I lean forward on my office chair, straining to catch the whispers of my new patient. With her heavily mascara'd black eyes starting out of her alabaster face, she reminds me of a porcelain doll poised to shatter. She has not slept for days and suffers from uncontrollable attacks of sweating and heart palpitations. Since beginning work as a physician at an inner-city community health centre, I've joined a beleaguered damage-control crew for an increasingly burdened refugee and immigration system. I'm told the Immigration and Refugee Board has a backlog of 38,000 asylum seekers, the result of a sudden surge of claimants in recent years.
Many of these people are left waiting for years, their lives coming to a grinding halt. Overwhelmed by despair and depression, some of them make the trip to my clinic.
The woman before me now says she and her boyfriend left Hungary after being assaulted by a gang. She came here, learned English, works 12-hour days as a housekeeper and has a volunteer position. Since her application for refugee status was turned down in June 2003, she's been consumed with anxiety. She's filed a petition for permanent resident status based on humanitarian and compassionate grounds, a process that may take another year to settle.
I give her some sedatives, but I know it's not enough. Tranquilizers won't cure a life in limbo. It's the larger immigration system that is ill, and the remedy is out of my reach.
Another refugee comes to see me. This time the complaint is abdominal pains. Her aloof, composed manner collapses, and she soon confesses to more troubling symptoms: "I cry every day. I miss my family. I cannot sleep, I cannot eat. I cannot do anything." I diagnose depression, start her on a course of antidepressants and refer her to a counsellor.
She is herself a physician and tells me she fled Pakistan when her husband made death threats. She says she left behind her seven-year-old son, planning to sponsor him as soon as she received asylum here. It took her a year and a half to be granted refugee status, and she has still not been processed as a landed immigrant. Without this crucial paper, she can't travel back home to initiate custody proceedings.
Three and a half years after separating from her son, she's overwhelmed by guilt and wonders if she made the right choice.
I feel myself succumbing to despair, my "objective" outsider relationship crumbling under the strain. The antidepressants have kicked in, and today she is sleeping better and her appetite has returned. But there is no pill for her emptiness.
Dr. Michael Lanphier, director of the Centre for Refugee Studies at York University, tells me what it's like in the waiting zone. These people, he says, have no organizational leverage. They are told to wait, go away and not bother anyone. Until they're landed, asylum seekers are precluded from upgrading their education, applying for professional accreditation or sponsoring family members. As for work, who is going to train a potentially transient employee? Those who are hired are often exploited, asked to work incredible hours and do all kinds of work below their skill level, eroding their sense of competence and confidence.
Psychologist Tatiana Wyse tells me that given their history of persecution, refugees are ill equipped to endure the re-victimization experience of prolonged uncertainty.
Another asylum seeker staggers into my office. He suffers from a back spasm that began when he lifted a heavy machine at work. He's working legally, but when he asked his boss to report the accident to the Workers' Safety and Insurance Board, he was told, "Don't fuck with me," so he kept his problems to himself. After examining him, I determine that he has herniated a disc in his back and treat him with anti-inflammatories.
A week later, the pain has subsided a little, but he reports nightmares and flashbacks. I suspect post-traumatic stress disorder. An engineering student in Turkey, he says he fled his country after he was tortured for challenging his government's prison policies. He was denied refugee status by the Immigration and Refugee Board and has launched an appeal. Three years after his arrival, he languishes in an abusive workplace while awaiting his answer. Incapable of improving his life, he is sinking in the quicksand of traumatic memories.
As he relates his tale, I nod empathetically, attempting to convey a reassurance I don't feel. Since his case has been turned down, he believes he's at risk of imminent deportation.
I'm overwhelmed by responsibility. Not only must I seek to alleviate his symptoms, but somehow I have to find a way to keep him safe. I spend the rest of the afternoon on the telephone. By the end of the day, the refugee network branch of Amnesty International has agreed to meet with him. If he convinces them of the truth of his tale, they'll advocate for him. There's no guarantee that they'll succeed.