$1 billion: The rising cost of asylum and the need for 24/7 border clinics

Canada is now spending about $1 billion annually for health benefits to asylum seekers. This is a five-fold increase from six years ago. For many reasons, we must tighten up the medical screening of asylum seekers from the United States.At St-Bernard-de-Lacolle, Quebec from July 1 to 27, 2025, there were 3089 asylum claims —five times more than in the same period the previous year. Most were from Haiti, Venezuela, the United States, Colombia and Pakistan.Over 15 million illegal migrants live in the United States, and the Immigration and Customs Enforcement Agency (ICE) is rounding up and deporting them. Very relevant is that infectious diseases are greatly increasing on both sides of the border. In Canada, there are surges in the incidence of HIV, syphilis, hepatitis B, and drug-resistant TB. In the U.S., reported TB cases increased by about 34% from 2020 to 2024. About 75% of them were foreign-born. In New York City, the incidence of TB is 2.5 times the national average. Consider this statement by Shannon Charlebois and Jasmine Pawa in the July 2, 2025 issue of the Canadian Medical Association Journal: “A crisis of communicable diseases is unfolding in North America, just as Canada’s health system responses are being hampered by the dismantling of health and research infrastructure in the United States.”During the Iran war, the U.S. government is spending just over $1 billion per day. Yet Donald Trump has proposed halving the budget of the CDC and has cut the budget of the NIH by 50%. Total staff positions at HHS overall will be reduced by 16%. These cuts have led to pausing of important research and safety functions and have reduced the ability of U.S. health institutions to collect, interpret and share data. In the past year, the Trump government has greatly increased the likelihood of undocumented persons and even U.S. citizens seeking asylum in Canada.It is attempting to terminate Temporary Protected Status for over one million persons from Venezuela, Haiti, Honduras, Nicaragua, Afghanistan, Burma, Cameroon, Ethiopia, Syria, Somalia, and South Sudan.The U.S. has halted the processing of existing asylum claims from 19 countries and may try to reverse some of them.ICE agents have been especially brutal and unconcerned about Constitutional and human rights. In “operation Midway Blitz” in Chicago, “operation Patriot 2.0” in Boston, and especially “operation Metro Surge” in Minneapolis, U.S. citizens and those going through the legal refugee process—even children— have been sent hundreds of miles away to detention centres. ICE has recently completed “Operation Catch of the Day” in Maine. Non-white immigrants across the U.S. are scared. In Minneapolis, many are missing vital appointments at hospitals and clinics for fear of being detained by ICE agents. This increases the likelihood that if they eventually cross into Canada, they may be bringing undiagnosed infectious diseases.Once in Canada, asylum seekers have 30 days to see a physician for a history, physical exam, chest X-ray, and blood work. I suggest that St-Bernard-de-Lacolle and any other major land border crossings receiving large numbers of migrants from the United States be staffed 24/7 by nurses who could do a quick history and physical examination. Those asylum seekers who appear ill should be detained in a holding area and fast-tracked to see a physician. The need for nurses at each land border crossing should be reassessed every few weeks. We must act promptly. The 30-day waiting period to see a physician should be shortened. Asylum seekers should not be permitted to disappear for so long when they may be harbouring TB and other infectious diseases that might easily infect many other persons in homeless shelters and similar facilities.Retired Ottawa physician Dr. Charles S. Shaver was born in Montreal. He is the former chair of the section on general internal medicine of the Ontario Medical Association. The views here are his own.

$1 billion: The rising cost of asylum and the need for 24/7 border clinics

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