The characters of Nia DaCosta’s empathetic debut Little Woods are all trapped in purgatory. No matter how hard the North Dakotan locals try to make an honest living, the punishing indifference of the American health care system demands that those who cannot afford its benefits must squirm around the law to survive. Eschewing tired junkie stereotypes found in films like Sid and Nancy (1986), The Basketball Diaries (1995) and Candy (2006), where drugs exist as a gateway to moral decay and youthful rebellion, DaCosta’s sobering status quo illuminates the human reasons behind addiction. True to life, she shows how the underground smuggling trade has become a necessary lifeline for whole communities.

When a busted leg or infected child can be a one-way ticket to destitution, smugglers have become an unlikely beacon of hope. The drama zeroes in on the real-life practice of people crossing the northern US border into Canada in search of opiates and prescription drugs, returning to sell their wares to the desperate working class. This illegal trade offers financial empowerment, with profits ensuring that there are warm beds to sleep in. The oppressive bleakness of the world of smugglers is heightened by Matt Mitchell’s barren cinematography, where the open sky dominates the frame, bearing down on the puny houses dotting the landscape. With a palette of hazy and sterile blues, the winter of Little Woods seems eternal.

At the heart of the film are two sisters: ex-smuggler Ollie (Tessa Thompson) and single mother Deb (Lily James), who are semi-estranged after the death of their mother. Ollie, caught sneaking her mother’s meds across the border, is nearing the end of her probation period. Working an honest job selling coffee and hot food to construction workers from the back of her truck, Ollie plans to move to another state for good. She reiterates over and over that she’s turned over a new leaf: she doesn’t sell Oxy, an opiod medication, anymore.

But Thompson soulfully telegraphs Ollie’s character’s innate, helpless kindness – obvious in the patient and playful way she jests with labourers; the way she stumbles out of bed at midnight to bandage the purpling foot of an old client who can’t afford to wait six hours at the hospital. Injured construction workers, drunkards and struggling parents are drawn to her like moths to a flame; they cling to her arm, blurting out their ailments, just short of begging her to get back into the business. Amid Thompson’s affecting performance of bone-deep exhaustion, there are hints at a martyr complex, with Ollie confessing that she enjoyed the thrill of smuggling – though DaCosta’s script leaves this woefully unexplored. For the most part, Ollie stoically rebuffs any temptation to return to her old habits, until her sister turns up pregnant on her doorstep.

Despite James’ tender likeability, Deb is a frustratingly underwritten character compared to  Ollie. She seems less a real person than a plot tool to drive the film into the territory of a border-hopping thriller and to act as a personified comment on how the health care system fails women. Although fraught familial bonds and bodily autonomy are compelling themes, Deb’s lack of dimensionality undermines the shocking restrictions of US’s health system. The viewer gains no sense of Ollie and Deb’s relationship outside of their immediate situation – we aren’t privy to what the women were like as girls (one adopted, one biological), nor do we ever understand why they were estranged beyond a vague reference to Deb “leaving” when their mother was ill. Deb does have time, however, to learn and recite medical facts – for example, to have a child without health insurance costs around $8,000USD. This seems a horrific fact, oddly removed from the flesh-and-blood human on screen. With barely any exploration of the unique bond of these women, including their shared grief, the film exists as a detached capsule, lacking a material sense of personal and more intimate history.

Ultimately though, the shortcomings of the core relationship are overcome by DaCosta’s humanistic storytelling. Dodging the trappings of misery porn, the film’s background characters are practical, hardened people, who behave in contradictory ways that feel vitally human – all at once demanding but understanding, violent but loving. The poetry of these people living physically and painfully close to their salvation is not lost on DaCosta. “I’m starting to see why Canada is so appealing to people,” Deb muses, referring to the country’s universal health care and free abortions. With haunting shots of the darkened cluster of trees that make up the titular “little woods” separating the US from Canada, DaCosta highlights the absurdity of an imaginary line determining who has access to care. It’s a message that feels essential and timeless, as our most vulnerable communities continue to live the reality of these characters, circling the same invisible barriers.

Little Woods is now showing in Australian cinemas.

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Claire Cao is a freelance writer and avid dumpling lover from Western Sydney. Her work has appeared in or is forthcoming in The Lifted Brow Review of Books, Voiceworks, SBS Life and the anthology Sweatshop Women. She tweets @clairexinwen.