Covid-19 is shining a stark spotlight on inequalities in South African society, notably on vulnerable groups like foreign nationals struggling to access healthcare in the midst of the pandemic. 

In a webinar hosted by Maverick Citizen on Friday July 17, social justice activists agreed that now is the time to “harness moral outrage” about the treatment of foreign nationals. 

The talk, titled “Access to Healthcare”, posited that thinking around healthcare, rights and migration issues must shift; informing structural change. Speakers pointed out that Covid-19 has no regard for race, colour, or border, and that similarly, combating the virus required solidarity between South Africans – and importantly – between countries in southern Africa. 

While Section 27 of the Constitution states that “everyone” has a right to healthcare services, the reality is often very different. 

Responding to the speakers, Maverick Citizen editor Mark Heywood said: “Yesterday I asked Gauteng Health MEC Bandile Masuku whether all people, regardless of nationality and legal status, will receive treatment and care. He said, ‘Yes they would.’ But that doesn’t mean that this will be the practice at facility level. We need to monitor and document and refer cases immediately.” 

At the grassroots level, Sibongile Tshabalala, national chairperson of the Treatment Action Campaign (TAC), noted “medical xenophobia”. 

“An injury to one is an injury to all,” she said. “We must build solidarity as Africans living on the African continent, we cannot leave anyone behind. South Africa is pushing for the 90-90-90 HIV goals as set out by UNAIDS (the Joint United Nations Programme on HIV/AIDS). But if we are pushing for 90-90-90, and immigrant patients still don’t have HIV treatment, and still don’t have TB treatment, because of their non-South Africanness, then we still have a problem. 

“It’s medical xenophobia, I see it happening. For instance, in South Africa where African brothers will be discriminated against and not assisted because they aren’t from South Africa. People will say: ‘I would give oxygen to a South African, but not to a non-South African’, which is very wrong.” 

Tshabalala outlined further challenges at primary healthcare clinics:

“We are talking about physical distancing, but we are not seeing that on the ground because the clinics are very small. Staff are on strike because there are no PPE’s [personal protective equipment] or a staff member is tested positive and other staff members feel unsafe to continue working before they are all tested or the facility has been fumigated.” 

Also on the discussion panel was Dr Eric Goemaere of MSF (Medecins Sans Frontieres), who pioneered South Africa’s first public health antiretroviral programme in Khayelitsha in 2000. Last month, Goemaere helped transform the Thusong Community Sports Hall adjacent to MSF’s Khayelitsha offices into a Covid-19 field hospital, with 60 beds. MSF has done extensive Covid-19 literacy in the area, distributing pamphlets in taxis and shopping centres, with messages shared on Radio Zibonele, in schools and in churches. 

Goemaere echoed Tshabalala’s concerns: “As mentioned by Sibongile, lots of clinics are closing because some staff tested positive and there was, to be honest, a complete sense of panic.

“It is very difficult to enforce social distancing in a place like Khayelitsha. And I would like to raise the point that lockdown in a community like Khayelitsha has terrible socio-economical consequences. So a programme was announced for grants, distributed by Home Affairs.

“Well, the Home Affairs building is just across the road from our hospital. Every single day there was a huge queue of people, close to a kilometre long, people queuing desperately trying to access these grants. Some people are staying for the night; there on the spot, they spend the night, with no blankets. Just to be early in the queue the next day. So there is something wrong here, this is unacceptable. It’s not good enough to announce grants. There must also be a system to distribute those grants, and to make sure that they are accessible for everyone.” 

On Covid-19 testing, Goemaere said: “Initially there were too few tests available to us, but these days it has definitely improved. However, the information on the test request form, it asks for an ID number. This touches on what Sibongile said about foreign national access to those emergency essential services. There’s no doubt about it, I think we need to work to make sure that everybody has access to a test if they’re symptomatic.” 

Wits Associate Professor Jo Vearey, of the African Centre for Migration and Society, pointed out how non-South Africans are often excluded from the government’s responses to the pandemic, and the impacts of lockdown. 

She noted how access to healthcare, education, food parcels, banking services, unemployment benefits, social grants, and even freedom of movement is often contingent on persons providing documentation, such as a South African ID book. In so doing, pandemic restrictions have posed crippling challenges for non-citizens. 

“Due to lockdown regulations, access to places of immigration detention, including police cells, as well as access to the required permits to move, have been severely limited,” she said.

Veary said that in the field of migration there were groups with clashing agendas, and that some groups were using Covid-19 to “build walls” and to further restrict immigration policy. 

“This has left individuals in an even more vulnerable position as lawyers and those who could provide assistance cannot access these spaces… Expired documentation can result in arrest, detention and possible deportation as well as refusal by a court to release an individual out on bail when facing criminal charges.” 

Vearey pointed out the discrepancy between policy and execution, and a need for accountability. 

“How do we make sure that the people who hold the purse strings, the people who are ultimately responsible, are being held to account?” she said. 

“We know that it’s incredibly difficult. I think the biggest challenge we’re facing in the South African space, and we can see it playing out elsewhere in the region, is that in many cases we do actually have good policy. Mark [Heywood] posted earlier about the MEC from Gauteng, assuring that people wouldn’t be turned away. But what happens on the ground is not the same as what we see with written policy. The challenge is how do we then hold the MEC accountable? Who should be holding people in power accountable? Where are those accountability structures?” 

Veary said that in the field of migration there were groups with clashing agendas, and that some groups were using Covid-19 to “build walls” and to further restrict immigration policy. 

“One thing is competing agendas,” she said. “Now, I’m talking about the fact that we have different actors and different agencies in the field of migration and health, with clashing interests. For example, we’re looking at people who are involved in managing borders and writing immigration policy. The aims of those individuals are not the same as those of us who work in the public health space, or those of us working to ensure access to care for all who need it. 

“And we have to recognise that South Africa does have a very restrictive immigration act, and that the immigration agenda is increasingly restrictive. We know it’s very difficult for people to safely move across borders into the country. We know it’s very difficult for people to ensure that they have the documents they require to be in the country. We need to be aware, there are those who are working to create heightened nation sovereignty, to build walls, who could use the Covid moment to their advantage.” 

Responding, parliamentary researcher Adam Salmon brought up financial constraints. 

He said: “Working through the many NHI Bill submissions at Parliament, remodelling of the healthcare system post-Covid is an opportunity, but also has a significant financial constraint. Have there been any submissions made or work showing the financial benefit of catering for migrants as a preventative rather than emergency response mechanism?” 

In turn, Veary argued that the economic contributions of SADC (Southern African Development Community) foreign nationals in South Africa outweighed the cost of their healthcare requirements. 

She called for mindfulness around language used to define people who move: 

“We need to remember that when we talk about people who move, we’re not only talking about people who cross borders from other countries, we have to recognise that South Africa and the region is associated with a long history of migration; migrant labour, and so forth. Many through systems that were, and still remain, many would argue, very dangerous, very unjust, very unfair. I mean, migrant labour, migrant workers; particularly looking at the mining sector, and what that means for people who move in terms of solidarity, in terms of health and well-being. 

“We need to recognise that many of us, many of our colleagues, many of our friends, are themselves struggling consistently with issues around migration and movement. The last months of lockdown in South Africa have reminded us how important movement between provinces is for many South Africans, in order to access work, to access education. And we need to recognise the challenges that these people face are sometimes very similar to those that foreign nationals face.

“We know that if somebody is from the Eastern Cape and they are trying to access a clinic in Johannesburg, it’s not unusual for staff in those clinics to suggest that that individual needs to return to the Eastern Cape, in the same way they would tell a Zimbabwean to go back to Zimbabwe. We know that there is something about power that really plays out very importantly here. Similarly, South Africa’s sort of geopolitical power.” 

Concluding his talk, Goemaere called for more activists to step forward in this trying time. 

“Let’s be honest guys,” he said. “It was not easy to relaunch the activism in a time of lockdown and working from home. And I want to make it very clear here that we need more activists, we need more feet on the ground.” DM/MC