The universality of the health system in Canada is often emphasised to contrast the differences between the Canadian and American systems of access to care. However, changes in migration patterns and tightening of administrative procedures around undocumented persons are beginning to challenge this Canadian image. Currently, there is a lack of data to support the existence and the consequences of this shift. This pilot project documents health care professionals' and community organisation workers' perceptions of the problems faced by recent migrants in accessing health care, and the health consequences of such barriers. Results confirm the existence of numerous health care access problems for both completely undocumented migrants and legal migrants who fall into the cracks of the provincial and federal health systems. The data suggests that these barriers may have important unrecognised morbidity and mortality consequences, and that they are a source of severe stress and psychological distress. To protect recent immigrant families, there is a need not only to revise the articulation between the provincial and federal health mandates but also to address the strong societal perception linking universality of health care to the notion of citizenship. Further research is warranted on this emerging social problem, but the institutional sensitivity of these issues may constitute an obstacle to a more comprehensive understanding. © 2007, Emerald Group Publishing Limited

Health services accessibility immigrants Migrants Refugees Medically uninsured

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