their experi- how funding is made available with ences and observations from the Syrian other service areas to better support refugee response to share their best newcomers. Primary care providers in practice recommendations. ese recom- our community have welcomed new- mendations can inform our planning of comers into their practices that they services and supports the next time we can’t communicate with. Because no resettle large groups of refugees within a public dollars to fund interpretation in short time frame. primary care. is is a big gap. So, we’ve made solutions in our communi- 1. COMMUNICATION ty. But we shouldn’t have to make those solutions. is should be part of Communication needs to ecient and policy planning and development in a timely, particularly data on arrivals of way that funds are allocated. Services refugees. need to be funded in order to be able to receive newcomers in communities." “I think the only thing, again the - P7, Senior-level Government O- communication. If you can get it cial timely around when they are coming, how many and what’s their health Promote knowledge of funding structures. status. So we can respond quicker. "One thing for me that was, (our ere’s actually an opportunity for agency), we are funded by IRCC to planning. […] if we can have the facilitate community engagement and ongoing information, we can e ect, coordination to better support immi- like, wait a second, sounds like there’s grants and refugees. And in our com- more coming. We need to pull in our munity it was given. With all our planning team earlier, right. And I community partners our response in think, if we have that broader discus- this community is gonna be through sion around what the model would our (agency). at was not the case in look like, or, here’s some key principles every community. And it was months for that model – then we can imple- into the resettlement before IRCC ment it quickly, right” - P18, even thought to come and ask us, if we Senior-level, Healthcare had a role, at all. It’s the reason they fund us, you know. ey should be Sector leaders need to establish good, using their funded structures to help ongoing communication between all the facilitate this kind of stu . is was a organizations involved on the ground to special project; it was a large cohort. ensure clarity in terms of roles and We should have been the rst point of responsibilities and to facilitate e ective contact, in my view. Because it is our problem solving. role to already be facilitating that coordination and collaboration. So, my 2. FUNDING recommendation would be to use your funders structures. Because they have Shift funding allocation from the wealth of knowledge through the project-based funds to long-term (agency) and a strong history of funding strategy. collaboration at community level “And I know that immigration 18
which is where resettlement happens. bottles. And a baskets of granola bars, at can and it should be leveraged. And and it was really sweet cuz they're like we did that here. But I don’t think that it hey we noticed that you guys are happened at the same level in every working here for 8-10hrs […] So we community." - P7, Senior-level, Govern- were just like - oh wow, this is ment & Policy awesome. And I'm like, it's such simple stu , but I'm like oh I guess - it Consider trends and community speci c feels good. Like for, as a sta to feel needs of refugee groups (such as family like there's bottles of water for you size – which intersects with housing, and granola bars, just so you know, childminding, transportation) when it let's keep going. Like that kind of comes to funding resources. morale boosting..." -P2, Frontline Healthcare Provider Provide adequate funding for professional, medically trained interpretation services Share and leverage on the knowledge to overcome gaps in interpretation: about agencies and their capacities by region. “I don’t know medical terms in Arabic. I’m not even that great in Arabic. So, it was pretty, you know, like I’m saying half Ensure a ordable housing is arranged hazard. And rules are important prior to arrival. sometimes, they hamper things. But sometimes, sometimes they protect. So, 4. COLLABORATION it was, I don’t know, what’s worse- not having a translator or bringing someone Engage previous newcomers (including whose not quali ed? at’s the kind of Syrian Canadian community, volunteer mess that we’ve lend ourselves in the groups) in planning and delivery of beginning.” - P19, Senior-level, services and supports. Non-Pro t & Community Sector leaders, particularly from regional 3. PLANNING FOR THE bodies, need to play an active role in promoting multi-sector collaboration that LITTLE THINGS is inclusive and that mobilizes the exper- tise and strengths that di erent sector/or- Plan and fund the “little things” and not ganization brings. just the big things – in order to provide "health with dignity". Leverage connections through collabora- “I did not like seeing people carrying tions with media. their life's belongings in a black garbage “I think, the collaboration with the bag. at was really hard for me to see. mainstream media is really important. at's not health with dignity to me. You We did a lot of work here with our know? Let's think if we have that time local TV providers, our newspapers. to plan ahead, can some company donate ere was regular coverage of things suitcases?” – P2 that were going on. Good pro les of you know, of the progress of some of is includes self-care for sta : the families that we were able to "We didn't think in the moment leverage. Because of our structure and maybe, but what with (international the involvement of the groups, you NGO) what was really sweet, when they know, their connections that they had came in, they had like boxes of water to all of the media, you know. Kind of 19
every time we thought oh it’s important mindset. But because a lot of the to be messaging out something right organizations, this is not their core now about this.” - P7, Senior-level, demographic, they weren't able to adjust Government Ocial in time. So that's why." - P8, Senior-level, Settlement 5. COORDINATE AND CLARIFY ROLES 7. STRONGER GOVERNMENT ROLE Establish a coordinating body (at city or regional level) that provides clear direc- Government bodies need to take a more tions to agencies and assigns roles and proactive role in facilitating e ective responsibilities in the most optimal collaboration and ensuring adequate manner. resources. "I think that people responded well Promote a shared model of roles and overall. I think there was an amazing responsibilities to prevent one agency community spirit that we saw. I think trying to do it all. that that goes so far, but as an example, that this government or any government Consult with sta on the ground to help said, you know, in two weeks from now, shape their roles in clear and consistent, oh by the way, we’re going to take including enabling them to respond in another 20 000, um and we’re going to dynamic ways to challenges. have them here by, you know, by May, “ ey're people who truly want to be and you know, thanks very much for there. ey don't mind that sometimes what you did the rst time, do it again you stay a little bit after 5. And there are because you did such a great job. I don’t people who say no this is a job, and I'm know that if the capacity of the getting out on time. And I'm not community spirit would be as uh, as judging, there's two attitudes of forthcoming as it was the rst time, so approaching work. But in that particular you can’t rely on, I don’t think it’s place where we're understa ed, get appropriate to rely simply on generosity people who are all on board and and good nature spirit of communities to like-minded because that to me was the support folks." - P12, Senior-level biggest reason that I loved the work” Ocial, Healthcare Agency - P2, Frontline Healthcare Provider 6. BUILDING EVIDENCE
Build evidence to better understand community & other contextual informa- tion about refugees ahead of time.
"Literacy levels, number of children, exposure to the outside world. We have seen clients who have never seen the capital of their country. But the expectations were based on the previous waves of newcomers of Syria who were skilled workers, who are more savvy, so everything has been set up with that 20
SOURCES CITED Access Alliance Multicultural Health and Community Services. (2013). Everyone can do research: A plain language guide on how to do research. Toronto.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(May 2015), 77–101. http://doi.org/10.1191/1478088706qp063oa!!
Danaher, A. (2011). Reducing Health Inequities: Enablers and Barriers to Inter-sectoral Collaboration. Wellesley Institute. Toronto.
Creswell, J. (2014). Research Design: Qualitative, Quantitative, and Mixed Methods th Approaches. (4 ed.). Thousand Oaks: SAGE.
Flicker, S. and S.A. Nixon (2015). The DEPICT model for participatory qualitative health promotion research analysis piloted in Canada, Zambia and South Africa. Health Promotion International. Sep;30(3):616-24
Glaser, B. G. (1998). Doing grounded theory: Issues and discussion. Mill Valley, CA: Sociology Press.
Government of Canada. (2017). #WelcomeRefugees: Key figures. Retrieved June 23, 2017, from http://www.cic.gc.ca/english/refugees/welcome/milestones.asp
Hansen, L., & Huston, P. (2016). Health considerations in the Syrian refugee resettlement process in Canada. Canada Communicable Disease Report, 42(S2), S3–S7.
Humble, A. (n.d.). Guide to Transcribing.
Martin, V.B., & Gynnild, A. (2011). Grounded theory: The philosophy, method and work of Barney Glaser. Boca Raton, FL: Brown Walker
NVivo qualitative data analysis software. (2008). QSR International Pty Ltd. (Version 8) [Software].
Office of the Premier. (2016). Newsroom : Ontario Helping Refugees Resettle, Integrate and Contribute. Retrieved June 23, 2017, from https://news.ontario.ca/opo/en/2016/02/ontario- helping-refugees-resettle-integrate-and-contribute.html
Robson, C. (2011). Real world research: a resource for users of social research methods in applied settings (3rd ed.). Chicester, West Sussex: Wiley.!
The Canadian Press. (2015). Drowned Syrian migrant boy’s father says he blames Canada for tragedy - The Globe and Mail. Retrieved June 23, 2017, from https://www.theglobeandmail.com/news/national/drowned-syrian-boys-father-says-he- blames-canada-for-tragedy/article26313666/ 21
SOURCES CITED
United Nations News Service. (2017). UN News - Syria “worst man-made disaster since World War II” – UN rights chief. Retrieved June 27, 2017, from http://www.un.org/apps/news/story.asp?NewsID=56349#.WVJs6xPytE4
UNHCR. (2017). Europe: Syrian Asylum Applications. Retrieved June 23, 2017, from http://data.unhcr.org/syrianrefugees/asylum.php
UNHCR. (2017). Syria Regional Refugee Response - Regional Overview. Retrieved June 23, 2017, from http://data.unhcr.org/syrianrefugees/regional.php
UNHCR. (2016). Internally Displaced People — UNHCR Syria. Retrieved June 23, 2017, from http://www.unhcr.org/sy/29-internally-displaced-people.html
Withnall, A. (2015). Aylan Kurdi’s story: How a small Syrian child came to be washed up on a beach in Turkey. Retrieved June 23, 2017, from http://www.independent.co.uk/news/world/europe/aylan-kurdi-s-story-how-a-small-syrian- child-came-to-be-washed-up-on-a-beach-in-turkey-10484588.html
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