Ma San Htoo lived with her family in refugee camps on the Thai-Burmese border for 30 years. They were overcrowded, filthy places. She met her husband, Htoo Htoo, in the camps and for a time lived with their seven children in a bamboo hut with a thatched roof, scrounging for food from their little garden. Her people, the Karen, believe they have the right to an independent state carved out of the current Burma. They’ve been at war with the Burmese military govern­ment for 59 years, and in that time, an estimated 200,000 Karen have been driven from their homes. During her years in the camps, Ma San and her husband had to watch as their three-year-old boy and nine-month-old girl succumbed to malaria, a disease common in Burma. Both children developed a high fever one morning. Ma San rushed them to the camp clinic, but by evening, they were dead.

When the Htoos arrived in Canada as government-assisted refu­gees in November 2006, they were taken to the COSTI Reception Centre, a large three-storey building on Lippincott, north of College, devoted to housing new refugees. The accommodations were minimal, but after their cramped quarters at the refugee camps, the Htoos found the sparse rooms luxurious, and the staff, most of whom were former refugees, welcoming and dedicated. The family had been here only a week when history repeated itself: two of their daughters, six-year-old Lah May Paw and two-year-old Kee Lar Paw, ran high fevers and began to shake and vomit. Ma San was terrified. Staff at the centre rushed the girls a few blocks down College to an immigrant health clinic called Access Alliance, where doctors confirmed the symptoms were consistent with malaria and sent the family to SickKids.

Ma San and Htoo Htoo, like many refugees, had never been in a hospital. Everything around them was unfamiliar, and they couldn’t understand any English. An interpreter came with them on the first day, but after that they were left on their own. There was a machine in the room, and they were told that if it made a sound, something was wrong. “I was very worried looking at the machine all the time,” Ma San recalls, speaking through a Karen interpreter, her face solemn, her manner formal and retiring. “It was the only language I understood.”

Kee Lar Paw was severely anemic from her years in the camps, and the doctors were concerned she would have trouble fighting the disease. Both girls were in hospital a week before they were well enough to be discharged. The family then moved to a two-bedroom apartment at Jane and Steeles. Two months later, however, Kee Lar Paw began to show symptoms of malaria again, relapses being quite common among some malaria sufferers. At first, Ma San and her husband did nothing. “The problem was I didn’t speak the language,” says Ma San. “I didn’t know how to travel from here to the hospital. We didn’t know just to say a simple thing like, ‘My child is sick.’ ” They also didn’t know whom to contact. After all those years of surviving in the camp, they were not accustomed to other people looking out for their welfare. But after three days of watching their girl suffer, they panicked and called the social worker assigned to them by COSTI, who arranged to have Kee Lar Paw taken to a hospital. After a few days of treatment, she recovered and returned home.

Malaria is not the only exotic disease immigrants and refugees bring with them, when they first arrive, or from subsequent visits to their homelands. Typhoid, tuberculosis, dengue, chikungunya, strongyloidiasis, bilharzia and other lethal illnesses arrive in Toronto every year. Many of Canada’s yearly influx of 250,000 immigrants come from countries that have seen a resurgence in some of these contagions. The World Health Organization estimates that 1.6 million people—4,500 a day—died from TB in 2005. (Like influenza and HIV, TB mutates, leading to multi-drug-resistant and extensively drug-resistant strains; the latter is particularly preva­lent in South Africa.) Typhoid is moderately less deadly (of the 17 million people who contract the disease annually, 600,000 die), and 250 million come down with malaria every year. In 2006, 881,000 people died from it.

How does Toronto—first choice for immigrants to Canada, inter­national crossroads, celebrated multicultural mosaic—escape these pandemics? Between 1998 and 2007, the city had only 277 reported cases of typhoid and 1,120 reported cases of malaria. We average about 340 cases of TB a year, a relatively low figure. That we haven’t experienced a massive outbreak is a minor miracle.

The association of immigrants with disease isn’t new. Xenophobic governments through history have used the poten­tial threat to public health as a way to restrict “undesirable” populations from Asia, and eastern and southern Europe. Fear of immi­grants continues to be stoked by organizations like the Etobicoke-based Canada First Immigration Reform Committee, which advocates stopping all immigration from the Third World.

The truth is that our screening process for communicable diseases is stringent. Citizenship and Immigration Canada hand-picks doctors and labs in countries around the world to check potential immigrants for TB, syphilis and HIV. Applicants found to have active TB must undergo treatment and be completely cured before being admitted. After arriving in Canada, former TB patients are kept on a registry and tracked.