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THE DISABLED AND IMMIGRATION (Globe and Mail)

Mohamed Mussa lies awake most nights, worrying about whether he'll be separated from his family. He worries about it every day on the Wheel-Trans on his way to work; he worries about it on his way home.

And, as he sits in his wheelchair, in his family's downtown apartment, clutching a lawyer's letter sent last November to Immigration Minister Sergio Marchi, he worries some more.

Choking back tears, Mr. Mussa explains how an immigration officer told him that he can't obtain permanent resident status in Canada because he is "a cripple".

Mr. Mussa, 49, can't comprehend how all this has happened to him. He holds a university degree in economics, he pays his taxes and he has no criminal record, chronic or communicable disease.

In l989, Mr. Mussa was a bank manager. He fled Somalia with his wife and two teenage daughters to escape clan persecution and routine beatings. Via Italy, they came to Canada, which they considered "a safe haven" and a "civilized society," and applied for refugee status.

Mr. Mussa and his family eventually were declared bona fide refugees and became eligible to apply for permanent residence. His wife and children since have become landed immigrants, entitling them to apply for Canadian citizenship.

But the Immigration Department would only grant Mr. Mussa temporary residence. Becaus he lost the use of his legs in a car accident, in Somalia, Mr. Mussa was classified as an "M7", which excludes immigrants because of "a condition which would cause excessive demand on health or social services, and which is not likely to respond to treatment."

Although he has a full-time job as a revenue clerk at the Ontario Ministry of Consumer and Commercial Relations, and although he requires no extra health or social services to care for his paralysis, the federal government perceives Mr. Mussa as a potential drain on resources.

"I believed everybody who was contributing to Canadian society and paying his taxes is welcome," Mr. Mussa says.

But soon, a new regulation, under the Immigration Act, will make it even easier for the government to keep out--and deport--people like Mr. Mussa, because of their medical condition.

Lawyers expect the new regulation--which aims to standardize and simplify the screening of applicants with medical conditions--to take effect this October.

The centrepiece of the proposed system is a handbook now being revised for medical officers. It will contain details of diseases and disabilities, and their costs to health and social services, based on the needs of the average Canadian with the same medical condition.

And if the projected cost, over five years, of admitting an applicant with a medical condition is greater than what Statistic Canada calculates the average healthy, ailing or disabled Canadian incurs on health and social services in the same period--about $12,370--the applicant will not be admitted into Canada.

Currently, medical officers have some discretion when determining if a person's medical condition is too costly for them to be admissible. Under the proposed system, they must instead use the costs in their new handbook to assess if the applicant's condition is over the $12,370 limit.

Although the system is not intended to keep immigrants out, the government expects that under the new rules, some applicants will be refused admission who could have entered the country under current regulations, says Neil Heywood, director of medical programs development for the Department of Citizenship and Immigration.

As a result, there may be savings to health and social services, he said, but added that it would be impossible to say how much until the new regulations have been in effect for a while.

There will also be administrative savings because "we're trying to speed up the whole process", said Brian Grant, director of the department's control and enforcement policy.

But immigration lawyers and disability rights groups worry about the implications for the disabled.

They say that entry into Canada will become even more difficult for both the disabled and their families who, they say, already face discrimination.

Last year, about 1700 prospective immigrants were refused entry because of their anticipated demand on health and social services; the largest category of medically inadmissible applicants being the developmentally disabled, numbered at 350 . (Some other categories included people suffering from other disabilities, infectious diseases, cardiovacular ailments, psychiatric disorders and cancers).

The Mussas had to turn for help from the Advocacy Resource Centre for the Handicapped (ARCH) in Toronto, because, usually when one family member is denied permanent resident status on medical grounds, the entire family is also denied. The centre eventually won permanent resident status for Mr. Mussa's wife, Asha Mohamed Ahmed, who works for Meals on Wheels, and for their daughters, Nina, 17, and Faduma, 20, both straight A students who plan to attend university.

But the government says the new model will provide an objective means to define a person who will present an excessive demand on health and social services.

"We're trying to introduce a notion of nationality, coast to coast, so if a person is admitted, there is in actual fact capacity to cope with them (in each province)," says Dr. Neil Heywood, director of medical programs development for the Department of Citizenship and Immigration.

"I think the claim was that the old system was too subjective. This (new model) is very objective. A dollar over represents excessive demand; therefore the person would on medical grounds, be denied admission. I've never heard anybody say (the new model) is too objective."

But the lawyers disagree. Howard Greenberg, past chairman of the immigration section of the Canadian Bar Association, says, "we've seen it, we've talked about it, and we don't buy it."

A major flaw of the model, lawyers say, is that it neglects to consider a prospective immigrant's cultural background, lawyers say. For example, the new model assumes that some disabled applicants will have to be admitted to a chronic-care facility, even though many cultures consider such a move inappropriate or even taboo.

The annual cost of keeping someone in an institution would easily cross the $2,474 yearly threshold, and the applicant would be refused, lawyers say.

"In 35 years, I know of not one single case where an immigrant family has taken a disabled person and put them into a home or institution," says Mendel Green, a Toronto immigration lawyer. "They have a different concept of family. It's something the Canadian immigration authorities really don't appreciate.

But Dr. Heywood says culture is irrelevant. "They may be at home overseas, but we must assume that if an individual is considered likely to require a service, they are actually going to seek it from established services in Canada."

Other attributes of a medically inadmissible applicant, such as their education and economic situation, would be considered secondary under the new system, as under the present system. But lawyers say that more cases will go to costly years of appeal as more cases are found medically inadmissible.

Lawyers say this means that applicants such as Mr. Mussa would not be able to demonstrate, for example, that they have a higher education and are employable.

The long-term financial benefit of the person's family is another factor that would not be taken into account under the new model, says Dennis McRae, a Vancouver immigration lawyer. He says that the disabled person's family, (routinely refused with their inadmissible member), may have skills that Canada needs.
"If they were contributing a few thousand dollars in taxes to the system, and their disabled member was only using a few hundred dollars more than the average Canadian in health and social services,it would be a good economic position for the government," he says.

Jerome Di Giovanni, president of the Canadian Disability Rights Council, has suggested that the Immigration Department appoint a tripartite committee, which would include a member of a disability rights group, to judge medical officers' decisions. Grant says the Immigration Medical Review Board, which reviews complex cases, may instead be augmented with a person knowledgable about the disabled.

New system or not, Mohamed Mussa doesn't understand why, as a contributing member of Canadian society, he can't get permanent resident status and may be deported.

"I don't know where I have to go and ask for help," he says. "The only problem I have is, I can't use my legs."

Dr. Heywood, however, forsees a warm reception for the new rules. "If the model works as we anticipate it to work, I think other countries will look at it in a very positive light."