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Much of the existing research literature on the health of immigrant populations does not address the health care experiences of refugees, even though they likely experience unique and different health care needs relative to economic or family class immigrants. The objective of this paper is to explore the systemic barriers to health care access experienced by Canada’s refugee populations. The paper focuses on understanding these challenges as expressed by health and social service providers at the local level in Hamilton, Ontario. Data from interviews illustrate the impact of these systemic barriers for both refugees and providers. The paper examines issues of interpretation/language, cultural competency, health care coverage, isolation, poverty, and transportation in terms of health care and availability of services. [ABSTRACT FROM PUBLISHER]

Refugee determination is one of the most complex adjudication functions in industrialized societies. In Canada, despite a relatively broad recognition rate and a teleological interpretation of the international refugee definition, dissatisfaction with the decision‐making process at the Immigration and Refugee Board (IRB) has been expressed by numerous actors. This paper documents the influence of legal, psychological and cultural factors on the process of refugee determination. Forty problematic cases referred to the research team by professionals were studied using both quantitative and qualitative approaches. The results indicate numerous problems affecting the role and behaviour of all actors: difficulties in evaluating evidence, assessing credibility, and conducting hearings; problems in coping with vicarious traumatization and uncontrolled emotional reactions; poor knowledge of the political context, false representations of war, and cultural misunderstandings or insensitivity. In a majority of cases, these legal, psychological and cultural dimensions interact together, often impacting negatively upon Board Members' ability to evaluate credibility and upon the overall conduct of hearings. These findings suggest that the refugee determination process might benefit from revised selection criteria for Board Members and refugee claim officers, as well as improved training and support for all actors. [ABSTRACT FROM PUBLISHER]