It is well known by now that South Africa has a healthcare skills crisis. During a recent parliamentary question-and-answer session, Health Minister Joe Phaahla revealed the alarming statistics that the country has a doctor-to-patient ratio of one to 3,198. In 2019 it was one to 1,266.

With healthcare practitioners emigrating in record numbers in search of greener pastures, South Africans are facing falling healthcare standards and rising costs. About 35,000 South African nurses alone are estimated to be working outside of South Africa, drawn by better salaries, among other motivations.

The situation has prompted the government to update the critical skills list to include an unprecedented 41 professional codes in the healthcare sector – qualifications that migration authorities commit to prioritising when allowing working expatriates to have a regulated legal stay in South Africa. 

But rather than hoping and waiting for skilled professionals from other countries to choose to move to South Africa, there is a ready solution at hand: tapping into the skills and knowledge of refugees and asylum seekers who are already here.

An untapped resource

South Africa is seen as a desirable destination for refugees, given its comparative stability and level of industrialisation, and we host the largest number of immigrants on the African continent. According to official estimates, the country is home to about 2.9 million immigrants who come to the country fleeing persecution for reasons of race, religion, nationality or membership of a particular social group, or because of political opinions. This is roughly 5% of the population of the country.

Many of these people are skilled professionals, including in the medical professions, but because of the non-voluntary nature of their immigration, their skills are often not used effectively.

The employment of refugees and asylum seekers tends to be lower than for other economic migrant groups and citizens. While the right to work is a fundamental human right – regarded as essential for life and dignity, and is explicitly granted to refugees in international and regional law as well as in numerous national constitutions – in practice refugees and asylum seekers have to overcome many obstacles so they can work in South Africa.

For example, refugees and asylum seekers can face an uphill battle in having their qualifications recognised. South Africa’s pre-immigration qualifications recognition processes, which seek to ensure that the qualifications and skills of immigrants are of sufficient quality and match those deemed essential by professional bodies, are extremely onerous even for voluntary migrants.

One requirement, for example, is that immigrants must produce the necessary paperwork before entering the country, probably the last thing you think of packing when leaving your country in a hurry – assuming, of course, you have a functioning bureaucracy in place to access that paperwork in the first place.

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And even when their qualifications are successfully recognised and pre-immigration work is done correctly, a variety of barriers can still deter African refugees and asylum seekers with healthcare qualifications from entering the healthcare sector.

Refugees and asylum seekers are also denied many protections. According to one study, the South African government is increasingly using national security as a motivation for limiting asylum seekers’ access to the labour market and socioeconomic programmes. And, as the UN Refugee Agency (UNHCR) has also recorded, the spectre of xenophobia is never far away.

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This makes daily life a struggle. Having effectively to fend for themselves, many refugees and asylum seekers end up accepting menial and other low-paying jobs and abandoning the quest to be recognised professionally.

Finding the sweet spot

In my own work, I have found that refugees and asylum seekers are effectively falling between the cracks of the respective regulations of the Refugees Act and the Immigration Act. While the Immigration Act, 2002 (Act No. 13 of 2002) and its critical skill list should, in principle, allow refugees and asylum seekers the opportunity to enter high-skilled labour markets, the Refugee Act restricts critical skills visas to economic migrants.

The journey to paid employment using their professional skills is further exacerbated because, in contrast to economic migrants, refugees and asylum seekers do not choose their host countries because of labour market characteristics whereby their skills, education and language proficiency may be better adapted to the labour markets of host countries.

Work needs to be done to identify a “sweet spot” between the regulations as a way to ease the path of refugees and asylum seekers who find themselves in South Africa, and allow them to do the work they are qualified to do, easing the country’s own skills deficits.

The cost to our country of not doing so is illustrated by the story of “Dr Futu”, a medical doctor who left the Democratic Republic of Congo due to the political instability there. In Critical Skills, a short documentary released in 2021 by the Scalabrini Centre of Cape Town, Dr Futu speaks of the challenges of entering South Africa and trying to get his qualifications as a medical doctor recognised here. Unable to do so for now, he finds small jobs such as welding and trench digging.

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“Being a doctor was a dream,” Dr Futu says in the film. Sadly, in South Africa, that dream is on hold. Meanwhile, the scarcity of healthcare workers in public hospitals has reached crisis levels. 

The “problem” of emigration could easily be solved by reframing the “problem” of immigration. With more efficient systems in place that recognise the skills and knowledge that asylum seekers and refugees bring, they could be a boon for South African healthcare, allowing us to replace the physicians, dentists, nurses and other medical professionals leaving our shores faster and more effectively.

This would also free refugees and asylum seekers from the cycle of structural poverty and socioeconomic dependency on the state. It really is a win-win situation. The question is: what will it take to ensure that the country steps up to take it? DM