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Lena Faust is a PhD student at the McGill International TB Centre. Courtney Heffernan is the manager of the Tuberculosis Program Evaluation and Research Unit at the University of Alberta. This piece was written in collaboration with the members of the Stop TB Canada network’s steering committee.

Indigenous peoples have long spoken of the missing children from Canada’s residential-school system. This knowledge has been recently affirmed by the heartbreaking recovery of hundreds of unmarked graves on the grounds of former residential schools. With little doubt, these unmarked graves are only the beginning of what is to come as searches across the country intensify. While tuberculosis (TB) has been implicated as a potential cause of death, no direct evidence for the causes of death is publicly known.

As a community of advocates for ending TB in Canada and abroad, we wish to underline that these deaths should not be dismissed as an unavoidable consequence of a long-standing epidemic, but as the result of deliberate neglect and mistreatment on the part of the architects of the residential-school system.

TB is a communicable infectious disease directly shaped by inequity at the individual and population level. It is well-established that social determinants of health, including malnutrition, overcrowding and poor ventilation, contribute to the development and spread of TB, and these conditions were common in residential schools.

As early as 1907, Peter Henderson Bryce, the physician and chief medical officer of the Department of Indian Affairs at the time, noted that the combination of poor sanitation, crowding and poor ventilation were making residential schools the perfect environment for the transmission of TB. In fact, he remarked it was “almost as if the prime conditions for the outbreak of epidemics had been deliberately created.”

Dr. Bryce investigated conditions in numerous residential schools and found that death rates in the schools were far higher than among school-aged children in the general Canadian population; in Southern Alberta, he found that 28 per cent of residential students had died, with TB being the most common cause of death. He made recommendations for the improvement of the school buildings and the children’s diets, and he suggested that TB nurses be present on site.

However, on the grounds that the expense of implementing these recommendations to improve the living conditions of Indigenous children was not justifiable, the federal government did little to act on Dr. Bryce’s urgent calls for change. Publishing his findings in a 1922 book entitled The Story of a National Crime: Being an Appeal for Justice to the Indians of Canada, Dr. Bryce wrote, “this trail of disease and death has gone on almost unchecked by any serious efforts on the part of the Department of Indian Affairs.”

The government not only failed to implement the improvements suggested by Dr. Bryce, but actively undermined his efforts, including preventing him from carrying out further investigations into the conditions in the schools, and from presenting his findings at conferences. It was therefore not only through inaction, but by design, indifference and negligence that the suffering of the children who lived and died in Canada’s residential schools occurred. These terrible losses happened despite concerns raised by Indigenous communities, and Dr. Bryce’s exhortations.

The legacies of colonialism and TB are interconnected, and continue to manifest to this day. Even though the persistence of TB is an injustice, slow and incomplete reporting of national TB data hampers progress on eradicating the disease in Canada. We know, however, that Canada reported 1,796 cases of active TB in 2017, and a disproportionate burden of these continues to be borne by First Nations and Inuit communities. For example, the incidence of active TB was more than 400 times higher among Inuit in Canada than it was in non-Indigenous Canadians. This staggering imbalance underlines the continuing consequences of colonial structural violence and a failure to address the social determinants of TB, such as equitable access to health care and adequate housing.

A genuine attempt at reconciliation involves not only recognizing the truth of the suffering deliberately inflicted on Indigenous peoples by settlers, but also honouring Indigenous community mourning and calls to action with a comprehensive review, and addressing the harms that persist in our relations today. As long as we allow TB – a preventable, and for decades, curable and treatable disease – to have a disproportionate impact on Indigenous communities, we fall deplorably short of this.

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