The substandard living conditions currently driving hepatitis A outbreaks and states of emergency in some First Nations mirror those that occurred decades ago, according to IJF records.

Overcrowding, poor ventilation, a lack of access to clean drinking water and inadequate sewage infrastructure remain a struggle for a number of First Nations in Manitoba, decades after deficiencies in residential and day schools fed similar outbreaks of what was then called “infectious hepatitis.”

“There hasn’t been any real significant improvements since the residential school days,” said Anisininew Okimawin Grand Chief Alex McDougall. “In fact, it’s a continuation of government and it’s an attempt at cultural genocide utilizing policies and institutions that are under their control.”

Anisininew Okimawin is a political advocacy organization for four First Nations in Manitoba’s Island Lake region: Garden Hill, St. Theresa Point, Wasagamack and Red Sucker Lake. All four northern communities are currently affected by outbreaks of the hepatitis A virus, also known as HAV. Garden Hill declared a state of emergency late last year.

Shamattawa First Nation, also in northern Manitoba, declared its own state of emergency because of the virus in July.

That’s an anomaly in Canada.

The Public Health Agency of Canada says the entire country reported an annual average of 236 HAV cases between 2011 and 2015. The agency’s website boasts that the "risk of becoming infected in Canada is low" thanks to "proper sewage disposal" and "accessibility to safe drinking water,” adding that "death from hepatitis A is rare."

However in Manitoba alone, there have been 898 HAV cases reported since September 2024. As of July 16 of this year the province has also recorded 197 hospitalizations and seven deaths.

McDougall said three of those deaths were in the Island Lake area.

Hepatitis A (HAV) is a virus that causes an acute liver infection with symptoms like fever, vomiting, diarrhea and jaundice. It spreads through drinking water or food contaminated by the feces of an infected person or by sharing needles or other equipment used to inject drugs, according to Manitoba Health. Close contact, or even touching the same surface after an infected person, can transmit the virus if you then later touch your mouth.

For some First Nations, those outbreaks mirror epidemics of the past.

Roughly two dozen children are standing in front of two wooden buildings with their arms spread out wide for exercise. — Lower Post Residential School had HAV outbreaks “each year from 1951 to 1960,” and was found to be "breaking B.C. law" due to overcrowding in 1961. *(National Centre for Truth and Reconciliation)*

At least eight residential schools across the country between the late 1950s and early 1970s had notable cases of HAV, according to the IJF’s Residential Schools Database. Some records say those outbreaks caused schools to close down for weeks at a time, while others administered vaccinations and continued their operations.

The latter was the case for Lapointe Hall in Fort Simpson, N.W.T., where four children were reportedly infected at the start of an HAV outbreak in March 1963. This led to an inspection by a National Health and Welfare agent who then vaccinated 45 “close contacts” out of 103 children in residence. A medical report from that agent indicates he expected more cases within weeks, but the only planned further action was to “wait and see.”

Some Indigenous leaders and health advocates suggest that describes the approach taken by the federal and Manitoba governments today.

Response to hepatitis A “unsatisfactory,” says Grand Chief

Manitoba’s government says residents of the Island Lake communities became eligible for free HAV vaccines in May 2025.

Roughly a year later, more First Nations in the province and the people who visit them started to become eligible for free HAV vaccinations including Peguis, War Lake, Bloodvein River, Ebb and Flow, Pimicikamak, Tataskweyak, Shamattawa, Norway House and Sagkeeng Anicinabe First Nations.

McDougall says these “immunization blitzes” by the federal and Manitoba government are “unsatisfactory.”

He says despite the vaccines, all four First Nations in the Island Lake area are still experiencing HAV outbreaks, driven by living conditions like inadequate water systems forcing residents to prioritize their water usage, and homes so crowded that residents have to take turns sleeping.

“It’s extreme,” says McDougall. “There’s no way to describe the conditions … It’s basic human rights violations right in front of us in our communities, where governments are not providing the adequate resources that every other Canadian and Manitoban enjoys.”

A small house with a makeshift expansion using tarp material to cover exterior walls. The inside shows one room with unfinished flooring and blankets separating sleeping areas. — Multiple families with children live in this makeshift shelter with no ventilation, plumbing or running water in St. Theresa Point. *(Supplied/McCarthy Tétrault LLP)*

Keewatinohk Inniniw Minoayawin (KIM), an organization that supports the health and wellness for 23 First Nations in northern Manitoba, said in a statement in May that Manitoba expanded vaccine eligibility in a “piecemeal way” and criticized that approach as “too reactive.”

“When communities face overcrowded housing, unsafe water systems and limited local public health capacity, the conditions for outbreaks exist long before the first case is confirmed,” said KIM CEO Michelle Monkman.

“First Nations should not have to wait for an outbreak before governments act.”

On July 24, Manitoba announced that any person over the age of six months who lived in, travelled to or had visitors from an Indigenous community in the province were eligible for one free dose.

The Manitoba government referred IJF’s questions regarding their HAV response on First Nations to Indigenous Services Canada (ISC), which in a statement said it has been “supporting community-wide vaccination clinics on-reserve in a collaborative effort with Manitoba Health, Indigenous health authorities, local leadership and nursing stations.”

McDougall says that while many First Nations in Manitoba face an epidemic worsened by living conditions, Canada is appealing two recent Federal Court decisions which affirmed the federal government owes a duty to provide adequate housing and safe drinking water to First Nations peoples on reserves.

The two class action lawsuits were led separately by St. Theresa Point and Shamattawa First Nation.

In response to questions regarding its appeal of the housing class action, ISC spokesperson Eric Head says it is limited on commenting as the matter is before the courts, but that “ISC continues to work closely with First Nations to help support access to adequate housing for everyone in First Nations communities.”

That’s not good enough for McDougall, who asserts that Canada would “stop fighting us in court” if they wanted to address the conditions contributing to the HAV outbreak.

“Without proper housing and proper infrastructure, like water and sewer to those houses, the condition is perpetuated,” says McDougall.

“I think [the appeal] points more directly to the strategy of the government in trying to amalgamate, get rid of the ‘Indian problem’ in this country.”

A makeshift house using blueish-green tarps for the roof and to cover walls made out of OSB panels. Inside is unfinished flooring, some couches, and other household items. — A community member's house made out of tarps and OSB panels in St. Theresa Point. *(Supplied/McCarthy Tétrault LLP)*

Hepatitis A in residential schools

McDougall said the similarities between HAV outbreaks in some First Nations now and those in residential schools in the 20th century show that “a group of people continue to be marginalized and continue to suffer at the hands of a government that’s supposed to be protecting them.”

Indigenous children were mandated to attend residential schools in 1920 by Indian Affairs deputy superintendent Duncan Campbell Scott as part of his goal to “get rid of the Indian problem.”

Five decades later in Manitoba, a headline reading “700 Indian children kept out of school again” tops a Globe and Mail newspaper page in 1973. The report describes parents from what is now known as Sagkeeng Anicinabe First Nation boycotting the Fort Alexander #2 federal day school after the federal government denied requests for a new school building, citing a lack of funds.

The article said a doctor diagnosed at least 23 school children with HAV. The First Nation’s former chief Phil Fontaine, parents and eight school teachers complained of overcrowding, contaminated drinking water and sewage backup in the basement as contributing factors to health issues including HAV.

Records from the Federal Indian Day School class action lawsuit show the school was closed the following year.

Residential schools often did not have the same parental oversight as day schools since children were housed far away from their homes for months at a time in church-run, federally-operated residences.

About 100 kilometres southwest of the Fort Alexander #2 federal day school was Assiniboia Residential School in Winnipeg.

Indian Health Services conducted an environmental report in May 1965 following a HAV “outbreak” at the school, according to a document in the school “narrative” for Assiniboia in the IJF’s Residential Schools Database.

The inspections point to “totally inadequate” toilet facilities, poor ventilation and overcrowding in several rooms, lack of drinking fountains and a cooking classroom with a pipe leaking from above that “flood(s) the room with raw sewage approximately six times a year,” of which the agent referred to as “somewhat astonishing.”

Despite the sanitary issues laid out in the report and recommendations for many rooms to be condemned, the agent finished his comments by worrying the outbreaks could lead to criticism of staff. “We would all come in for adverse criticism if the City Health Department were to become involved in the event of an epidemic or an outbreak of communicable disease originating in this school,” the report said.

Narratives in the database also contain reports of HAV outbreaks or epidemics at residential schools in British Columbia, Nunavut, Quebec and Nova Scotia, plus a number of other schools with smaller case amounts.

The Lower Post Residential School in B.C. saw HAV outbreaks “each year from 1951 to 1960,” says a handwritten history of the school published in 1990. Another document shows a National Health and Welfare inspection in 1961 found the school was “breaking B.C. law” due to overcrowding in the girls’ dormitory, which provided “only 312 cubic feet of air space for each bed occupant” below the minimum of 384 cubic feet.

Seventy-six girls slept in bunk beds “placed closely together” throughout a 2,376 square foot room. The agent recommended “at least” 17 of them be sent elsewhere.

A few dozen children stand outside La Tuque Residential School. — La Tuque Residential School in Quebec had more than two dozen HAV cases during an outbreak in 1970 and was put under quarantine. *(National Centre for Truth and Reconciliation)*

The La Tuque Residential School’s living quarters in Quebec were quarantined during their outbreak in early 1970, though a letter from a local superintendent said “Indian children” still went to the attached school.

A former child care worker at the school later wrote a letter explaining she felt the outbreak could be attributed to neglected, unsanitary washrooms and having rations placed on the children's toilet paper.

Where are the living conditions for First Nations heading?

Margaret Kîsikâw Pîyesîs is a life-long Indigenous health advocate focused on viral infections and is the current okimâw, or CEO, for CAAN Communities, Alliances & Networks.

She says the substandard living conditions contributing to health inequalities of the past and present are part of a “slow genocide.”

“I’m not sure if Canada even knows what an outhouse is, but people still have that on reserves and sometimes that’s their only source of using the bathroom,” said Kîsikâw Pîyesîs, “[First Nations peoples] should have every access to what is available but yet we don’t.”

“I was in Africa a couple months ago — no clean water there. Well guess what, no clean water in Canada for the First Peoples. So it’s all consistent.”

She advocates for community-led solutions to the HAV outbreak, through a combination of western and ancestral sciences, instead of waiting for government intervention.

“If we continue to rely on Canada through their existing institutions, systems, and agencies, we won’t see anything,” said Kîsikâw Pîyesîs. “The government can’t come in and save anybody. We have to save ourselves. And they have to allow us the resources to be able to do that.”

Shamattawa and St. Theresa Point First Nations are attempting to do just that through their separate clean drinking water and housing class actions, respectively.

St. Theresa Point’s lawsuit claims it is “common” for their single unit bungalow-style homes to “house up to 32 people.” It says in 2022, “St. Theresa Point received a one time grant from Canada's stop-gap rapid housing initiative for only 20 two-bedroom housing units. At present, St. Theresa Point still requires more than 500 homes to fill its housing gap.”

A small house with exposed wood sheets for exterior walls and a blue rain barrel near by. — A residential school survivor lives in this self-constructed house with no plumbing or running water in St. Theresa Point. *(Supplied/McCarthy Tétrault LLP)*

Shamattawa has been under a boil water advisory since 2018 affecting approximately 170 homes and 14 community buildings, according to the federal government.

Their lawsuit’s statement of claim mentions community members resort to hauling pails of water from a creek due to their unreliable water system. One Shamattawa member testified that even when boiled, the tap water “makes her sick” and bathing in it “frequently” gives her and others “lesions and boils.”

James Shields, a lawyer from Olthuis Kleer Townshend LLP who represents Shamattawa First Nation in their case, told the IJF the current HAV outbreak “demonstrates just how serious the situation is” for communities that don’t have access to clean drinking water.

“But unfortunately this is not news. The government has known for decades just how severe the implications of long-term drinking water advisories are for First Nations and for too long the problem has gone unaddressed.”

Head, ISC’s spokesperson, told the IJF in a statement that “we recognize these communities have extra challenges in preventing the spread of Hepatitis A due to a need for improved water and sewer services. Where issues or gaps in service are identified, the Department works in partnership with First Nations to address them.”

He said that between April 2016 and December 2025 the department invested roughly $1 billion in water and wastewater projects on all 63 First Nations in Manitoba, plus about $870.3 million for housing projects. That amounts to $16.03 million and $13.8 million per community over an almost 10-year period.

Despite the investments, Shields says Canada “has appealed nearly every aspect of the Court’s ruling” in the Shamattawa class action.

Shields said understanding Canada’s historic policies affecting First Nations people is key to understanding why things are the way they are today.

“It goes to show that the government still has not learned its lesson."

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