Refugee Health and Resettlement: Lessons Learned from the Syrian Response

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 specic 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 eorts 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 aect 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 dierent 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 dierent 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 dierent 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,

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