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Perhaps the most gutting thing about Attawapiskat’s suicide emergency is how unsurprising it is to those closest to the crisis.

NDP MP Charlie Angus says he’s lost count of the number of states of emergency declared in the region he represents.

“Normally you declare a state of emergency and the whole country stops and says, ‘Move in, let’s fix this.’ What we see in the communities in the north, time after time, government just waits it out,” he said.

“There’s nothing new here. This is the culmination of years of problems and underfunding and calls for help and it’s now tearing the life out of some of our young people.” Tweet This

The 2,000-person community on the west shore of James Bay in northern Ontario again declared a state of emergency over the weekend amid a statistically stratospheric spate of suicides and suicide attempts.

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Eleven people in the community of 2,000 tried to kill themselves in one night. Ten-year-old children have tried to end their lives.

Two Attawapiskat residents, one of them a 13-year-old girl, have killed themselves in the past several months, giving the community a suicide rate of 100 per 100,000 people. The Canadian rate is 11.3.

READ MORE: Crisis team dispatched to Attawapiskat after state of emergency declared

This is Attawapiskat’s fifth state of emergency since 2006.

Attawapiskat declared a state of emergency in October, 2011, as families living in small, particle-board shacks without running water or electricity braced for winter.

But it wasn’t until Angus shot and posted video along with an opinion piece weeks later that the country was shocked to attention. Offers of assistance poured in along with indignant demands for change. The Canadian Red Cross sent emergency aid. Aboriginal Affairs said it was working things out financially with the community, which was also facing allegations of financial mismanagement.

WATCH: 2011 video of Attawapiskat housing conditions

2:15 Archive (Nov. 2011): MP Charlie Angus visits Attawapiskat following state of emergency over housing crisis Archive (Nov. 2011): MP Charlie Angus visits Attawapiskat following state of emergency over housing crisis

Have things gotten better?

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“No,” says Anna Betty Achneepineskum, deputy chief of Nishnawbe Aski Nation.

“If you were to come here right now, it’s even worse.”

The suicide rate in that postal code, which also includes Moosonee, Kasechewan and Fort Severn, is 17 per 100,000, according to Ontario government data obtained by Global News.

That would make residents of this region more than 50 per cent more likely to kill themselves than the average Canadian. (Note: The statistics we have probably underestimate rates because deaths are only recorded as suicides when intent is certain.)

Interactive: Compare suicide rates between Ontario postal codes in the map below

There’s no certified mental health clinician in the community. If you try to kill yourself, you get first aid and then wait for hours in the tiny hospital to talk to a doctor via telemedicine.

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If the doctor thinks you need to be committed, you’re sent to the nearest psychiatric ward in Timmins, 500 kilometres away. About 80 per cent of people who attempt suicide are just sent home.

Whether you’re sent to an out-of-town psych ward or not, there’s zero follow-up once you’re home. Health workers are too busy responding to human crises to even think about prevention.

READ MORE: First Nation community looks to ‘heal together’

Attawapiskat’s state of emergency declaration this week focused national attention — and resources — on the community. Health Canada sent mental health counsellors; Ontario sent a five-member emergency team, including mental health nurses and social workers; Nishnawbe Aski Nation sent frontline workers and technical staff.

Public figures of all political stripes expressed their sadness in statements and online.

Some things have changed in the past five years: The scrutiny in 2011 got about 40 people moved out of a trailer and into homes, Achneepineskum says. Angus says that attention brought the momentum needed to get Attawapiskat a school.

But there are still homes with 12, 15, 20 people in two or three rooms; there’s still mould creeping up walls where kids sleep.

That means rates of respiratory illness and tuberculosis common in far poorer countries.

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Rheumatic fever is 75 times more prevalent in northwestern Ontario than the rest of Canada.

INTERACTIVE: Death rates for people under 18, by Ontario postal code

But there’s also a psychological squeeze to crowded conditions, says Claudette Chase.

“There’s no physical space, but there’s also no emotional or mental space — to think, to have peace.”

The only thing that surprised Chase about this week’s state of emergency was that it didn’t happen sooner: Chase, a family physician in northwestern Ontario, saw opioid abuse decimate communities in the Sioux Lookout region where she works before it moved east to the James Bay area.

“I don’t think people should be surprised. … It’s been in the news, my god. The water, the kids with the rashes, the poor education,” she said. Tweet This

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“I’ve been doing this for 30 years and it’s been discussed in the news for 30 years and, for the first time, the government is acknowledging it.”

Achneepineskum was in Attawapiskat Monday for a community meeting, to offer support and — hopefully — hash out a way forward. NAN‘s extra bodies also spelled off health workers run ragged: Three of Attawapiskat’s four are in Thunder Bay being debriefed, Achneepineskum said.

Residents of these remote communities are making herculean efforts to ameliorate their homes, Chase said. But the systemic problems remain.

“There are laypeople stepping up, working in these programs, and I’m proud of my physician group: We’ve worked very hard to support the communities in this,” she said.

“But the true social determinants of health are not really changing to any significant degree that I’ve witnessed.” Tweet This

People in this postal code die a decade earlier, on average, than people in affluent Ottawa and Toronto neighbourhoods.



Interactive: Compare median age at death between Ontario postal codes in the map below

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They’re twice as likely to die of homicide as people in downtown Toronto; more than twice as likely to die of lung cancer; four times as likely to die in a land vehicle accident; more than eight times to die before age 18; ; almost 10 times more likely to die of diabetes.



INTERACTIVE: Explore diabetes death rates across Ontario postal codes in the map below

As Global News has written, these inequities don’t stop in Attawapiskat or in Ontario: If you’re indigenous you’re more likely to be raped or murdered; if you’re born in Nunavut, you’re far more likely to die as a baby.

Systemic deprivation runs so deep, it’s hard to know where to start.

“You have to have education; you have to have policing; you have to have the health services,” NAN’s Achneepineskum said.

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Some have argued that the factors perpetuating despair in Attawapiskat are so entrenched, the only solution is to evacuate the communities entirely.

Angus is not a fan of that proposal.

“I think it’s the ultimate lazy-assed response of racist Canada to say, ‘Why should we bother giving your children education? Why should we bother providing the same health care we demand for our children?’ … Tweet This

“What king of nation is that lazy with its vision for the future, for its children?”



INTERACTIVE: Explore homicide rates across Ontario postal codes in the map below

Federal Health Minister Jane Philpott told reporters Monday she knows the counsellors her department sent won’t be enough.

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“We continue to work on a long-term strategy,” she said.

“We can’t keep working crisis to crisis.” Tweet This

And Philpott admits one of the biggest challenges is not the cash but the human capital: Recruiting people to work in a challenging, isolated environment guaranteed to burn them out is no easy task. Attawapiskat’s police officers are so overworked by 18-hour days they’re frequently on sick leave, Achneepineskum said.

Chase, who’s brought health care for three decades to a marginalized region that has gotten no less marginalized, is “very cautiously optimistic.”

“If there’s a tipping point, it’s now.” Tweet This

With files from Jennifer Tryon



INTERACTIVE: Of the top 10 postal areas for deaths under 50, seven were in the north. Northwestern Ontario tops the list.

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INTERACTIVE: Half of the top 10 Ontario postal codes for road accident deaths are in northern Ontario