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This Handbook provides instructions, information and reference material related to the work of panel members and to the IME process.
Issues affecting the health of immigrants and the immigration process itself are subject to change. Client A foreign national who is seeking to enter Canada, and in accordance with the Immigration and Refugee Protection Act and its Regulations, is required to submit to an IME.
Clinic staff Persons who are working in the panel member’s clinic and may be involved in the immigration medical process. EDE Excessive demand exempt is a category of client who is exempt from assessment of excessive demand.
ELISA Enzyme-linked immunosorbent assay, also known as enzyme immunoassay, which is a blood test for HIV.
Furthered cases Cases that require supplemental medical reports to complete the medical assessment.
Guardian A legal guardian is a person who has custody or who is empowered to act on behalf of another person and has been recognized as such by the competent authorities in the jurisdiction where the status was either recognized or granted. Handbook This Handbook is the standard reference for the orientation and training of panel members. IFHP Interim Federal Health Program: a program funded by CIC that provides limited, temporary coverage of costs related to health care for specific categories of people, including protected persons, refugee claimants, rejected refugee claimants, certain persons detained under the Immigration and Refugee Protection Act (IRPA) and other specified groups.
IMM 0535 Medical Surveillance Undertaking Form, issued to individuals who have undergone their IME in Canada or abroad and have been determined to require medical surveillance by Canadian Public Health Authorities.
IMM 1017 An IME form containing the client’s biodata, IME grading and panel physician declaration. IMM 5544 Supplemental medical and resettlement needs assessment form providing information on the special needs a client may have while settling in Canada. Locum tenens Medical practitioners who replace panel physicians for a short period while they are on vacation, taking training or unable to provide service for other reasons. Panel member A general term that refers to a panel physician, panel radiologist or panel laboratories or specialists authorized by CIC to perform IME-related activities.
Panel physician New term used for a medical doctor designated to perform, grade and submit IMEs.
Panel radiologist A radiologist designated to perform, grade and submit chest x-rays for IMEs. PHLU Public Health Liaison Unit, located in the Health Branch, CIC (the former term was Medical Surveillance Unit).
Protected person – In Canada People who have been determined to be protected persons by the Immigration and Refugee Board of Canada (IRB), or in a Pre-Removal Risk Assessment, and who have been granted permanent residence as a result.
RMO Regional medical office is the location of operations for medical officers who are CIC officials with responsibility for the Canadian immigration health program in a given region.
The IRPA and its accompanying regulations set out the medical requirements that clients must meet in order to come to Canada as temporary or permanent residents.
In addition, the legislation sets out the grounds on which a person may be found to be inadmissible to Canada, including inadmissibility on health grounds. The purpose of this Act is to protect the privacy of individuals with respect to personal information collected by the government and to provide individuals with a right of access to their personal information. Under the Privacy Act, all individuals have the right to the protection of their personal information held by a federal institution. Pursuant to paragraph 8(2)(f) of the Privacy Act, Health Branch has concluded Memoranda of Understanding with certain partner countries on information sharing in order to align our network of panel members, which allows Health Branch to share information about our network with partner countries. The Access to Information Act gives every Canadian citizen, permanent resident and individual or corporation present in Canada the right to access records, in any format, held by a government institution, subject to certain exceptions. The Act is used to access information held by the government apart from an individual’s own personal information. It is not necessary for clients to use the Act to obtain a copy of the results of their own IME. Completion of orientation, which includes reading and understanding this Handbook and participating in discussions with CIC medical personnel.
Completion of training, including eMedical training where and when relevant, which may be done individually or through group activities involving several panel members in locations where they operate in geographic proximity. Designation is not a permanent status and completing the designation process does not create any contract or agency relationship with CIC. CIC immigration officials and medical officers consult one another regularly in order to determine the number of panel members required in a given location. If a panel member relocates his or her practice, that relocation must be brought to the attention of the RMO, as designation as a panel member is related to your location. Complaints or disputes regarding a panel member’s performance may result in termination, depending on the situation. Panel members, depending on their field of work, are authorized to perform IMEs, arrange for diagnostics and investigations, and complete immigration medical forms. Panel members performing IMEs should ensure that they meet CIC-mandated service standards and that there are no conflicts of interest in providing services.
For all clients, the Canadian IME will include an examination by a panel member and a medical assessment by a CIC medical officer. The assessment of whether or not a client is inadmissible on health grounds is based on the health findings identified during the examination by a panel member. Once CIC has designated a laboratory in your area, panel physicians will be required to use this facility.
The eMedical system is a Web-based system implemented by CIC and the DIAC for the electronic recording and transmission of IMEs. Panel physicians are to provide appropriate and timely advice to the client when they discover a serious disease not known to the client. In doing so, they are to uphold professional and ethical standards by referring back to the client’s usual physician or to an appropriate specialist, upon request. The panel member discovers inappropriate activity relative to the provision of IMEs by clinic, office, laboratory or radiology centre staff. To support fraud prevention and the integrity of the IME process, panel members must confirm the identity of the client using an identification document acceptable for the Canadian Immigration medical examination. Panel members or clinic staff must also inform CIC if they suspect that clients are providing false information or attempting to falsify any aspect of the IME. Panel members can proceed with the IME, and CIC will follow up on the concern raised about the individual’s identity and any other report of possible fraud.
Panel members should help prevent fraud by educating their staff on procedures used to verify client identity (refer to Section 4.1 for additional information). Panel members must be aware that clients from some cultures may request special accommodation during the IME. Panel members should try to accommodate personal and cultural sensitivities, while keeping in mind that IME standards must be respected. A panel member who fails to meet the IME performance standards reflects badly on the immigration medical program. If the panel member will have a locum tenens replacing him or her during extended absences, the panel member must give the RMO at least 14 days’ notice, preferably by email. Panel members cannot submit IMEs if their leave information indicates that they are on leave.
Extended or repeated unapproved absences may result in termination of a panel member’s status. For personal and program integrity, they must enter leave dates directly in their personal record. The RMO will update the information in their record in order to track the leave in their system. A statement from the proposed locum indicating that he or she has read this Handbook and agrees with the standards and requirements defined herein. Note: Prior to recommending a particular physician or radiologist as a prospective locum, the panel member must be satisfied that the proposed locum has the qualifications and experience to perform IMEs. If the RMO approves the request, a written response (by letter or email) will be sent to the panel member. The panel member must give the RMO at least 14 days’ notice, preferably by email, for every period of time where the locum will be acting on behalf of the panel member.
Panel members must ensure that the locum has adequate training in IME requirements, reporting procedures and any updates.
The termination of a panel member will automatically cancel prior approvals of a locum for this panel member.
English and French are the official languages of Canada and panel members must be able to communicate with Canadian officials in at least one official language. Panel members should inform CIC of the official language they prefer to use in correspondence. Panel members should inform CIC of the official language and any other language they speak. Panel members should also indicate in the drop-down list in eMedical other languages they speak. When performing IMEs, panel physicians may examine clients who speak neither of the two official languages, nor any other language that the panel physician speaks.
If an interpreter is used, panel members must select and ensure that the interpreter is unbiased and has no connection to the client. The panel member’s unique identifier should be included in all correspondence with CIC. For panel members or their locum tenens performing a paper-based IME, the unique identifier, along with their name, must be clearly readable on each Medical Report (forms IMM 1017 and IMM 5419) and on each chest x-ray.
Each photo attached to the Medical Report (IMM 1017) must be stamped to confirm the identity of the client.
Panel radiologists may embed this information on the chest x-ray along with other required information about the client. Forms, documents and results of investigations required for the completion of IMEs are the property of CIC. Panel members who perform IME-related activities must follow the procedures below for copies and files as well as for original documents and information. Original documents and information related to an IME must be forwarded to the responsible RMO electronically. Original documents and information related to an IME must be forwarded to the responsible RMO by regular mail or commercial courier and must never be given to the client for delivery to the RMO.
Panel physicians are required to keep copies and records of files for at least 2 years and in compliance with their local regulatory and licensing requirements. Regular contact will be maintained between panel members and RMOs regarding both medical and administrative issues.
Written correspondence, such as letters, faxes or email, is preferred, but the telephone can be used when necessary (see Appendix I for RMOs’ addresses and contact information).
Information about IME fees, services included in the fees, clinic’s address and contact information may be included in the advertisement. On occasion, the media may become interested in the IME of a particular individual and contact the panel member for information. Panel members should never communicate confidential information they are privy to with respect to the immigration system or to individual clients. Clients may have questions about the immigration process, particularly when CIC officials request additional medical information or investigations. These questions should be addressed to the immigration or visa office responsible for the case.
If panel members have non-eMedical-related questions regarding IMEs, they may contact their RMO listed in Appendix I. Panel members who have questions about eMedical should consult the eMedical System User Guides and Quick Reference Guides. Panel members in Canada should refer to Chapter 5 for instructions regarding requirements and fees for refugee claimants under the Interim Federal Health Program (IFHP). Clear and transparent procedures for responding to complaints and resolving disputes improve client service and the integrity of the immigration medical program. If, during an IME, a panel member has a disagreement with a client, or confusion arises or an event occurs that might compromise client service, panel members should report these incidents to the RMO. The panel member feels that reporting a one of a kind situation may benefit the program or increase other panel members’ knowledge. Reports to the RMO should include the date of the incident, the client’s IME, UMI or UCI number and a brief description of the incident. CIC’s Health Branch will consider the opinions and viewpoints of panel members and of anyone submitting a complaint or critical comment. Health Branch officers will occasionally visit panel members to ensure the quality of their work. Failure to meet performance standards may result in termination of the panel member’s designation.
Continued failure to maintain an acceptable level of performance as set out in this Handbook or in accordance with written instructions from the RMO. For serious complaints, such as harassment, sexual misconduct or illegal activities, the RMO will suspend the panel member, issue a letter summarizing the facts that gave rise to the complaint and provide the panel member with an opportunity to reply. However, if the panel member’s designation is terminated because of performance deficiencies or complaints, there is no transition period and the termination is effective as of the date of the notification letter sent by the RMO.
CIC will consider all requests for reconsideration and make every effort to provide panel members with a written reply within 30 days of the receipt of their request for reconsideration.
This chapter provides panel members with a step-by-step method for completing an IME and associated forms. The IME consists of a medical history, physical examination, age-specific laboratory tests and age-specific chest x-ray. With the launch of eMedical, the IME will be conducted, where technologically feasible, in a Web-based computer program designed for the electronic recording, transmission, processing and temporary storage of the IME and its associated results. Panel members performing IMEs in a region where eMedical has been implemented must use the system to complete and submit all IMEs. Differences between the paper process and the eMedical process have been pointed out throughout this document. IME paper forms have been redesigned to ensure consistency between eMedical IMEs and paper-based IMEs.
Client photographs are essential for ensuring that there is no substitution at any time during the lifecycle of the IME and that the person who undergoes the IME is the same person who is applying for entry to Canada. The eMedical system will include the photograph on all requisitions and referrals (laboratory, radiology, specialists and others). If the photographs do not meet the specifications, ask the client to provide new photographs before their IME can be completed. The photograph on the Medical Report (IMM 1017) must be stamped in the top right corner with the panel physician’s ID stamp.
The client must submit a passport or other identification document acceptable for the Canadian Immigration medical examination. Important: To ensure the integrity of the IME process, the same identity document must be used for all components of the IME, including laboratory, radiology and specialist referrals. If the client provides personal details that seem inconsistent with the information on the submitted identity documents, panel members must identify the concern in the eMedical system or on the IMM 1017 – Medical Report (Client Biodata and Summary) for paper-based IMEs.
Photocopies of the identification document concerned must be attached to the IME and submitted to CIC.
Consent for the collection and release of IME information related to the administration of Canada’s IRPA or to the protection of the health and safety of Canadians. If a client does not give consent, the IME cannot be carried out and the panel physician must notify the responsible RMO.
Clinic staff or a panel member should review the Consent and Declaration form with the client and answer any questions. CIC has implemented one standard form, the Medical Report: Client Biodata and Summary (IMM 1017), for all immigration categories. EDE clients are those who are exempted from assessment of excessive demand on the Canadian health care system.
Note: Panel physicians must complete and submit, either electronically or on paper, the IMM 5544 Resettlement Needs Assessment Form. Note: EDE clients include refugees, refugee claimants and certain family classes and individuals with protected person status. The Medical Report (IMM 1017) form is typically issued by CIC with the client information and immigration information sections completed. Clients who have been issued a Medical Report (IMM 1017) must present the form to the panel clinic when presenting themselves for their IMEs. Clinic staff will search for the client health case in eMedical using the IME# (search may also be done using client name and passport number, or UCI# or UMI#).
A live photo of the client is taken and uploaded to eMedical to verify identity throughout the life cycle of the IME.
Clinic staff must attach a client photo (provided by the client) to the Medical Report (IMM 1017). The Medical Report (IMM 1017) will be completed and submitted along with all other IME forms. Clients who are being processed as refugees overseas will have a Resettlement Needs Assessment (IMM 5544) form issued to them along with their IMM 1017 by a Visa Office (VO).
Refer to the IMEI on the Resettlement Needs Assessment (IMM 5544) for detailed instructions on completing the form. UFM examinations are performed when clients report to a panel physician for their IME before a visa application has been submitted to CIC.
Panel physicians must ensure that they provide the client with the proof of having completed their upfront medical examination. Since an IME is valid for 12 months, panel physicians should remind clients to submit their visa application along with the proof of having completed their upfront medical examination well before the expiration of the 12 months; otherwise, the client may have to undergo a second IME.
Enter the Client personal details (mandatory fields include Title, Family name, Gender, Date of birth and Country of birth). Panel physicians will use IMM 1017B Upfront paper forms, which have been provided to them and that are pre- populated with a UMI# and a barcode (see sample form in Appendix III). Clinic staff must select the immigration category by checking the appropriate box (student, worker, visitor, family EDE or refugee claimant (in Canada only)). Note: It is very important to ensure the correct page goes to the client and the correct page goes to your RMO. Grade A indicates that there are no abnormal findings present and no significant abnormal history. Panel physicians must provide this information in the comments section or they may attach a report to the IME.
The following table lists additional requirements when the answers to medical history questions show abnormality, whether the IME is completed in eMedical or on paper. Congo's conflict minerals leave a trail of destruction as they make their way from the mines to your moblie phone. Our demand for conflict minerals in electronics and jewelry fuels the world's deadliest war.
Companies that produce electronics that could contain conflict minerals from eastern Congo have a responsibility to ensure that their business dealings are not inadvertently helping to fuel atrocities. Bringing transparency to the consumer electronics supply chain will be a significant first step toward transforming Congo’s rich mineral resources, from a fuel for violence into an engine of empowerment for the millions of people caught up in the conflict and all those dependent upon the meager livelihoods they earn in mines throughout eastern Congo. Finally, any effort to address the conflict minerals problem must be wed to a broader strategy to generate the political will in Congo and among its neighbors to find diplomatic solutions to the local, national, and regional tensions that have proliferated over the past 15 years.
The majority of the violence in eastern Congo has been carried out in mineral-rich areas of the eastern provinces of North and South Kivu and Orientale. Estimating the profits that armed groups earn from the minerals trade is a challenging endeavor, given the difficulty of obtaining reliable data for a trade that is rife with smuggling and deliberate efforts by those who profit from the illicit trade to cover their paper trail.

Mining sites are spread across a vast swathe of eastern Congo and run the gamut from large-scale operations such as Bisie mine in Walikale territory, which employs approximately 2,000 miners, to scattered holes in the ground mined by just a handful of workers. Exacting bribes and taxes from transporters, local and international buyers, and at border controls. The link between armed groups and the mineral trade has been extensively documented by the United Nations and NGOs.
From eastern Congo, minerals are transported through neighboring countries including Rwanda, Uganda, and Burundi. Actions to address the conflict in eastern Congo have largely been reactive and incommensurate to the scale of the problem. The Congolese government lacks meaningful control over the mineral-rich areas of the Kivus and neighboring provinces.
Although Congolese authorities may need resources and expertise to help ensure that the country’s mineral wealth benefits the state and its citizens rather than armed groups and criminal networks, capacity is only part of the story.
A range of international efforts have endeavored to address Congo’s conflict minerals. The prospect of imposing sanctions on minerals emanating from conflict-ridden areas of eastern Congo has proved controversial. A potentially promising long-term initiative has been championed by the German government and the G-8: the development of Certified Trading Chains, or CTCs, with legitimate mining sites linked to international purchasers. In addition to the above efforts to break the link between conflict and trade in natural resources, substantial international assistance has been directed toward building the capacity of Congolese institutions. Certification programs and development efforts hold out the possibility of technical or developmental solutions, but they must be implemented with the understanding that the problem is fundamentally a political one. Regional politics complicate the question of Congo’s conflict minerals but also offer the best prospects for a long-term solution to this issue. The reform of Congolese institutions is a long-term goal, but critical prerequisites and first steps can be undertaken in the next 12 months. There are four intertwined components to a new strategy to reduce the trade in conflict minerals and help empower the Congolese state and its citizens that should be carried out in conjunction with vigorous enforcement of strengthened sanctions against the individuals and middlemen buying minerals from armed groups.
Lessons from other campaigns show that when pressured, these end user companies can dramatically influence middle companies further down the supply chain (suppliers, smelters, etc). International advocacy and corporate engagement on this issue has already started in Europe thanks to the work of the NGO coalition, Make IT Fair. Building on these efforts, consumers and activists need to demand independently verifiable supply chain audits to ensure that products are indeed conflict-free. There are two keys to an effective system: compelling the key players in the supply chain to work together to create a tracing system, and implementing credible monitoring of the system by independent third parties.
Although altering the risk calculations and business practices of companies along the supply chain has the potential to positively impact the economic incentives that sustain the conflict, it also runs the risk of unanticipated consequences.
Companies operating at the critical chokepoints in the mineral supply chain will need to feel the costs of continuing the status quo in order to embrace the benefits of more responsible behavior. Industry should trace and audit their supply chains: Companies, particularly those in the electronics industry, should trace the 3Ts and gold in their products down to the mine of origin. Governments should buttress supply chain action: The United States and other governments should vigorously support implementation of the Security Council Resolution 1857.
Changing this situation requires physically securing the major mines and wresting them away from the control of armed groups.
In the short-term, poorly planned action by ill-disciplined Congolese forces incapable of protecting civilians or actually holding FDLR territory will only compound already dire circumstances in Congo. Lueshe Pyrochlore Mine, Rutshuru District, North Kivu: Now under the control of the Congolese Army and CNDP. Bisembe, Mwenga Territory, South Kivu: Mines around Mwenga are controlled militarily and economically by the FDLR, who have established a mini-state in this region of South Kivu. Other important mining areas include the Misisi gold mine in Fizi, South Kivu, tin, tantalum and gold mines in Ziralo, Kalehe South Kivu and the gold mines around Ksugho in North Kivu’s Lubero territory. Congo’s mineral wealth enriches networks composed of local and international businessmen, militia leaders, and politicians who benefit from resources that should form the basis for a legitimate state authority. The international community should work hand in hand with the Congolese government to forge the political will and capacity to exercise control over mining and commerce in eastern Congo. Dialogue to forge political will for reform: The United States and MONUC should work with international and Congolese partners to begin an inclusive process of dialogue around mineral trade reform in eastern Congo.
Donor coordination around a joint effort to support reform: Piecemeal reform and uncoordinated interventions should give way to coordinated international cooperation to support legitimate trade in minerals. Regional export harmonization to remove incentives for smuggling via neighboring countries: Due to drastically different tariff rates, exporting a container of tin ore from Rwanda costs $200 in taxes, while exporting the same container from the DRC costs $6,500. Impoverished Congolese miners and their families are often entirely dependent on their meager income from mining, and they currently have few viable economic alternatives to lift them out of this indentured servitude.
Infrastructure: The World Bank and donor countries should work to help reconstruct the roads that will reconnect eastern Congo with trade routes to western Congo and the Rift Valley so that other sectors can benefit from trade.
Breaking the stranglehold of corruption and violence in eastern Congo will not be easy, nor will helping Congolese build legitimate institutions that represent their interests. David Sullivan of the Enough Project and Sasha Lezhnev of the Grassroots Reconciliation Group were the lead researchers on this report. It is our hope that continued dialogue and consultation on the profits reaped by armed groups from the conflict minerals trade will help researchers, policymakers, and industry develop more accurate, transparent, and reliable figures.
The data on armed groups' profits from the conflict minerals trade is estimated based on four main sources.
As a starting point for the 3Ts, we use the official 2008 Division of Mines data for North Kivu and Private Sector Federation data for South Kivu as a starting point for the 3T minerals, as reported by Garrett and Mitchell in April 2009. 7  According to Africa Confidential, the Pole Institute published this information in 2008. 23  The International Court of Justice ruled in 2005 that Uganda should pay reparations to the Congolese government for violating the principles of nonintervention with its armed forces from 1993-2003. 24  International Conference on the Great Lakes Region Pact on Security, Stability, and Development in the Great Lakes Region. 36  Tin production in DRC has been lower in previous years (likely closer to 20,000 tons in 2007) but the real figure could be higher due to misreporting by DRC government agencies. 37  These figures are based on officially reported figures from the Division of Mines of the DRC Government, or DM, plus an estimated 35 percent rate of underdeclaration by the official agencies.
The DM reports 12,502,000 kilograms for North Kivu and 4,196,000 kgs for South Kivu for the first 11 months of 2008. 40  The official DRC Ministry of Mines reports 56,000 kgs for North Kivu and 295,000 kgs for South Kivu for the first 11 months of 2008. Business impact analysis (BIA) is a systematic process to determine and evaluate the potential effects of an interruption to critical business operations as a result of a disaster, accident or emergency.
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As part of a disaster recovery plan, a BIA is likely to identify costs linked to failures, such as loss of cash flow, replacement of equipment, salaries paid to catch up with a backlog of work, loss of profits, staff and data, and so on. Business impact analysis and risk assessment are two important steps in a business continuity plan. A risk assessment identifies potential hazards such as a hurricane, earthquake, fire, supplier failure, utility outage or cyber attack and evaluates areas of vulnerability should the hazard occurs. During the risk assessment phase, the BIA findings may be examined against various hazard scenarios, and potential disruptions may be prioritized based on the hazarda€™s probability and the likelihood of adverse impact to business operations.
An organization may elect to outsource the BIA to a skilled third party or may include internal and external staff on the project team. A detailed questionnaire or survey is commonly developed to identify critical business processes, resources, relationships and other information that will be essential in assessing the potential impact of a disruptive event. The information gathered may include a description of the principle activities that the business units perform, subjective rankings of the importance of specific processes, names or organizations that depend on the processes for normal operations, estimates of the quantitative impact associated with a specific business function and the non-financial impact of the loss of the function, critical information systems and their users, the staff members needed to recover important systems, and the time and steps required for a business unit to recover to a normal working state. Questions to explore during the discovery phase include interdependencies between systems, business processes and departments, the significance of the risk of points of failure, responsibilities associated with service-level agreements, staff and space that may be required at a recovery site, special supplies or communication equipment needed, and cash management and liquidity necessary for recovery. Human and technology resources needed to support the process including computers, networks, offices, people, etc. A description of the customer impact of external facing or inward facing processes, and a list of departments that depend on the process outputs.
Description of workaround procedures or work shifting options to other departments or remote workers as applicable. A BIA for information technology might start with the identification of applications supporting essential business functions, interdependencies between existing systems, possible failure points, and costs associated with the system failure. When information gathering is complete, the review phase begins in consultation with business leaders who can validate the findings. The goals of the BIA analysis phase are to determine the most crucial business functions and systems, the staff and technology resources needed for operations to run optimally, and the time frame within which the functions need to be recovered for the organization to restore operations as close as possible to a normal working state. Challenges include determining the revenue impact of a business function and quantifying the long-term impact of losses in market share, business image or customers.
The business impact analysis report typically includes an executive summary, information on the methodology for data gathering and analysis, detailed findings on the various business units and functional areas, charts and diagrams to illustrate potential losses, and recommendations for recovery. Senior management reviews the report to devise a business continuity plan and disaster recovery strategy that takes into account maximum permissible downtime for important business functions and acceptable losses in areas such as data, finances and reputation. Cold storage is the retention of inactive data that an organization rarely, if ever, expects to access.
A data center migration plan is a strategy created by an organization to migrate a data center with minimal downtime. With Azure VM backup, virtual machines can run in the cloud while a business gets back on its feet.
32 page MS Word template and 7 Excel spreadsheets as well as Business Impact Analysis, Damage Assessment Report and Test Report templates. Disaster Recovery Template: Benefits This Disaster Recovery Plan will help you establish procedures to recover systems following a disruption.
These responsibilities include management of the panel members (including panel physicians, panel radiologists and laboratories) who perform immigration medical examinations (IMEs) in Canada and abroad.
In providing these services, the RMOs rely on the IMEs that panel members conduct on clients for permanent residency and some categories of temporary residency in Canada.
As part of its modernization agenda, CIC has implemented an electronic IME Web-based processing system called eMedical.
Panel members may include physicians, radiologists, laboratories and other designated health care professionals involved in the IME process. All panel members must ensure that they remain familiar with it and with departmental instructions, including interim changes and updates provided by CIC. Panel members should be aware of the following legislation as it relates to immigration and the requirements with respect to medical examinations and inadmissibility on health grounds. One of the objectives is to ensure that the movement of people into Canada contributes to the country’s cultural, social, and economic interests and affirms its humanitarian commitments, while protecting the health, safety and security of Canadians. Moreover, Canadian citizens, permanent residents and other individuals present in Canada have the right of access to their own personal information held by government institutions. Subsection 8(1) states that the government institution shall not disclose personal information without the consent of the individual to whom the information relates except under the circumstances provided under subsection 8(2).
Health Branch requests that all panel physicians sign a consent form to share information with other immigration health authorities. Panel physicians are authorized to provide clients with a copy of their own IME upon the clients’ request. Based on CIC’s operational requirements, the number of designated panel members in any given location may be reduced or increased.
They do not have the authority to assess or determine whether the medical conditions of clients are grounds for inadmissibility. They are also required to help prevent fraud and abuse of Canada’s immigration laws, submit to performance evaluations, follow proper procedures for absences, and use English or French in their communications with CIC. Where necessary to establish compliance with the IRPA and the Immigration and Refugee Protection Regulations, clients will be asked to undergo further medical examinations.
In regions where eMedical is available, panel members and their clinic staff will be required to complete all IMEs and enter the results in the eMedical system, unless otherwise specified by the responsible RMO. Panel members are expected to exhibit professional behaviour and perform their IME-related activities in a manner that is in keeping with the principles of proper medical practice and with CIC policy.
Female clients, for example, may be uncomfortable with a male examiner, in which case panel members should offer to have a chaperone present during the examination. In such cases, panel members will indicate on the examination form the type of accommodation provided and the names of other persons present during the examination. Consequently, the panel member’s inclusion in the panel member network may be terminated. The procedure for completing the IME is discussed in Chapter 4 and is also subject to performance evaluation. This will allow the RMO to activate the locum’s P number allowing him or her to use eMedical. The panel member will then notify the locum that he or she has been authorized to provide services.
This unique identifier will replace the designated medical practitioner stamp that was previously used. For panel members, the eMedical logon information will be linked electronically to the panel member’s unique identifier. When documents are sent by courier, panel physicians must ensure that the IME forms and results are sent in appropriate order (refer to Appendix V for instructions) and should retain shipment tracking numbers for six months. It may not be used for other purposes, including research, clinical studies or investigations, without appropriate consent of the client and CIC. RMOs are the points of contact for panel members to address inquiries, questions and comments about individual immigration medical cases, examinations and about the immigration medial program. These officials may be seeking information about local health conditions, medical resources for consular services or help with a personal medical condition.
Under no circumstances should a panel member provide the media with information about a particular case.
This section explains how CIC will deal with incidents, complaints and quality assurance concerns. Complaints regarding the IME and related services may arise from clients or other persons outside CIC. While the panel member’s designation is suspended, IME activities by the panel member cease until the panel member is notified that he or she has been reinstated by CIC. If the response is deemed satisfactory, the panel member will be informed of the decision and be reinstated with appropriate recommendations. Panel members should send written notification to the RMO, including the anticipated date on which activity will cease. Photographs must be attached and submitted with the IME whether the IME is completed in eMedical or on paper.
Clients who are eligible for UFM examinations will not have a Medical Report (IMM 1017) issued by CIC nor will they have an existing file in the eMedical system.
Note: For refugee claimants in Canada, select the category family EDE, and scan and attach the document provided by the client. The Democratic Republic of the Congo, scene of the deadliest conflict since World War II, remains the most dangerous place in the world to be a woman or a girl—in significant part because of the international demand for electronic products that requires minerals found in the eastern Congo. The United States and other policymakers and activists can decisively alter these dynamics by focusing their attention on the international dimension of the trade in conflict minerals, and by ensuring that peacemaking efforts address the long-neglected political economy of the conflict.
Transparency and accountability must extend across borders to include other governments in the region. The percentage of world production of these minerals coming from Congo varies by substance. However, based on available data, we estimate that in 2008 armed groups in Congo earned approximately $185 million from the trade. All of the mining in conflict areas is artisanal—it uses manual labor, simple tools, and only the most basic of technologies. Other key areas rich in natural resources include Katanga, which has large-scale copper and cobalt mines, and the diamond-rich Kasai province. The mining sector is also controversial, especially given the high profile role of Western and Chinese investments. This begins with road blocks just outside the mining sites, but also includes co-opting those state institutions that are present in eastern Congo as well as local traditional authorities.
There remains a significant discrepancy between the legal framework that ostensibly governs mining and trade in Congo and practices on the ground. The World Bank has developed a comprehensive plan for Growth with Governance in the Mining Sector, and donor agencies, including the U.S. Eastern Congo’s mineral wealth travels to international markets via well-documented trading routes through neighboring states, notably Rwanda and Uganda. The German government has now situated technical advisors on mineral certification within the secretariat of the conference in Bujumbura, Burundi, a commendable first step toward encouraging a regional approach.
But if the Congolese and regional governments, the international community, and the private sector can align their efforts on the common goal of a revitalized legitimate mineral trade in eastern Congo, it would have a major impact in resolving the conflict.
Action must be taken to prevent the flight of investment away from Congo and to harness the potential of the private sector to contribute to recovery in the East. The ability of end users to trace and audit the supply chains for the metal components in their electronics products is a critical step to channeling international demand away from armed groups and toward legitimate sources. Wal-Mart, for example, was able to influence its suppliers in China to change their packaging practices. This should not be a boycott of Congolese minerals, but rather more stringent requirements for purchasing of minerals so that consumers can be credibly assured that armed groups are not benefiting from illicit activity or the subjugation of local populations. If international companies simply walk away from Congo and the market for all its minerals dries up, this could make the situation on the ground worse. It is understandable that end user companies may not currently have this information, but they should work closely with their suppliers and smelting companies to obtain this information, as the alternative is continued demand for conflict minerals. This should include increased targeted sanctions, as well as legislation to require independent audits, tracing of minerals to mine of origin, and other stringent due diligence. Group of Experts has documented how armed groups on all sides of the conflict, including the Congolese military, profit from resource exploitation and threaten the local population.
Former CNDP, Mai Mai groups, and non-integrated army brigades may be best dealt with via security sector reform. One of the few industrial mining sites in the Kivus, produces Niobium, which is closely related to Tantalum. Securing this area will require significant efforts to sever the FDLR’s military and administrative control, and should only be considered with ample planning, including provisions to protect civilians. To the maximum extent possible, this should be carried out via negotiation and with positive incentives for commanders willing to relinquish their hold over these sites and enter into DDR programs.
State building efforts in eastern Congo have focused on the most basic aspects of extending the writ of the state – putting select roads under the control of government authorities. The building blocks of such an effort are outlined in the World Bank strategy, but require a greater focus on the particular dimensions of the resource conflict in the eastern provinces. The Certified Trading Chain concept developed by the German government provides a useful frame for such an initiative, but prioritization of locally led efforts and Congolese institutions must be the priority. This authority could be made up of Congolese and international technocrats and oversee the provincial mining authorities in North and South Kivu. Miners also face incredibly difficult and dangerous physical conditions in carrying out their work.

Infrastructure projects with guaranteed labor at decent wages can help lure miners out of conflict mines and create opportunities for demobilized combatants. Private investment can be a part of the solution if a tracing mechanism is in place and appropriate standards are observed. These have involved innovative public-private partnerships, such as that between USAID, the jeweler Tiffany, and the Foundation for Environmental Security and Sustainability.
But consumers and their elected representatives have the opportunity to decisively alter the dynamics of conflict in the Great Lakes Region by finally focusing international attention on the economic drivers of this human rights catastrophe.
The calculations provided here are well-educated estimates, and we welcome any insight others can provide on the topic.
We start with a recognition that this trade is difficult to track with precise detail because of the frequent underreporting of both quantity and price by official Congolese government official agencies—as numerous research reports have documented. As the Pole Institute and others have highlighted, the majority of the 3T minerals are not smuggled, but rather are underreported. In North Kivu, FDLR controls many gold-mining pits based in the jungle west of the town of Lubero. The figures of 18,412,000 and 6,180,000 factor in one additional month and the 35 percent underdeclaration rate. For 2007, Garrett cites 12,754.56 tons from North Kivu based on six plane-loads per day carrying two tons each leaving the Walikale mining area for Goma, and a further 4,115 tons arriving in from Goma from other areas of North Kivu. Future percentages could fluctuate from 10-25 percent as well depending on prices, production in other areas of the world such as Australia, and corporate buying patterns.
The official DM reports 441,000 kilograms for North Kivu and 56,000 kgs for South Kivu for the first 11 months of 2008. A BIA is an essential component of an organization's business continuance plan; it includes an exploratory component to reveal any vulnerabilities and a planning component to develop strategies for minimizing risk.
For the past 13 years, we've honored the best and brightest technologies for the upcoming year. A BIA report quantifies the importance of business components and suggests appropriate fund allocation for measures to protect them. Assets put at risk include people, property, supply chain, information technology, business reputation and contract obligations. A BIA may be used to justify investments in prevention and mitigation, as well as disaster recovery strategies. A spreadsheet may be used to store and organize information such as interview details, business process descriptions, estimated costs, and expected recovery timeframes and equipment inventories.
Impacts to consider include delayed sales or income, increased labor expenses, regulatory fines, contractual penalties and customer dissatisfaction.
The report prioritizes the most important business functions, examines the impact of business interruptions, specifies legal and regulatory requirements, details acceptable levels of downtime and losses, and lists the RTOs and RPOs. Senior managers need to review and update the BIA periodically as business operations change. If you reside outside of the United States, you consent to having your personal data transferred to and processed in the United States.
It describes the IT framework and procedures to be activated in the event of a disaster occurring. Health findings on the IMEs allow CIC medical officers to make recommendations on the medical admissibility of persons requesting entry to Canada. The information to be shared will not be related to individual clients or a specific type of care; rather it will be generic information concerning administrative (such as email, contact addresses) and operational activities (such as electronic capabilities, locations) as well as information gathered during evaluations, assessments or onsite visits by CIC officers. Upon examination of the new location of the practice and an assessment of the operational requirement for panel members in that location, the affected panel member will be informed of a decision confirming his or her status and given an opportunity to respond. More specifically, panel members do not have authority to give clients an opinion on their medical admissibility. The panel member’s unique identifier will be embedded electronically in each IME or chest x-ray they submit through eMedical.
The eMedical logon ID must not be disclosed to any other person or used by any other person to submit IMEs or chest x-rays. Such requests are not related to the immigration medical program and panel physicians may respond to these inquiries as they choose. Consequently, the fees for IMEs may vary from country to country and even within a country. In addition, CIC personnel may provide critical comments or notifications of errors, performance issues or situations of concern regarding the IME and related services. If the response is unsatisfactory, the panel member’s designation will be terminated.
Panel physicians who are terminated because of operational needs will be notified in writing by the RMO at least 30 days prior to any such change in the network.
Only in the event of a system outage should paper IMEs be used by eMedical-enabled panel members.
If the client or clinic staff completes it, the panel physician must review and confirm the information provided.
Electronics companies can pressure their suppliers and trace the minerals they use to ensure they do not originate from mines that are financing armed groups and criminal interests.
In remote areas that remain beyond the control of the Congolese state, the armed groups that perpetrate the violence also control much of the minerals trade. In many ways, this is a well-educated guess, and we hope that this figure and our calculations can initiate a broader, more detailed exploration that leads to greater transparency. The Congolese government has been conducting a comprehensive review and renegotiation of all mining contracts since 2007. Group of Experts report in December 2008 cited that the FDLR controls the majority of mines in South Kivu.
Other private companies have also stated that the technologies exist to trace tin and other metals, utilizing isotope testing. Agency for International Development, or USAID, and DFID have developed a joint initiative known as Trading for Peace, which seeks to use the trade in natural resources to build peace in the region.
Likewise, if development efforts are not coupled with a political strategy to isolate the more egregious actors and make trading with rights abusers’ unacceptable behavior, they risk legitimizing the status quo and harming the civilians they seek to help. From 1998 to 2003, both states occupied and systematically looted large swathes of the Congo. Although the United States has played an important leadership role in facilitating political negotiations aimed at resolving chronic conflict in eastern Congo, it has largely abdicated responsibility for addressing the economics that perpetuate the conflict.
Although the effects of the global economic downturn pose a threat to Congo at the moment, they also present an opportunity to sow the seeds of reform. Campaign strategists have further highlighted that campaigns focusing on consumer companies and visible brands resonate with a much wider public and therefore have a higher chance of success. Companies currently only provide vague written assurances from suppliers that they do traffic in Congo’s conflict minerals. Numerous industry sources have confirmed in interviews that tracing these minerals is possible.
Out–of-work miners could be tempted to swell the ranks of the armed groups in order to secure their livelihoods. They should also have independent audits conducted of their supply chains that show chain of custody for each step along the 3T mineral supply chain. These efforts are unlikely to completely demilitarize the mining sector in the short-run, but have the best prospects of shifting the status quo toward fostering legitimate trade in the medium-term. MONUC should collaborate with the government of Congo in identifying key mining sites under the control of armed groups. Such initiatives will require a far more robust approach than prior Congolese demobilization programs, which have wound up providing cover for continued coercive minerals exploitation without reducing its militarization. While this is an important first step, such efforts will prove unsustainable without a revenue base for local and provincial authorities.
Congo’s endemic corruption and the highly sophisticated networks that dominate the mineral trade are sizeable obstacles to reform.
Over a three- to five-year period, a mining authority would provide greater regulation of the mineral trade, improve revenue collection, and work with existing government agencies to develop a cadre of mining and customs officials capable of handling these tasks on their own. Each Great Lakes country has a large potential interest in a legitimate minerals trade, and the United States and international community should work with these states to build mutually reinforcing export tax regimes.
These factors make it all the more important to manage reform efforts in such a way that it does not make life even more difficult for these miners and their families.
Other livelihood initiatives, such as small business development projects, should also be promoted. Achieving them will require coherence and commitment from both the Congolese government and the international community. That said, extensive field research has been conducted on this issue over the past three years, which we believe provides the basis for a reasonable estimated range of profit sharing.
Second, we use Garrett and Mitchell's rate of 35 percent underreporting of amounts of export by weight for the 3Ts.
Geological Survey specialists in tin, Central Africa, and tantalum, February 2009; Interview with Resource Consulting Services, February 2009. Factoring in the underdeclaration rate of 35 percent, this totals 880,000 tons for the Kivus.
The result is a business impact analysis report, which describes the potential risks specific to the organization studied. As always, we are proud to present a batch of technologies we believe will make a big impact on the data storage market technology. The possibilities of failures are likely to be assessed in terms of their impacts in areas such as safety, finances, marketing, business reputation, legal compliance and quality assurance.
The BIA focuses on the effects or consequences of the interruption to critical business functions and attempts to quantify the financial and non-financial costs associated with a disaster. Information can be collected in a variety of ways, including in-person interviews and automated surveys. Panel members working in countries where eMedical is implemented will need to complete and transmit all IMEs through this Web-based system.
In all cases, the online version of the Handbook will be the most current and is the version that should be consulted. Questions and information on specific cases should always include identification details, such as the IME, unique medical identifier (UMI) or unique client identifier (UCI) number along with the client’s date of birth. If a panel member is completing a paper-based IME that must be mailed to the RMO, he or she should discuss the method and cost of sending the documents with the client beforehand.
Affected panel members will receive a letter of concern from the RMO and be given an opportunity to reply to the complaint. Consumers and global citizens have a critical role to play in demanding that companies and governments exercise leverage over the supply chain to end the trade in Congo’s conflict minerals.
By the same token, Congo’s neighbors have legitimate security concerns and economic interests in eastern Congo, and a more even-handed approach to these regional actors from the United States and its allies is vital to address these security concerns, ending the prominent role these states continue to play in the destructive conflict minerals trade, and promoting the rule of law in Congo and beyond. In a statement announcing its closure, the Australian mining company Talison attributed its decision to the inability to compete with cut-rate production from Central Africa, particularly from the Democratic Republic of the Congo where the trade in conflict minerals thrives.3 For tungsten, Congo remains a minor player at only 2 to 4 percent of world production.
For a detailed breakdown of the calculations used to arrive at this estimate, see Appendix 2. Even in Katanga province, home to the copper and cobalt mines that dominate the mining sector, much of the current production is artisanal and large-scale industrial operations remain predominantly in the exploration phase. This was scheduled to be completed in April 2009, but was extended for an additional six months. In 2004, following the imposition of an arms embargo and targeted sanctions regime for Congo, the Security Council established a second Group of Experts with a more narrow focus on monitoring the provisions of the sanctions regime.
However, implementing this initiative would entail huge challenges in terms of logistics, political opposition, and costs. Trading for Peace has recently published a reform agenda that encapsulates many of the elements necessary to help legitimize regional trade, but such development efforts will have to be married to a viable political strategy if they are to achieve critical mass.
These initiatives can and should complement a political strategy, but they cannot act as a substitute for it. An effective public campaign on the electronics industry should have a multiplier effect on the other key industries in changing their calculations.
Mitigating these effects requires not only comprehensive support to legitimize the mining sector in Congo, but also outreach to those companies in the supply chain who have a vested interest in the survival of the market for Congolese minerals. State mining inspectors are intimidated or co-opted by armed groups and are incapable of reigning in these activities. A mutually acceptable security context around the mineral trade in eastern Congo is a critical component of a lasting détente between Kinshasa and Kigali, and the international community has an opportunity in the wake of recent events to support solutions that benefit ordinary Congolese. In contrast, operations against the FDLR will require much more military strength in a concentrated effort to weaken the FDLR leadership, deny them access to minerals wealth, encourage defections, and protect civilians from reprisals. Such efforts should not focus on any one militia, but instead should be selected based on size, proximity to transit routes, and the ability of MONUC or trained and vetted Congolese forces to maintain their security. With thorough vetting to screen for human rights abusers, and following a significant training process, the rank-and-file from armed groups should become eligible for integration into security services. Bringing part of the mining economy under state control could provide this much-needed base of support and would develop a highly visible legitimate mineral trade upon which substantial international support could be focused. But with the Congolese government on the verge of a balance-of-payments crisis and sorely in need of emergency funds from the World Bank, the International Monetary Fund and donor governments, the international community has an opportunity to press for not just commitments but demonstrable reforms to the regulation of mining, commerce, and taxation regimes. The exact nature and extent of such an initiative must flow from dialogue and coordination. This could be developed under the Great Lakes Regional Pact and Protocol on Natural Resources, a legislative instrument signed by all the relevant heads of state.
Efforts to end the trade in conflict minerals absolutely must be accompanied by international support for livelihoods and economic opportunities in eastern Congo. But efforts won’t succeed unless individual consumers in the United States and around the world step up and demand a change. The 2007 official export figures from the Congolese Ministry of Mines are 10,175.2 for North Kivu and 4,731 for South Kivu.
However, the DM officially reported 767,000 kgs for North Kivu in 2007, and other government agencies reported even higher figures, meaning that the real amounts could be up to 1,500 tons. Bates and Sunman, who in a major report for DFID based on Pole's research, estimated gold export from South Kivu to be around 5,000 kgs. One of the basic assumptions behind BIA is that every component of the organization is reliant upon the continued functioning of every other component, but that some are more crucial than others and require a greater allocation of funds in the wake of a disaster.
The business impact assessment looks at the parts of the organization that are most crucial.
A mitigation strategy may be developed to reduce the probability that a hazard will have a significant impact. To avoid possible breaches of confidentiality, information requests should never identify a client by name.
In accordance with the principles of natural justice and procedural fairness, privacy rules will not be breached when sharing the content of the complaint. Unfortunately, under the current Congolese legal framework, all artisanal mining in eastern Congo is technically illegal, because none of the mining areas have been officially designated as artisanal mining zones. Efforts to date have either focused exclusively on sanctioning individual malfeasance or on piecemeal capacity building for institutions.
The United Nations and other major donor governments like the United States have remained skeptical of a CTC approach, and thus it probably only has promise over a much longer period of time than would be ideal. USAID has also funded the NGO PACT, which has piloted work in partnership with international mining companies to improve conditions for miners and their dependents in the Katanga and Ituri regions, but no such efforts have yet targeted the Kivus. These policies will help to ensure that benefits from the country’s mineral wealth accrue to the miners and their families, not to criminal enterprises. Advocacy efforts must ensure that companies do not simply paper over concerns with anodyne reports and statements. Together with a strengthened MONUC, such a force could provide the immediate physical security necessary to regulate the trade in minerals, from these specific mines to markets to export points in eastern Congo. Absent focused pressure on companies and governments alike, the best we can expect is half-measures that perhaps provide a semblance of reform but allow the coercive exploitation of Congo’s natural wealth to continue.
The 35 percent rate is also partially based on the discrepancies between firsthand observations of the tin ore coming from Bisie mine by the Pole Institute, DGM Kilambo, and Garrett, on the one hand, and dramatically lower data for the same tin ore being exported at Goma.
However, these official figures must be revised, taking into account that it is 65 percent grade tin, and approximately 44 percent was nondeclared by customs, according to Garrett.
For example, a business may be able to continue more or less normally if the cafeteria has to close, but would come to a complete halt if the information system crashes. For example, a business may spend three times as much on marketing in the wake of a disaster to rebuild customer confidence. A BIA can serve as a starting point for a disaster recovery strategy and examine recovery time objectives (RTOs) and recovery point objectives (RPOs), and resources and materials needed for business continuance. Similarly, Congo’s gold production is less than one percent of global production, but is a critical source of financing, especially for the FDLR.
This lack of a viable legal framework for even legitimate mining efforts complicates efforts to deal with the predatory armed groups that dominate, but do not entirely control, the sector.
Some of these initiatives have the potential to contribute to developing much needed legitimate economic opportunities in eastern Congo, but they have thus far sorely lacked the coherence and diplomatic momentum necessary to alter the status quo. The Security Council and regional governments must signal to these companies that they have a choice: become part of the solution by severing all ties to the armed groups and supporting reform efforts on the ground or face sanctions.
This approach must be grounded in a more comprehensive and coherent effort to support broad security sector reform in Congo. Calling or emailing top electronics manufacturers and telling them to ensure that their products are conflict-free will help to create the conditions necessary to end the war in Congo.
Third, for estimates of the percentage of mines and transport routes controlled by armed groups, we use the U.N. The BIA should assess a disastera€™s impact over time and help to establish recovery strategies, priorities, and requirements for resources and time.
As a result, ordinary Congolese remain trapped, their livelihoods dependent on an exploitative minerals trade.
The specific measures recommended by these groups have varied over time, ranging from an embargo on select conflict minerals to more attenuated measures such as a traceability system for mineral supply chains or due diligence requirements for companies buying minerals from the region. Providing the correct mix of incentives to keep these players from driving the trade further underground will be a crucial component of providing legitimate economic opportunities in the formal economic sector in eastern Congo.
You can also ensure that your voice is heard by endorsing our Conflict Minerals Pledge online.
Group of Experts data from December 2008 as well as independent reporting by Africa Confidential and minerals traders from the region. Violent armed groups remain well-financed as they rob the state of resources that belong collectively to Congo’s people.
Mine-of-origin declarations and supply chain audits should be verified by third-parties with the skill-set to properly monitor metals transactions, such as forensic accountants, or the U.S. Meanwhile, western consumers continue to purchase electronics products, unaware that their devices may be fueling this viscous cycle of despair. Geological Survey and metals traders have provided excellent information on the minerals supply chain and estimated pricing along the chain. The German mineral fingerprinting initiative, if properly implemented, would be extremely helpful in this regard.
Although the gold trade is more difficult to track because of much more extensive smuggling, the Pole Institute and Pact have provided useful research on this which we use as a basis here.
Recognizing the possible variations in percentages for several of the variables, we provide a range of estimates for the profits—high, medium, and low.

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