Operation Dudula blockades deny migrants access to at least 53 clinics countrywide

“I am so worried about how I will give birth, it stresses me every day. I know, as I am now, I cannot go to the clinic, but I also cannot go to a private hospital to give birth. I wish I could just go home and fix my papers so I can be treated normally.”

This is what Tendai told Daily Maverick weeks after Operation Dudula refused her entry to a public clinic because she was not a South African citizen.

On 21 July, Tendai went to the Yeoville clinic in Johannesburg for a routine sonar scan.

“I was in the line with many other pregnant women. Some other guy came to us and said, ‘If you don’t have ID, all of you must go out. If you don’t have what I am asking for, you won’t use our free medication,’ ” Tendai recounted.

She told Daily Maverick that she left the Yeoville clinic traumatised, but convinced that she could go again another day. After 21 July, she tried to visit the clinic several times, but every time she was stopped at the door by Operation Dudula members, who refused her entry because she didn’t have documentation, even though she is in dire need of prenatal checkups and blood pressure medication.

“I’m taking tablets and medication for high blood pressure, but that medication is finished now. I don’t work and I sell food at the side of the road, but some days I only sell one or two plates. The medication is expensive. I try every day to make some money so I can buy, but it is not enough,” the expectant mother said.

Tendai said that since being unable to access healthcare because of the disruptions caused by Operation Dudula and other smaller anti-migrant groups, her high blood pressure has caused havoc.

“I am struggling; sometimes my feet get swollen and I can’t cope, but I am trying. I have kids also to look after, so I have to be strong and manage, but I am struggling,” she said.

Tendai is one of the hundreds of vulnerable people who can no longer access medical care since Operation Dudula embarked on its eight-week campaign to bar people they deemed to be born outside South Africa from accessing public healthcare.

At least 53 clinics disrupted

After speaking to several civil society organisations and collating data from reports from patients and the organisations, Daily Maverick could map some of the clinics where Operation Dudula and similar groups barred migrants and, in some cases, South African citizens from accessing medical care.

Daily Maverick found that migrants attending at least 53 clinics had been stopped from accessing medical care, mostly in Gauteng, where Operation Dudula’s presence is the strongest, but spilling into KwaZulu-Natal, Limpopo and the Eastern Cape.

While the targeted disruptions by anti-migrant groups are not new and have been a longstanding concern for many human rights organisations, reports of the latest campaign began surfacing as early as June this year. By July, the disruptions intensified with reports of widespread incidents across Gauteng and KwaZulu-Natal.

Médecins Sans Frontières regional advocacy coordinator Clair Waterhouse told Daily Maverick her organisation had tracked 15 clinics where Dudula members had been permanently stationed. Contrary to claims that the disruptions target only illegal foreigners, the consequences are broader. People with valid work permits, permanent residence and even South African citizens have been refused care.

“Our observation shows very strongly that for migrants, it doesn’t matter if they are documented or not. We’ve seen people with South African IDs, valid visas, even passports, being told their documents are ‘not good enough’ and ordered to leave. South Africans who forget their IDs at home are also barred. We’ve even seen children and pregnant women denied care,” said Waterhouse.

Alarming cases

Médecins Sans Frontières teams on field assessments witnessed alarming cases. In Johannesburg, a six-month-old baby with a severe respiratory infection was turned away. In other facilities, pregnant women were denied access to antenatal care.

One of the most disturbing trends Médecins Sans Frontières documented was collusion by health staff with the anti-migrant groups.

“At two clinics, the work of these groups was actively facilitated by either clinic security or healthcare workers themselves. We’ve even heard reports of nurses saying they are grateful, because it means fewer patients. In some cases, Dudula members told us they ‘check in’ with staff every morning as if they were part of the clinic’s routine,” she said.

Daily Maverick has extensively reported on the impact of these disruptions, from mothers unable to seek post-natal care, migrant parents being unable to access life-saving healthcare for their children, and injured people without documentation being turned away from clinics by Operation Dudula members.

Reports on how people on the ground who use clinics regularly feel about the anti-migrant groups’ latest campaign, however, have been scant. Daily Maverick visited clinics in areas where the disruptions have been most concentrated to get a sense of what patients make of them.

In Tembisa, where there have been at least five disruptions, the Tembisa Health Clinic was a hum of activity. Outside the facility, a security guard told the publication that the anti-migrant groups had not caused any disruptions that day, but they had seen a significant reduction in the number of migrants coming to the clinic.

Inside, we spoke to some patients about how they felt about migrants accessing healthcare.

"They [Operation Dudula] are not doing anything wrong. These people [migrants] are using our money to get medication and sending [it] back home. The government is not doing anything, so what must happen?" one elderly woman said.

Lack of urgency from government

Despite repeated appeals from Médecins Sans Frontières and the Treatment Action Campaign (TAC), the Department of Health has yet to issue a robust response. Médecins Sans Frontières’ Waterhouse confirmed that MSF had written to national and provincial authorities, sharing detailed concerns and even cases of collusion, but received no reply.

“We don’t believe this is being treated with the urgency it deserves,” she said. “What little has come out has not been sufficient. Seven weeks of significant blockages at health facilities is not acceptable.”

Daily Maverick asked the Department of Health for clarity on protocols to halt the disruptions:

• Does the department know how widespread the disruptions are — and are they being formally recorded or monitored? Can the department shed light on the number of clinics/hospitals that have been affected and the locations?
• What impact have the disruptions had on the functioning of clinics and the quality of healthcare delivery overall?
• What measures has the department taken to protect patients and health workers when such disruptions occur?
• Are there formal protocols in place for clinic managers and staff to follow when members of the public attempt to block services?
•  The Constitution guarantees everyone the right to access healthcare. How does the department ensure this right is protected, regardless of a person’s nationality or immigration status?
• Has the department issued any directives to clinics, clarifying the obligation to treat all patients in need of care?
• What long-term steps is the department considering to ensure that clinics remain inclusive and accessible?

No response had been received by the time of publication.

The TAC believes the silence reflects a deeper governance failure.

“The existence of legislation that guarantees healthcare to all means nothing if it is not enforced. We see police standing by without intervening. We see facility managers turning a blind eye. In practice, this amounts to condoning the violations,” TAC Gauteng provincial chairperson Monwabisi Mbasa said.

 Civil society steps in

In the absence of decisive government action, civil society has moved to fill the gap. The TAC, long known for its grassroots fight for access to HIV and TB treatment, is now redirecting much of its energy to assist those excluded from healthcare by the Dudula disruptions.

“In just three weeks, we’ve helped more than 28 people access medication, and the number keeps growing daily. Recently, we received a list of 200 patients who had been completely turned away. They all needed urgent support to get treatment or medication, and without intervention, their lives would have been at serious risk,” Mbasa said.

The TAC operates through a network of local branches and volunteers. When a patient is denied care, the organisation steps in to connect them with comrades closer to alternative facilities, ensuring they can safely access treatment.

“We don’t want to tamper with the health system’s data, so we link patients directly to nearby facilities,” Mbasa said. “That way, treatment continues, and their medical information remains recorded in the system.”

The testimonies TAC receives from patients are stark reminders of what is at stake. He told stories of how one person living with HIV who developed a kidney infection was told never to return to their clinic. Another, a TB patient turned away from treatment, risked infecting the entire community. Pregnant women denied access to viral load testing have faced the terrifying possibility of passing HIV on to their unborn children.

“For many, our intervention has not just restored access to healthcare, it has saved their lives,” Mbasa said. “We get messages from patients saying, thank you, I can finally sleep tonight. That’s the kind of desperation we are dealing with.”

Médecins Sans Frontières’ Waterhouse commended the campaign: “TAC is doing amazing work connecting migrants to ARVs in particular. These are South Africans standing up for the right to healthcare, refusing to accept scapegoating, and making sure patients aren’t abandoned.” DM