For the refugees and asylum seekers at Matthew House, life is about adjusting to a new city, country and routine, all while trying to navigate a confusing and cumbersome immigration process, getting their siblings or children into the school system and figuring out how to get a job.

Matthew House is a non-profit that has seven homes it uses to house people at various points in their immigration journey, and helps them access other services.

"The back of your mind, you have the issues you're running away from — that's already pressure," said Doreen Katto, program co-ordinator with Matthew House.

"Now you have the pressure of figuring out the next steps. I can't imagine myself going through that."

Recently, Quebec signalled it wouldn't be able to continue accepting refugees who arrive through the irregular border crossing called Roxham Road.

Thousands of asylum seekers have been bused to Ontario shortly after arriving in Quebec from New York over the past few months.

Roughly 39,000 people seeking protection arrived in Quebec from Roxham Road in 2022 alone. According to the latest federal government statistics, another 4,875 people crossed at Roxham Road this past January.

Asylum seekers and refugee claimants usually spend some time in a hotel — paid for by the federal government — when they first arrive in the country.

Refugees are given a list of the paperwork they need to fill out, may have access to legal aid and might have a chance to see a nurse about any health issues, but none of that is consistent.

According to some accounts, there is pressure to find other living arrangements after the first couple of months.

"I'm just imagining how anyone would figure out what you need to do when you just arrived in Canada and you're a refugee claimant," Katto said.

In a statement, Immigration, Refugees and Citizenship Canada said the department provides an on-site nurse available 24/7 at each hotel.

"They are responsible for ensuring the wellness of asylum claimants and are able to dispense over-the-counter medications, perform first aid and assess and refer claimants to emergency services or urgent care clinics as needed," the statement said.

The department also said asylum seekers are eligible for health coverage under the Interim Federal Health program, which gives access to services like hospital care, doctor visits and lab tests, as well as urgent dental care and limited vision care.

Matthew House offers a way to transition, with more consistent access to support aimed at helping refugees thrive, not merely survive in a new country.

The organization estimates 70 per cent of its residents have come through Roxham Road.

Assistant program co-ordinator Abdul Al-Kaf said it's clear the entire process is stressful and exhausting for refugees.

"Ninety per cent of the time when people come, they sleep right away," he said. "Then we do the contract and show them outside of the room and the kitchen."

Big picture approach needed

Al-Kaf said each house is managed by the people living in it where everyone has a chore, which changes every two weeks.

"That way many people who come who have never shovelled the snow before, or never cleaned the bathroom or kitchen before, they learned how to do that in here, in this house," he said.

Executive director Allan Reesor-McDowell said governments need to start taking a big picture approach to refugees and asylum seekers, and evaluate the types of people who come to Canada.

If not, Reesor-McDowell said he worries the country will "end up with a massive homelessness crisis on our hands."

"No one's really talking to the experts on the ground, kind of at the grassroots level, community organizations like ours, that have been doing this," he said.

Health-care pressures

Health-care systems across the country are currently facing staffing issues and sustained pressure, as hundreds of thousands of Canadians look for a family doctor and emergency departments are overflowing.

The situation is no different for community health centres that serve refugees and asylum seekers.

Michelle Maynard, director of primary care for Somerset West Community Health Centre, said staff have seen a 300 per cent increase in the number of new patients over the past 14 months, and a growing wait-list that already sits at about 900 people.

Many need help dealing with serious health issues and navigating a complex health-care system, including many newcomers.

"The newer arrivals, it's been some time since they've received medical care. [Their challenges] are becoming far more complex, requiring multiple visits and some significant followup," she said.

Staff have also seen a 200 per cent increase in the number of people seeking care at the nearby Centretown Community Health Centre, according to executive director Michelle Hurtubise.

Some patients have arrived with "undiagnosed cancers," as well as undiagnosed long-term issues such as diabetes, plus women in their final trimester of pregnancy who have never received care.

"They're looking for things like glasses, dentists, how to get their kids enrolled in school, how do you even actually find housing because they're put in the hotel, and not a lot of supports are being provided to them," said Hurtubise.

Struggle to help newcomers, locals

The demands of refugees and asylum seekers also have to be triaged with the needs of local residents who need these community health centres. Helping newcomers is often extra work.

"We are doing this off the side of our desk. We don't have specialized funding to do this," Hurtubise said.

Maynard said her centre will also lose five positions at the end of March because they don't have enough money to sustain operations, which will create "significant pressures on current staff."

"We're not even going to be able to meet the current needs of our already served clients, let alone taking in new ones," she said.