Dr. Paul Caulford has had a busy and unusual year. Since November 2016, he’s seen an unprecedented volume of patients and treated a peculiarly high number of frostbite cases. Many of these visitors have travelled on foot from the United States, escaping the Trump administration’s anti-immigration agenda. As the co-founder of the Canadian Centre for Refugee and Immigrant Healthcare (CCRIHC), Caulford and his small team of volunteers are often the first people asylum seekers turn to when they arrive in southern Ontario.

Caulford, along with Jennifer D’Andrade, founded the clinic in 1999. While they intended to help undocumented migrants safely access health care (many avoid it for fear of being detained or deported), another objective was to fill the health care gap for sponsored refugees.

Government-assisted refugees and other refugee claimants in Canada access health care through the Interim Federal Health Program (IFH). “The problem is that a lot of places like walk-in clinics and medical offices won’t take IFH,” Caulford explains, because doctors aren’t required to sign on to the program. In many cases, refugees can only access health care through expensive emergency room visits.

“When we found out about this in 1999, we were shocked,” says Caulford. “We found thousands of people living and working in our community, going side by side with us to the parks with their children, but as soon as they get to the door for their own health care, it’s shut for them.”

The CCRIHC provides daytime and evening health care assistance to its many patients. The clinic had more than 3,000 patient visits last year—a number that continues to grow as Canada’s refugee health system remains stagnant yet increasingly in demand.

“It’s been very hard to get government-assisted funding for the clinic,” Caulford says. “We have a little bit of a grant that we use for some lab tests and X-rays but it runs out very early. There’s no money for rent, supplies, security, telephones, computers— what it takes to run an office.” All 30 volunteer doctors pool money together to help pay for the clinic from their own pockets.

“Canada is a compassionate nation with a humanitarian soul, and I’m proud of our country, and proud to be doing this,” says Caulford, who hopes the government will enforce a health care program that offers all refugees—documented or not—coverage for urgent circumstances. “But Canada has lived and profited from this dirty little secret. To have people working here, paying taxes here, but not giving them health care in return is shameful.”