In 2001, a 29-year-old Cree woman, nicknamed S.A.T. in legal documents, went to the Royal University Hospital in Saskatchewan, Canada, to give birth to her sixth child. After she gave birth, she says, she was wheeled into an operating room to be sterilized. She says she desperately protested, but no one listened. To this day, she remembers “the smell of burning flesh” as her fallopian tubes were cauterized against her will in an irreversible birth control procedure.

This claim is laid out in a new class action lawsuit alleging widespread abuse of power by Saskatchewan health professionals and the violation of many indigenous women when they were at their most vulnerable.

If successful, the women in the lawsuit will each be entitled to millions of dollars of reparations from the Saskatchewan and Canadian governments and their health systems. While these women may only represent a fraction of the people negatively affected by forced sterilization in Canada, their lawsuit is recognition of the ubiquity of the practice—and its consequences.

Attorney Alisa Lombard is directing the lawsuit. She’s an associate at Maurice Law, Canada’s only indigenous-owned national law firm. Since news broke of the legal action last month, over 60 more women have contacted Lombard’s office, saying they were sterilized without their consent. In the seven days after CBC’s November 13 article about the lawsuit, 29 women called or emailed her.

The women were mostly from Saskatchewan, but also from Ontario and Manitoba. They reported similar experiences of being coerced into signing consent forms and being misled about the irreversible nature of the procedure. The stories go back decades; one is as recent as 2017. Most of the sterilizations happened in the hectic time directly after the women gave birth. In some cases, women were denied access to their newborn babies unless they agreed to the procedure.

The class action currently has two representative plaintiffs, and when certified, dozens more may be added. “My clients’ lives were upended,” Lombard told Rewire.News. “They’ve lost relationships, and they’ve come down quite hard on themselves. I really don’t think you can overstate the trauma.”

The lawsuit is aimed at three specific doctors, the Saskatchewan and Athabasca Health Authorities and their health professionals, the province of Saskatchewan, and the Canadian federal government. The charges include battery of a sexual nature, negligence, breach of contract and fiduciary obligations, violation of the right to life, cruel and unusual treatment, and the violation of the right to freedom of conscience, belief, and religion.

The lawsuit was launched about six months after a 2017 report exposed the pervasive forced sterilization of indigenous women in Saskatchewan hospitals. The report, an independent review commissioned by the Saskatoon Health Region, shares stories of seven indigenous women who were pressured into a tubal ligation, a permanent form of birth control in which the fallopian tubes are cut, burned, or tied in an irreversible procedure. The women say they were sterilized against their will, usually in the hectic and fraught period directly after giving birth.

The women in the report, anonymous to the public, shared similar stories to those of the lawsuit’s plaintiffs—full of feelings of confusion, distress, and shame. They said they felt harassed by health-care workers to agree to the procedure, which they didn’t know much about, and they were told it was for their health.

“When [I was] in for C-section, the nurse came to [get] me to sign the paper for tubal ligation … Even though I didn’t want to, I signed it,” said one women in the report. “I just said, ‘I don’t want to do this.’ and he [the doctor] just didn’t hear me. I was being ignored,” said another.

One women recounted that a social worker told her the doctors didn’t want her to leave the hospital until the procedure was done, and she felt she didn’t have a choice.

“They were all severely traumatized,” said Yvonne Boyer, a Canadian senator, a legal scholar, and a co-author of the 2017 report. “They had either revoked their consent, not realizing that a tubal ligation was a permanent procedure, or they had not consented at all to the procedure that they were having done,” she told Rewire.News.

The 2017 report sparked a growing recognition that the practice of forced and coerced sterilization of indigenous women in Saskatchewan hospitals was rampant.

According to Boyer, the precedent for indigenous women being mistreated in Canadian public systems is rooted in a deep history of colonialism, sexism, and racism. “Unfortunately, far too many institutions today claim to be value free but continue to reflect a colonial male dominated comprehension of reality,” she and physician Judith Bartlett wrote in the 2017 report.

Boyer said medical practices that assume non-indigenous doctors know what’s best for indigenous women, despite their express wishes to the contrary, mirror a historical legal system that seeks to undermine the autonomy and independence of indigenous people of Canada. She refers to this as the “guardian and ward model” of law, which assumes that indigenous people do not have the capabilities to make decisions about their own health and well-being. In Canada, it is mostly famously exemplified by residential schools, a widespread practice that removed an estimated 150,000 First Nation, Métis, and Inuit children from their communities before ending in 1996.

According to Boyer, the “guardian and ward model” of law contributes to a mainstream culture that does not respect the autonomy of indigenous women, and the forced sterilization cases currently coming forward show that this patronizing and racist mentality is present in Canadian health systems. “The health-care professionals are saying, ‘we know what’s best for you. You’ve got three kids at home, you don’t need anymore, so I’m just going to sterilize you, because that’s what I think,’” said Boyer. “That’s what happens. There’s a power imbalance.”

Boyer and Bartlett’s 2017 report highlights the “degradation” experienced by the women interviewed about forced sterilization. Most of the women were never again able to trust doctors, and they consequently don’t seek health care or address chronic pain or illness. “We found with the women we interviewed that there was a terror, an absolute terror of these women [with regard to] seeking health care,” said Boyer. “They’re not going [to the doctor], and they’re not allowing their families to go.”

Canada has a long history of eugenics and forced sterilization. The provinces of Alberta and British Columbia both had legislation condoning sterilizing people without consent, and records suggest the practice was widespread across other provinces as well. The practice of forced sterilization in Canada started with people with mental illness or disabilities but it soon became pretense for the sterilization of indigenous people, mostly women, based on racist ideas of culture and behavior.

Forced sterilization of Native women based on racist policies was also rampant in the United States, persisting into the 1970s and 1980s. Some estimate that as many as 25 to 50 percent of Native American women in the United States were sterilized between 1970 and 1976. In Puerto Rico, an estimated one-third of women were sterilized between 1936 and 1968 by the U.S. government, which spread misinformation about the sterilization procedure.

The impact of forced sterilization can be severe. The plaintiffs in Lombard’s lawsuit say they have experienced debilitating physical and mental repercussions, including hormonal disorders, migraines, depression, anxiety, and social isolation. One of the women said her marriage ended as the result of her sterility.

Lombard told CBC News that one woman in Manitoba took her own life 10 months after the procedure.

“It’s hard to sum it up in a sentence and say, ‘these are the damages,’” said Lombard. “The greater trauma here … it can’t be overstated. I think that any well-thinking, well-meaning human being looking at the scenario will inherently understand that.”

She says health professionals and the Canadian public have known about forced sterilization in Canadian hospitals for decades. “What this teaches us … is that this continues to happen,” she said. She poses the rhetorical question: “At what time does inaction in the face of knowledge become intent?”

Once the lawsuit is certified by the Saskatchewan courts, Lombard can add more women to the class action. She says no matter how many women are included, there are countless cases of women who will never see a shred of justice. “Certainly there are many women that these things have happened to who are no longer with us, who are not here to speak on their own behalf,” she said. Lombard added that the bulk of the women who have approached her have experienced forced sterilization in the last three decades. “It’s not a very long time ago,” she said, “This basically happened yesterday.”

Lombard told Rewire.News she will be pleased if they win the lawsuit, as it would mean recognition for a problem that is too often swept under the rug. “[Winning the lawsuit] would be a reinforcement and a confirmation that indigenous women have bodily autonomy,” she said, “It’s about saying these women have a right to have families on their own terms. It’s about saying these women have the right, first and foremost, to make decisions about their own bodies.”

But real justice will only come with a systemic overhaul of Canadian health care to address the pernicious underpinnings of racism and unequal access to care that are deeply rooted in the system.

In their 2017 report, Boyer and Bartlett outlined “Calls to Action” based on what they heard from the affected women, which include legal, procedural, educational, and structural changes to the health system. They include enacting a constitutionally protected right to traditional indigenous medicine and reproductive health care, mandatory cultural training for health-care workers, greater representation of indigenous advocates in the shaping of health-care policy, and the creation of a reproductive center for vulnerable indigenous women who need particularly sensitive care.

“We know that indigenous patients can face systemic barriers in accessing medical services, including discrimination and racism,” said Jane Philpott, Canadian minister of indigenous services, in a statement. “We all have a role to play to ensure that Indigenous patients receive quality health care free of prejudice, including ensuring medical professionals receive cultural safety training.”

After the 2017 report came out, the Saskatchewan Health Authority did change its policy around tubal ligation and now requires women to have a documented discussion with their doctor about the procedure before coming in for birth. They also shared the report with their staff and implemented cultural competency training.

“We are working closely with our First Nations and Métis community partners (Federation of Sovereign Indigenous Nations, Métis Nation-Saskatchewan), as well as Elders and Grandmothers, through the establishment of an advisory council to guide the SHA on the future of health care in Saskatchewan,” the Saskatchewan Health Authority said in a statement. “The council continues to meet regularly to create detailed plans specific to the 10 calls to action outlined in the review, with SHA leadership teams working to put these plans into action.”

Boyer is currently working on getting support from her senate colleagues for more action and investigation into the practice. “The more people we can have talking about this, the more solutions we are going to be able to come up with,” she said.

Boyer said that only the women can determine what justice means for them personally. Moving forward, the goal is to never let this happen again. “Quite frankly, I don’t think there is any justice, I think the only thing we can do is stop things like this from happening to their children,” said Boyer.

“We don’t want their daughters to go through the same things that they’ve been through. That’s what we’re working at.”