A coroner’s reports into the deaths of two Nunavik women during their stays at a medical boarding facility near Montreal two years ago include several recommendations to improve the safety of Inuit in the city. Mary-Jane Tulugak, 22, died on Aug. 19, 2022, after she was struck by a vehicle on Hwy.

520. Nellie Niviaxie, 26, died less than 24 hours later after she was struck by multiple vehicles on Hwy. 20.

They were both staying at the Ullivik medical lodging facility in Dorval, Que., which houses Nunavimmiut who travel south for medical treatment. Coroner Éric Lépine announced an investigation into the deaths about a week later.

Those investigation reports were released earlier this month and include information about Tulugak’s and Niviaxie’s deaths as well as 12 recommendations aimed at preventing similar incidents. According to the reports, both women spent the evening at Café-Bar Dorval, about a 25-minute walk away from the centre. The incidents were not related, but the recommendations are the same for both deaths.

On Aug. 19, Tulugak returned from the bar with the help of police around 3 a.m.

and she was left in the care of a security guard because the Ullivik’s manager in charge of the facility at the time was on a break. The security guard did not let Tulugak into her room but instead left her to roam around the common area for 30 minutes until she left and called a taxi. Tulugak was hit by a vehicle at 4:12 a.

m. and later died. Ullivik’s manager was no.