Executive Summary

— Ndona, Congolese refugee, Johannesburg

Ndona speaks for the many thousands of migrants in South Africa who were made homeless by xenophobic attacks in 2008, forced to take shelter in unsafe and unsanitary camps, abandoned buildings, churches, and on open ground, where they are vulnerable to disease and further violence. Refugees like Ndona fleeing war in places like the Democratic Republic of the Congo (DRC) and Somalia and economic and political crises in places like Zimbabwe, have found themselves without the most basic human rights fundamental to life: food, shelter, physical security, and access to basic health care. As shocking as the severity of the xenophobic violence is the fact that such widespread abuses are tolerated in South Africa, a country with some of the most expansive rights in the world for refugees and other migrants. The widespread violence and displacement leading to homelessness and unsafe living conditions, along with systemic government failures to protect migrants from arrest and deportation, has created a massive health crisis for migrants—and their hosts—in South Africa. Xenophobia, violence, and discrimination create both environments that promote risks to migrants' health as well as barriers to obtaining basic health care.

South Africa's Constitution provides for the right to health for "everyone" within the country. In recent years, this provision has been tested as regional crises created unprecedented numbers of asylum seekers and undocumented migrants entering there. Since 2007 the Department of Health (DOH) has repeatedly affirmed the rights of asylum seekers and refugees to access the same public health care to which citizens have access. However during this same period, documented and undocumented migrants alike have been denied access to health care. Even when seeking emergency care after xenophobic attacks or rapes, migrants are often turned away by medical personnel who may discharge them prematurely, harass them, charge them excessive user fees, and call the police to deport them.

But the risks to health and barriers to care that migrants experience in South Africa are not the responsibility of the DOH alone. The South African asylum system has failed for years to provide protection to asylum seekers and recognized refugees due to systematic problems. Restrictive immigration provisions leave many labor migrants, long an important part of South Africa's economy, undocumented and unprotected from deportation, discrimination and ill treatment. Up to a million undocumented Zimbabweans may be eligible for asylum or for a still-unimplemented special dispensation program, but remain without protection and documentation that would facilitate their access to health care. The perpetrators of xenophobic violence have gone largely unpunished. Wherever asylum seekers, refugees, and undocumented migrants gather to find shelter in South Africa–in the remnants of closed camps, outside of government offices in cities and near the border, in abandoned garages and in the sanctuary of churches–they are subject to health-threatening conditions, eviction, and arrest. These abuses work against the aims of the inclusive right to health professed by the South African Constitution.

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