Skip to Content
A home for paediatricians. A voice for children and youth.

COVID-19 and Indigenous children in Canada: What can paediatricans do?

Posted on May 27, 2020 by the Canadian Paediatric Society | Permalink

Topic(s): COVID-19Advocacy

By Ryan Giroux MD, Cindy Blackstock PhD, Radha Jetty MD, Susan Bennett MD, Sarah Gander MD

Many First Nations, Métis, and Inuit children and families are facing a colonial catch-22 when it comes to COVID-19. Enduring colonial legacies mean they are more prone to pre-existing conditions, placing them at higher risk for poor outcomes from the virus. At the same time, many of their communities have inequitable resources to respond to the virus and to the disruptions caused by public health measures.  To make matters worse, cultural practices that are core to resilience and wellness—such as Elders looking after children—have also been disrupted. 

With COVID-19 amplifying inequities for many marginalized groups in Canada, these gaps will continue to widen without coordinated action between communities, Indigenous leaders, health providers, and governments. During this pandemic, paediatricians must be aware of the specific challenges that exist for Indigenous children and how they can contribute to their patients’ well-being.

Have we learned from the past?

Past pandemics and epidemics foreshadowed the higher risk Indigenous peoples have to COVID-19. European settlers brought foreign diseases to the Americas, leading to the deaths of over 90% of Indigenous people. In the early 20th century, Dr. Peter Bryce, Chief Medical Health Officer of the federal Indian Department, found that tuberculosis outbreaks in some residential schools resulted in death rates of up to 69% of children—a direct outcome of inequitable health care funding and poor health conditions. The Canadian government systematically silenced this evidence, and First Nations and Inuit people (including children) continue to have tuberculosis rates significantly higher than other groups.

More recently, the H1N1 pandemic in 2009 saw higher proportions of Indigenous children hospitalized and in intensive care, as well as higher mortality among all Indigenous people. These outcomes were also linked to poorer underlying health status, challenges in accessing health care, as well as systemic inequities. Despite the lessons from past pandemics, Indigenous families and communities continue to lack basic necessities: clean water, access to health services, and adequate housing, among others.

Why Indigenous children need a special focus

While in general, children tend to have fewer direct health consequences from COVID-19 than older people, they bear a heavy burden due to the public health response and outcomes. Indigenous communities, particularly remote Inuit and First Nations, also face heightened vulnerability during a crisis situation because of the cumulative effects of compounding emergencies (see, for example, Auditor General of Canada, Spring 2015). Table 1 shows how challenges multiply to create difficulties for Indigenous children and families.

Table 1. Additional challenges for Indigenous communities during health crises
  Challenge Example

Health care access


Lack of information in Indigenous languages, underfunded healthcare centres, availability of PPE and COVID-19 tests

Métis villages in northern Saskatchewan without financial supports, supply chains, or pandemic plan due to unclear jurisdiction between federal and provincial health systems

Preventative measures


Isolation difficulties due to poor housing, overcrowding, lack of clean water for effective hygiene, significant poverty and food insecurity

Eabametoong First Nation in northern Ontario has identified overcrowding as a major issue for their pandemic response: average number of people/ household is between 6 and 18

Risks for community


Isolation means families and communities cannot work together for child care or teaching cultural practices knowledge

Aboriginal Head Start Programs have closed, and Elders or Knowledge Keepers cannot visit families in their homes

Family and caregiver burden

Loss of income, difficult access to childcare, caregivers illness leading to child displacement, lack of internet access

Many rural and Northern communities, such as in Nunavut, have minimal access to high bandwidth, posing challenges to online learning platforms

Supporting Indigenous children in your practice

Paediatricians often advocate for both individual patients and families as well as specific populations. The Canadian Paediatric Society supports the Many Hands, One Dream Principles  that describe principles of effective advocacy for Indigenous children. The Truth and Reconciliation Commission Calls to Action (2015) is another sentinel document with 94 distinct recommendations for priorities and solutions that Indigenous communities have identified.

Here are some actions paediatricians can take to identify and support Indigenous children during COVID-19 and beyond.

  • Promote a culturally-safe and trauma-informed care environment, and ensure patients and families can identify whether they have achieved safe health care.
  • Learn about and address the structural inequalities and colonialism that undermine child and family wellness.
  • Learn about each Indigenous patient and family’s background and work to understand how this affects their health needs.
  • Screen children and their families for poverty, vulnerable housing, clean water availability, and other social determinants of health.
  • Partner with Indigenous community organizations to help support high-risk families, through measures such as such as phone check-ins, mental health counselling, food delivery or grocery gift cards, or by ensuring the availability of internet and technology to maintain healthy relationships with isolated family members.

If a patient’s family member is at the end of life (due to COVID-19 or other causes), ensure there is a safe process for families and communities to complete ceremony and death protocols. Help coordinate competing interests from communities, health care institutions, and other Indigenous health organizations.

Not all the same: Patient-level advocacy for specific groups of Indigenous children during COVID-19

Advocacy for Indigenous children requires an understanding of the similarities and differences between and within First Nations, Métis, and Inuit communities, and specific populations within these groups. “Pan-Indigenous” approaches fail to capture how these distinct differences affect child health. For example, the federal government funds public services on reserves, whereas provinces/territories fund these services off reserve. Repeated reports by the Auditor General of Canada and repeated decisions by the Canadian Human Rights Tribunal point to significant and ongoing inequalities in the funding of these services. Table 2 describes distinct challenges for specific groups.

Table 2. Challenges for specific Indigenous groups in Canada
Group Challenges COVID-19 advocacy

First Nations on reserve

Chronic underfunding of basic infrastructure like water, sanitation and internet., social services, health, early childhood programs and education on-reserve

Insufficient health care workforce and inadequate health care supplies

Disruption of traditional health care approaches due to colonialism and in some cases COVID social distancing protocols

Some First Nations have blocked entry into their communities to mitigate COVID infection but this has also disrupted family connections and supports

Continue to apply for funding for services and products First Nations children need through Jordan’s Principle (Toll free 24-hour line: 1-855-JP-CHILD or here)

Develop COVID-19 protection strategies that account for boil water advisories, inadequate sanitation and overcrowding.

Screen for IT connectivity when exploring tele-medicine or discussing socio-educational supports.

First Nations off reserve

Difficulty accessing culturally appropriate healthcare and social services

Lack of service provider awareness of funding structures for health services

Comparatively low federal funding to off-reserve organizations for COVID-19 relief

Connect children and families with local First Nations or Indigenous service providers, such as Friendship Centres.

Familiarize oneself with how to navigate federal funding for health, education, and social services, particularly Non-Insured Health Benefits (NIHB) and Jordan’s Principle that children can access off-reserve.

NIHB has made temporary changes to account for COVID-19 and their updates can be found here.


Inadequate housing, poor ventilation, overcrowding, and food insecurity create conditions for rapid COVID-19 spread

Mandatory 14-day isolation in preparation to return to Nunavut that can create difficulties for families

Disruption of vital health services to communities, including specialist pediatric care

Use the Inuit Child First Initiative to fund to receive funding for health, education, and social services for Inuit children living inside or outside of the Inuit traditional homelands. 

Community providers and tertiary pediatric providers should partner to scale up virtual health visits to prevent out-of-territory movement.

Screen for IT connectivity when exploring tele-medicine or discussing socio-educational supports.


Lack of recognition and identification of specific health needs

Comparatively low funding to Métis communities and organizations for COVID-19 relief

Become aware of specific COVID-19 supports for Métis children and their families provided by provincial Métis organizations: Métis Nation of Alberta, Métis Nation Saskatchewan, ( Manitoba Métis Federation, Métis Nation of Ontario

Urban Indigenous

Difficulty accessing culturally appropriate care

Inability to return to home communities if their nation has restricted visitors or require isolation for visitors from urban centres

Explore the difficulties that these families face if they are not able to return to their home communities and/or visit their families.

Connect children and families with local Indigenous service providers, such as Friendship Centres.

Homeless or vulnerably housed

Inability to effectively isolate or socially distance

Threat of eviction or being asked to leave temporary housing as a precaution against landlords

Screen for homelessness and housing insecurity in youth and families

Be aware of community supports and financial supports available to assist in housing for Indigenous families and youth

Children involved with the child welfare system

Threat of ‘ageing out’ of the system during the COVID-19 pandemic

Potential for increased neglect, psychosocial distress, and witnessed violence during pandemics

Family visitation and other therapeutic supports for children and youth in care can be disrupted due to COVID-19

Discuss extension of services and screen for distress for youth in care.

Screen for neglect and violence, and understand the underlying factors that lead to different forms of maltreatment.

Offer early intervention and social support for families experiencing distress from COVID-19.

Screen for IT access and discuss COVID-19 safe education, socialization and family visits.

COVID-19 has highlighted existing structural inequities and created new challenges for Indigenous children, families, and communities. Despite this, Indigenous families and communities have remained resilient and have raised strong and healthy children for thousands of years. Paediatricians must contribute to justice for all Indigenous children during the COVID-19 pandemic in our offices and hospitals, and recognize continued advocacy will be essential after this crisis. If we fail to do both, then we fail to learn from yet another pandemic, and risk the health and well-being of First Nations, Métis and Inuit children and families across Canada.

Additional resources

Ryan Giroux is Métis from the Métis Nation of Alberta and is a third-year paediatrics resident at the Hospital for Sick Children in Toronto.

Cindy Blackstock is a member of the Gitxsan First Nation who serves as the Executive Director of the First Nations Child and Family Caring Society and is a professor of social work at McGill University.

Radha Jetty is a general paediatrician at the Children’s Hospital of Eastern Ontario in Ottawa and is the chair of the Canadian Paediatric Society's First Nations, Inuit, and Métis Health Committee.

Susan Bennett is the Director of Social Paediatrics at the Children’s Hospital of Eastern Ontario in Ottawa.

Sarah Gander is a general paediatrician in Saint John, New Brunswick and President of the Canadian Paediatric Society’s Social Paediatrics Section.


The Canadian Paediatric Society holds copyright on all information we publish on this blog. For complete details, read our Copyright Policy.


The information on this blog should not be used as a substitute for medical care and advice. The views of blog writers do not necessarily represent the views of the Canadian Paediatric Society.

Last updated: May 28, 2020