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Open letter – Collective Voices against Health Xenophobia’s appeal to the health minister

6 Mar 2023

The coalition’s written plea for help in the face of often violent health xenophobia is published here, since neither the minister nor the Gauteng health MEC has responded.

On 7 February 2023, 26 civil society organisations wrote to the health minister and Gauteng’s health MEC to request an urgent meeting to address ongoing attempts to prevent migrant patients from accessing healthcare services – sometimes violently. Our hope is to work with the government to forge strategies to ensure access for all, as enshrined in Section 27 of the Constitution and provided for in the National Health Act and the Refugees Act.

There is evidence that the treatment and medication of some patients continue to be disrupted because they are being turned away from health facilities, while others have endured xenophobic abuse and harassment. Meanwhile, no action has been taken against the assailants who violently attacked migrant patients at the Jeppe Street Clinic in February 2023.

Neither the minister nor the MEC acknowledged our correspondence or responded, despite repeated efforts to engage them on this matter in February.

In an attempt to increase attention to this issue and in the hope of catalysing a response from our health leaders, we publish our letter here in full.

Read in Daily Maverick: “Medical xenophobia: It’s time to level the power imbalance in healthcare facilities”

We make the following urgent appeal: Acts of vigilantism and xenophobia in any form and in particular in the context of denying people access to healthcare are completely unacceptable, should be publicly condemned and the perpetrators should be held accountable. Xenophobia endangers all who access healthcare, inhibits health-seeking and has a far-reaching impact on public and individual health.

We call on the South African government, the minister of health (or his replacement) and MECs of health to publicly condemn all forms of xenophobia and to publish a plan on how it will prevent xenophobia in the healthcare setting.

Limpopo health MEC Phophi Ramathuba. (Photo: Flickr)

We re-state our commitment to work with the government and other stakeholders to address these critical issues.

Dear Dr Phaahla (or the new incumbent following the Cabinet reshuffle) and Ms Nkomo-Ralehoko,

Xenophobic attacks on patients at public health facilities: Request for a Meeting

The Collective Voices against Health Xenophobia is a coalition of civil society organisations, activists, healthcare workers and researchers who work on furthering social justice and challenging xenophobia within the healthcare sector. We uphold South Africa’s comprehensive human rights legislation, the South African Constitution and international obligations that recognise and facilitate the right to health for all.

We are writing to express our increasing alarm and concern over the rising levels of xenophobia against migrants in South Africa and in particular, Operation Dudula’s ongoing campaign to exacerbate health xenophobia.

We strongly condemn the ongoing attacks by Operation Dudula on patients in public sector facilities, most recently at Jeppe Clinic in Johannesburg earlier in January 2023. The basis for the removal of patients from facility waiting rooms or preventing patients from entering health facility premises is unequivocally xenophobic. The Jeppe Clinic incidents have been documented in the media and corroborated by our colleagues. One such confrontation at Jeppe Clinic was captured in a video circulating on social media that shows three adult patients in the waiting room being told in isiZulu that “foreigners can be located by the smell of their armpits”. Furthermore, that they should seek healthcare elsewhere. They are then aggressively instructed to leave the facility and are escorted to the clinic gate. The party included a frightened toddler of around three years. No clinic staff member or security guard intervened or prevented this illegal removal from taking place. No member of the public objected.

Read in Daily Maverick: “Healthcare without borders — the importance of eradicating medical Afrophobia”

Similar incidents have recently been recorded at Zandspruit Clinic and Cosmo City Clinic.

This is a deliberate infringement on people’s right to access healthcare, a right enshrined in Section 27 of the country’s Constitution and provided for in the National Health Act and the Refugees Act. It also violates South Africa’s international obligations.

Preventing people from accessing health not only endangers individual health, but also public health. It ultimately increases the burden on the healthcare system as people who are turned away from healthcare become sicker and require more care. It also impacts on the ability of our country and the region to bring the continued spread of Covid-19 and other communicable diseases such as TB, HIV and measles under control.

It puts everyone’s lives at risk.

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We also note with concern the escalation of public comments by government leaders supporting health xenophobia and that have been met with little condemnation or government action. Examples include Limpopo health MEC Dr Phophi Ramathuba who in 2022 publicly chastised a migrant patient for “killing [her] healthcare system”, and Minister of Home Affairs Aaron Motsoaledi who stated that non-South African patients “cause overcrowding, [which means] infection control starts failing”. Civil society organisations, such as the Helen Suzman Foundation and Socio-Economic Rights Institute, have also come under attack, sometimes by government officials and politicians, for challenging xenophobia.

In a statement issued by the Department of Health in September 2022, Minister Phaahla stated that:

“I am hereby making a call to the leaders and followers of [those] responsible for the blockades of our health facilities to stop these with immediate effect. Yours as citizens is to hold the government accountable for improvement of services whatever the cause of poor service might be. We do not prefer to rely on law enforcement to create an environment conducive for our health workers to do their best in saving lives, that is our last resort, but of course if we are left with no alternative, we will call on the police to keep law and order.”

Against this background, we would appreciate it if you could provide us with the following information:

A breakdown of steps you have taken to ensure that the offenders of health xenophobia are apprehended and prosecuted; and

A breakdown of measures taken by the national and provincial government departments – including legal proceedings – to prevent health violations by Operation Dudula and other groups in future and to ensure that public health facilities can react speedily and firmly on patient attacks and rights infringements in the future.

Health Minister Dr Joe Phaahla. (Photo: Gallo Images / Luba Lesolle)

We call on you to publicly condemn this spate of attacks, and to encourage healthcare workers and members of the public to speak out and report such incidents, and to affirm the rights of everyone to access health care.

We would like to request a meeting at your earliest convenience to discuss these pressing matters and to jointly forge a plan to combat health xenophobia in the future.

Open Letter undersigned by:

Africa Legal Students Association and Justice Chapter

Africa Revival Foundation

Africa solidarity Network (ASONET)

Africa Unite

Amnesty International South Africa

Congolese civil society of South Africa

Consortium for Refugees and Migrants in South Africa (CoRMSA)

Health Justice Initiative

International Commission of Jurists

Jesuit Refugee Service

Johannesburg Migrant Health Forum

Keep Left/socialism from below

Kopanang Africa Against Xenophobia

Lawyers for Human Rights

Medecins Sans Frontieres South Africa

MikNel CharitAbles NPO

Neighours NPO

PASSOP

Perinatal HIV Research Unit

People’s Health Movement-South Africa

ProBono.Org

Refugee Social Services

School of Public Health, University of the Western Cape

SECTION27

Socio Economic Rights Institute

Sonke Gender Justice

Southern African HIV Clinicians Society

South African Jewish Board of Deputies

Sophiatown Community Psychological Services

The Desmond and Leah Tutu Legacy Foundation

Treatment Action Campaign

Tshwane Leadership Foundation

UTRS

Inchanga Community Resource Centre

On behalf of the Collective Voices against Health Xenophobia coalition. DM/MC

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Xenophobic attacks on patients at public health facilities: Request for a Meeting