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Refugees are risking severe frostbite to get to Canada.

In Manitoba last week, two refugee claimants from Ghana were hospitalized after a seven hour walk to Canada from North Dakota in frigid weather. Now, in Toronto, doctors have seen nine cases in the past three weeks of frostbite. That's after women and children were left in remote areas of the city by human smugglers.

Paul Caulford looks after a child in the clinic. (Canadian Centre for Refugee and Immigrant Healthcare)

Dr. Paul Caulford is a physician at the Dr. Paul Caulford is a physician at the Canadian Centre for Refugee and Immigrant Healthcare . He spoke with As It Happens guest host Helen Mann about treating "unprecedented numbers" of asylum seekers arriving at his clinic with severe weather-related injuries. Here is part of their conversation.

Helen Mann: Dr. Caulford, just how severely frostbitten are some of the people who are turning up at your clinic right now?



Paul Caulford: The severity varies. But sadly, I would say about 50 per cent of the cases involve very severe injury to the hands, and particular fingers. For frostbite of that severity, and by the way about 50 per cent of whom we are seeing are children, but the implications for the frostbite are the potential for loss of digits, fingers, and hand. If it involves the feet, the toes and portions of the foot.

HM: Can you describe what the hands of these people look like when you see them?



PC: On our first case, the doctor even actually drew out and traced around the hand because the fingers were so swollen. It was quite ghastly. Nails are dying, hemorrhaging is occurring under the nails and an enormous amount of pain and pressure.

Abandoning them in a desolate park, at -15 C with an 18-month-old, should just shock everybody to the core. - Dr. Paul Caulford

HM: Where are these people being left?

PC: We have had one person in a remote park area of Toronto. We've had another person dropped near a church. One was dropped in a road area on the edge of Toronto. They are generally in the condition of not being properly clothed for the severe weather we have. They are left there and this is what happens.

HM: Who is transporting them?



PC: We hear that they have been transported in a truck, generally. There are a number of people in a cold, unlit truck. The journey can take up to three hours. All cases have come from the US. Their original journey started in sub-Saharan Africa.

Toronto remained under an extreme cold weather alert in early January. (Mark Blinch/Canadian Press)

HM: Given where they originate, do they even know what frostbite is? Who is transporting them?We hear that they have been transported in a truck, generally. There are a number of people in a cold, unlit truck. The journey can take up to three hours. All cases have come from the US. Their original journey started in sub-Saharan Africa.Given where they originate, do they even know what frostbite is?

PC: Even for us, we've been stunned when, I guess it was the last patient we saw, put her hand out finally. She looked at us and said, "What is wrong with my hands?" We said it's frostbite. "What is that?" was the answer. In the first case, the woman's hands that were most severely injured that I described, she had huddled her 18-month-old child under the only coat she had and had kept that hand over that child's face for three hours.

It's heartbreaking to see it in the children, in the mother. You think about what that mother did for three hours and you are moved by it. - Dr. Paul Caulford

HM: Have you heard from them or from anyone who is keeping an eye on what is happening here, why they decided to make this trip from the US to Canada?



PC: Their comments to us are that they are told it's not a good environment for them to be in the United States now as a refugee, as somebody coming in to make a claim. They've been told that they are going to have to have their journey extended. Our main focus here is alerting — it's a long border. We saw what happened in Winnipeg.

PC: When that happened, and we had seen our first two or three families, when we had another one last week, we got together at the centre and said we have a problem here.



HM: How does it affect you as a doctor to see this happen, especially in a cluster?



PC: You know, it's heartbreaking to see it in the children, in the mother. You think about what that mother did for three hours and you are moved by it. The shelters have been terrific. Of course, we've been in touch with Toronto Public Health. We're trying to reach out to as many people as we can, the Canadian Doctors for Refugee Care, they've all been terrific in spreading the word, getting it out to area hospitals now in the last 48 hours.

From 2012, Dr. Paul Caulford speaks on a megaphone to protest proposed changes to health care for refugees and refugee claimants. (Maureen Brosnahan/CBC)

HM: Do you know if the patients you've treated have all claimed refugee status?



PC: Yes. They all have claimed refugee status and all now have the Canadian protection that that grants them. They will have healthcare in about four weeks, which is a problematic issue. One of the requests we have is that there be some action on the part of governments to expedite the access to healthcare because it's the physiotherapy in the hands that is critical in the first number of weeks and months to prevent the amputation that might occur later on. When that happened, and we had seen our first two or three families, when we had another one last week, we got together at the centre and said we have a problem here.How does it affect you as a doctor to see this happen, especially in a cluster?You know, it's heartbreaking to see it in the children, in the mother. You think about what that mother did for three hours and you are moved by it. The shelters have been terrific. Of course, we've been in touch with Toronto Public Health. We're trying to reach out to as many people as we can, the Canadian Doctors for Refugee Care, they've all been terrific in spreading the word, getting it out to area hospitals now in the last 48 hours.Do you know if the patients you've treated have all claimed refugee status?Yes. They all have claimed refugee status and all now have the Canadian protection that that grants them. They will have healthcare in about four weeks, which is a problematic issue. One of the requests we have is that there be some action on the part of governments to expedite the access to healthcare because it's the physiotherapy in the hands that is critical in the first number of weeks and months to prevent the amputation that might occur later on.

HM: What do you think of the people who are transporting these folks across the Canadian border?



PC: I believe they are no different than the people who are transporting them in rickety boats and leaving children on the beach dead. I believe that they are criminals. By abandoning them in a desolate park, at -15 C with an 18-month-old, should just shock everybody to the core.



This interview has been edited for length and clarity. For more on this story, listen to our full interview with Dr. Paul Caulford.