“If you are not South African, from today you will not be allowed into any South African hospital.”
This was the message delivered by a member of Operation Dudula outside Hillbrow Clinic on Monday to a foreign national.

It was not an isolated incident. In recent months, many videos have circulated on social media showing South Africans – including private citizens and members of the anti-migrant group Operation Dudula – barring individuals they identify as foreign nationals from accessing healthcare services at various facilities across Gauteng and other parts of the country.

The group blames migrants for placing undue pressure on the already strained public health system and expresses growing frustration over the deteriorating conditions in clinics and hospitals. Dudula members have also accused foreign nationals of collecting medication to manufacture nyaope, a street drug.

The group also blocked the entrance of the Diepsloot Extension 5 Clinic, demanding to see ID documents from everyone attempting to enter. Some members complained that some of the foreigners were not even sick but alleged that they were taking medication to sell it back in their countries.

Who’s entitled to access healthcare services? 

South Africa’s constitution guarantees everyone the right to access healthcare services, regardless of nationality or legal status. But the use of public health services by foreign nationals has been brought into question and criticised – even by government officials. 

In a 2023 report of the Health Ombud’s investigation into complaints about the conditions at Rahima Moosa Mother and Child Hospital in Johannesburg, former Gauteng health Head of Department Dr Nomonde Nolutshungu is reported to say, “foreign nationals put pressure on hospitals, as they are not catered for in the budget”. 

The same report quotes former health MEC, Nomathemba Mokgethi saying: “the issue of foreign nationals is the leading cause of overcrowding at Gauteng hospitals, which calls for a policy change”.

Numbers from Rahima Moosa show that more than 40% of the patients at the hospital are foreign nationals (documented and undocumented). 

Medical xenophobia

Nyiko Manyusa, head of Lawyers for Human Rights Durban Office and Law Clinic, tells Health-e News that the organisation is deeply concerned about the treatment of migrants, both documented and undocumented in public healthcare facilities.

“The recent videos posted on social media are a clear example of the harsh xenophobic treatment migrants face in public hospitals,” Manyusa says.

James Chapman, Head of Advocacy and Legal Advisor at the Scalabrini Centre of Cape Town, notes that while many public health facilities are generally receptive and compliant with the law, there is a troubling disparity in how policies are implemented.  

“In certain parts of the country, primarily Gauteng, we have observed a troubling gap between what the law provides and how it is implemented on the ground,” he says. 

Chapman says some migrants, particularly undocumented individuals on the move, in certain areas have been denied services. He could not say how many undocumented individuals were denied medical services. 

He says this practice is commonly referred to as “medical xenophobia”, a deeply concerning phenomenon that undermines individuals’ fundamental rights and public health at large.

The right to healthcare

South Africa recognises various categories of migrants, all of whom are entitled to at least emergency healthcare:

• Asylum Seekers: Individuals fleeing persecution in their home countries and awaiting recognition as refugees. They are generally granted access to basic health services, which include access to clinics and community health centres for general health concerns, maternal and child healthcare, emergency medical services, HIV treatment and TB care and mental health support
• Recognised Refugees: Those granted official refugee status in South Africa. Under the Refugees Act, they are entitled to the same healthcare services as South African citizens. These include full access to public healthcare, treatment of chronic illnesses, maternal and child healthcare, emergency trauma care and access to health promotion and disease prevention programs
• Permanent Residents: They also have the same rights to healthcare as South African citizens.
• Temporary Residents: They are entitled to receive medical care at public health facilities, emergency care, and they don’t qualify for free services; the cost of services is determined based on their income and ability to pay
• Undocumented People: Individuals without legal documentation, either from South Africa or their country of origin. The Constitution still guarantees them the right to emergency medical treatment.

Chapman emphasises that documentation status, while administratively important, should never become a barrier to accessing life-saving care.  

“There are many South Africans who are undocumented, too. Access to healthcare must remain a human right, not a privilege based on paperwork,” he says.

Legal pushback against exclusion

Policies that attempt to limit access to healthcare based on nationality or documentation have been challenged in court and in some cases, overturned.

In 2019 Gauteng Department of Health issued a circular instructing health facilities to charge foreign nationals full fees, regardless of whether they were refugees, asylum seekers, or undocumented individuals, but this was later withdrawn as a result of public pressure.

In a landmark decision in April 2023, the Gauteng High Court ruled that all pregnant and lactating women, as well as children under the age of six, must be provided free health services at public hospitals, regardless of nationality or documentation status.

The ruling declared as unlawful a 2020 policy introduced by the Gauteng Department of Health, which had denied free healthcare to undocumented women and children, including asylum seekers and stateless persons. According to section 4(3) of South Africa’s National Health Act, state-funded clinics provide free primary healthcare services to children under six and pregnant women, except those covered by medical aid schemes.

“This was a major victory for the right to health and the dignity of all people living in South Africa,” says Chapman.

A call for inclusive policy

Manyusa says what’s needed is a health policy grounded in the principles of South Africa’s Constitution.

“We would like to see a policy framework that ensures equal enjoyment of fundamental human rights for all people regardless of nationality or documentation status,” says Manyusa.

“Our laws are built on the values of democracy, equality, and human dignity. That should be reflected in the healthcare system too.”  – Health-e News