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Jason Malinowski, an emergency physician in Barry’s Bay, Ontario, says that the requirement for a doctor to agree to accept a patient can lead to dramatic delays in some cases. “Doctors are sometimes in the operating room and can’t get back to us quickly,” he says. “But I’ve assessed the person and it’s very clear they need to be treated somewhere else.”

While personal support workers, kitchen staff and other unionized employees held placards and waved oversized CUPE flags Wednesday afternoon, Whaley said, they have been without a contract for almost two years.

It was also a trauma his family would face again, a coroner’s inquest into the 45 suicides in Nunavut in 2013 was told when the inquest began Sept. 14. Three months after Rex’s death, yet another brother — 15-year-old Peter — killed himself. Rex was living with as many as 23 family members in his grandmother’s four-bedroom house in Naujaat, a community of about 1000 people. The family shared eight beds and one bathroom while they waited for subsidized housing.

The evening before he died, Rex played with his cousins and stayed overnight at their home. His aunt and uncle found him and tried to revive him. His family reported not knowing the immediate triggers for Rex’s decision to hang himself. “I don’t know what was wrong with him,” Martha Uttak, Rex’s mother, testified. “He was my baby and he hugged me all the time.”

Five years ago, four partner organizations came together and released a suicide prevention strategy that was visionary and evidence-based in its design. The Government of Nunavut, the Embrace Life Council, the Royal Canadian Mounted Police and Nunavut Tunngavik Inc.’s goal was to reduce the territory’s suicide rate to one commensurate with, or lower than, the rest of the country.

But as the inquest heard, Rex was living with many of the risk factors for suicide that researchers have identified, including repeated exposure to the suicide of others. From 1999 until 2014, Nunavummiut took their lives at a rate of 111.4/100 000 population — nearly 10 times the rate of other Canadians, which stands at 11.4/100 000 according to the most recent Statistics Canada data (2000–2011).

The widespread unresolved grief surfaced again when testimony from Shuvinai Mike, a senior government official who was called to talk about her department’s involvement in cultural activities, devolved into a description of the impact of her own daughter’s suicide. When someone kills oneself, the news spreads rapidly, often via social media, throughout this vast territory of only 36 000 people. Parents live with the constant fear that one of their children will be next

The inquest, which ran Sept. 14 to 25 and included testimony from about 30 witnesses, touched on many underlying issues: poverty, high rates of child sexual and physical abuse, housing shortages, unemployment, educational deficiencies, food insecurity and historical trauma that are the reality for too many Inuit families. It is also exposed the deep divisions among the territorial government and organizations coping with the population-wide damage that suicide inflicts.

Nunavut coroner Padma Suramala, a registered nurse who presides over death investigations in Canada’s newest territory, called the inquest to examine the rate of suicide that has seemingly left no one here untouched. “Nunavummiut are soaked in unresolved grief,” testified Jack Hicks, an expert witness at the inquiry and Nunavut’s former suicide prevention advisor. Hicks helped with a landmark follow-back study interviewing the families and friends of 120 people who committed suicide in Nunavut from 2003–2006 and 120 control subjects.

A year later, in 2011, the territory released and began to implement an action plan with specific goals, assigned responsibilities and time frames in eight different areas. Those areas, including early childhood education and school curriculum programs, gatekeeper prevention training, and mental health and addiction supports, are intended to address the root causes or risk factors that trigger suicide. The need for a strategy is undeniable. Between 1999 and 2014, 436 Inuit completed suicide. Like Rex, 22 of them were children between the ages of 10 and 14.

Before the implementation plan was tabled in the legislature, however, the territorial government stripped out the column stipulating the financial resources required to implement each item, Hicks testified at the inquiry. None of the other partners was consulted. Not only did the Government of Nunavut never allocate a specific pocket of resources, it never asked the federal government for money to tackle this critical public health issue. As a result, “we’ve had to cobble together funding from various sources,” Natan Obed, Nunavut Tunngavik’s director of social and cultural development, testified.

Nunavut has made progress on implementing pieces of the strategy, according to an independent evaluation. The government’s lack of capacity, poor communication with the other partners and inadequate resources have retarded success, the evaluation states. Nunavut has not yet achieved its overall vision for decreasing suicide rates, denormalizing suicide and keeping children — like Rex — safe.

Ms. Banerji said Inuit may also have a genetic predisposition to these types of infections. But until those environmental conditions are addressed, a medicine called palivizumab is effective against such infections. In 2010, the Canadian Pediatric Society recommended that "consideration should be given" to administering a preventative drug to all fullterm Inuit infants younger than six months of age in areas with high rates of hospital admissions for respiratory infections. The territory currently gives palivizumab only to children born prematurely or who have chronic heart or lung conditions. The region of Nunavik has recently changed its policy and will administer the drug to all newborns. Palivizumab costs about $6,500 an infant. Ms. Banerji said the cost of treatment, including flying sick kids south, is so high that it would be cheaper to give it to all babies born in the worst areas. She says that policy would save $36,000 for each hospital admission avoided. It would also save wear and tear on families. "A mother has to either come with her two-month-old baby to the hospital in Ottawa and leave all the rest of the kids behind, or the baby's there all alone. It has a huge societal impact." The government of Nunavut has received a copy of the paper. The territory's chief medical officer of health was travelling Tuesday and not immediately available to react to its findings. © 2016 The Globe and Mail Inc. All Rights Reserved.