Skewed attitudes against migrants in South Africa’s public health system fuel medical xenophobia

Skewed attitudes against migrants in South Africa’s public health system fuel medical xenophobia

By Paul Kariuki and Tawanda Matema• 26 September 2021 2021

The basic human right to healthcare for all, including migrants, refugees and asylum seekers, is being hamstrung by bureaucracy and passing the buck of policy interpretation on to healthcare provision staff. The government needs to enact a significantly less exclusive and more coherent healthcare policy.

Dr Paul Kariuki is the executive director, Democracy Development Program (DDP) and Tawanda Matema is the project manager (Migration Project) at the Konrad Adenauer Stiftung (KAS) Johannesburg. The perspectives shared are their own.

The Covid-19 pandemic which crippled the world in 2020 exposed the importance of efficient healthcare systems by accentuating the challenges affecting healthcare provisions, such as poor infrastructure, limited medical resources and unequal access to healthcare services the world over.

Moreover, access to vaccinations has remained a persistent challenge though most of the developing countries have made significant efforts towards securing vaccines for their citizenry.

In South Africa, as in many other countries around the world, the pandemic has heightened the cleavage of unequal access to public services, particularly healthcare which has negatively affected populations at risk, such as the poor, women, children, the homeless, the LGBTQI+ community and migrants, including refugees and asylum seekers. 

The ongoing challenge of providing healthcare services equitably remains elusive. For instance, black African migrants continue to be compromised given the recent xenophobic attacks in some parts of the country and the ongoing inaccessibility to quality healthcare services based on their nationality, a phenomenon referred to as “medical xenophobia”.

Medical xenophobia generally refers to the negative attitudes and practices of health sector professionals towards migrants. A ground-breaking study by Jonathan Crush and Godfrey Tawodzera on Zimbabwean migrants found that the South African public health system was marred by medical xenophobia, and this directly contradicted the country’s Constitution and Bill of Rights.

The situation is complex, due to various reasons such as cultural and language differences between local health personnel and black African migrants. In some instances, the research found that some health practitioners from other African countries practising in the country also face some forms of discrimination, often blamed for taking health jobs “meant” for South Africans. While these claims are unfounded and false, concerns remain on why a critical sector such as health would be discriminatory.   

So then, what fuels xenophobia in the healthcare sector? The first challenge is a policy one. For instance, the South African Constitution, National Healthcare Act of 2004 and Refugee Act provisions assert that everyone in South Africa has the right to primary healthcare and, based on international law, no person should be denied emergency healthcare services.

Moreover, the Immigration Act places the onus on healthcare staff to determine the legal status of patients and report to Home Affairs any migrants that do not produce appropriate documentation.

This policy dislocation has resulted in many African migrants being denied medical services simply because they do not produce documentation or payment for medical services. Additionally, the National Health Insurance Bill of 2019 limited the rights of undocumented migrants in accessing healthcare. This happened even though migrants, including undocumented ones and particularly pregnant women and children under six years old, are entitled to free healthcare services.

Second, institutional challenges such as a shortage of healthcare facilities, medicines and healthcare personnel can also contribute to medical xenophobia. A recent study found that institutional challenges often led to poor treatment for both migrants and South Africans.

Similar studies conducted by the Scalabrini Centre of Cape Town, Sonke Gender Justice and Lawyers for Human Rights found that in some cases and areas the South African healthcare system is not capacitated enough to provide adequate healthcare services to patients in spite of their nationality.

The way forward begins on the policy level. Healthcare is a basic human right and the South African government must have a coherent overarching healthcare policy to avoid leaving the interpretation of the policy to healthcare provision staff. The policy must also be comprehensive enough to include African migrants.

Moreover, the healthcare system needs additional personnel to support the increasing demand for health services, especially at the moment, due to the Covid-19 pandemic.

In addition, other factors such as sociocultural and communication factors as well as other bureaucratic barriers must be addressed to promote equity in healthcare. In this way, populations at risk such as refugees and asylum seekers are catered for and can more easily access public health services.

www.samigration.com


US to lift travel restrictions on vaccinated South Africans

Fin 24 – 20 September 2021

By November, the US will allow entry to South African travellers as long as they’re fully vaccinated against Covid-19.

The US government has had a travel ban imposed on most countries for more than 18 months.

The measures, announced on Monday by the White House, will ease restrictions on the UK and the 26 Schengen countries in Europe, as well as Ireland, China, Iran, Brazil, South Africa and India, The Guardian reported

Travellers must prove that they are fully vaccinated before boarding a flight and must have a negative Covid-19 test within 72 hours of departure. They will not be required to quarantine upon arrival in the US, AFP reported

Bloomberg reports that while the move will open the US to millions of vaccinated people, the White House cast the measure as a crackdown, pointing to stricter testing rules and a new contact tracing regime.

The new policy will take effect in "early November", according to the White House, though the precise date isn’t yet clear.

"We know vaccines are effective, including against the delta variant, and vaccines are the best line of defence against [Covid-19], so this vaccination requirement deploys the best tool we have in our arsenal to keep people safe and prevent the spread of the virus," White House Covid-19 response coordinator Jeff Zients told reporters on Monday.  

The new rules will replace the current system, which includes outright bans on entry for foreigners who’ve been in certain regions, such as the UK and European Union, within the previous two weeks, regardless of vaccination status. 

"We will protect Americans here at home and enhance the safety of international travel," Zients said.

www.samigration.com

 


Germany – unlike the UK – no longer considers SA high risk for travel

Germany – unlike the UK – no longer considers SA high risk for travel

Business Insider SA - 20 Sep 2021

  • Germany has removed South Africa from its list of high-risk countries.
  • That means only European Union travel restrictions now apply to those who travel from SA to Germany – and those are friendly to those who have been vaccinated.
  • SA's electronic vaccine passports should, in theory, soon smooth things for those vaccinated here.
  • The UK, for reasons still not entirely clear, still thinks travellers from South Africa have to quarantine on arrival there.

Germany no longer considers South Africa to be a coronavirus high-risk area, and has dropped its national travel restrictions for travellers who have been in SA.

That means only the general European Union rules apply to those who travel from SA to Germany. And that means freedom to enter for anyone who has been fully vaccinated for at least 14 days which should – in theory – soon mean a smooth ride for people vaccinated in SA. The South African government is due to make available electronic vaccine passports any day now, with the expectation that those will be accepted at EU borders.

In the meanwhile, Germany has confirmed that South Africa's standard vaccine card is currently acceptable as proof of vaccination.

"The commonly used South African Vaccination Record Card -if properly filled out- does fulfill these formal requirements," says Germany's mission to Southern Africa.

The change in Germany's approach to SA, effective from 19 September, makes for a growing list of European countries that are now accessible to South Africans, including Switzerland, France, Spain, and Finland.

Germany's reclassification means South Africans no longer have to register on its einreiseanmeldung.de website, as before, but proof of a recent coronavirus test is still required.  

Germany simultaneously removed Eswatini, Zimbabwe, and Zambia from its list of high-risk countries, alongside Brazil, India, and a handful of others.

The removal became effective shortly after the United Kingdom failed to drop its quarantine requirement for those travelling from South Africa.

South Africa has been on the UK's red list since its inception. Only British or Irish nationals and those with residence rights have been allowed to enter the UK. These exempted travellers have, however, still been forced to spend ten days in quarantine in a state-managed hotel at their own cost of £2,285 (R44,800).

www.samigration.com

 


Foreign nationals file class action against Home Affairs to avoid separation from their children

Foreign nationals file class action against Home Affairs to avoid separation from their children

Daily Maverick  25 September 2021

Forced to stay in unbearable marriages and faced with the constant fear of being separated from their children, three foreign nationals have asked the Cape High Court to declare parts of the Immigration Act unconstitutional as it requires them to leave the country if they get divorced and leave their children behind.

In a desperate fight to stay with their kids, three single parents faced with having to leave South Africa immediately without their children, have filed a class action suit against Department of Home Affairs in the Cape High Court.

In court papers the parents, represented by immigration attorney Gary Eisenberg, described how they are forced to stay in marriages characterised by verbal abuse, drug addiction and abandonment to remain with their children as South Africa’s immigration laws make no provision for their situation.

The Department has indicated that it will oppose the legal action.

The Immigration Act does not provide a visa for the purpose of parenting South African children by foreign nationals once a spousal relationship breaks down. As a result foreigners must leave the country regardless of whether they are the primary caregiver of the children.

The court has been asked to declare these parts of the law unconstitutional and order Parliament to remedy the defects and also for an order that will allow for the three parents to stay in the country.

The names of the applicants are known but withheld to protect the identities of their children.

One of the applicants, a 45-year old German woman, from Kommetjie said she has two sons, aged 10 and 11, who live with her.

She said her husband became aggressive and abusive. “Things have deteriorated to such an extent that the children have no desire to see [him]…He is an absentee father and I am, in effect, a single mother.”

She said while her husband provides minimal financial support she cannot get a divorce as she fears she will be forced to leave the country without her children who are South African citizens.

Her visa will expire in November.

“I should be leaving South Africa immediately … it would be tantamount to abandoning my children.”

She said while she applied for permanent residence her application will likely not be finalised before 2023.

“I am at a loss for what to do,” she added. “It is [the children] who will suffer the most.”

Another applicant, a 46-year old French citizen, has separated from his wife after she became addicted to tik and alcohol and had abandoned him and their two sons.

He is currently in South Africa on a visitors visa and is not allowed to work.

“I can never forgive her for her final abandonment of our two minor children, a trauma that will take them a long time to resolve. I cannot again leave them alone … I am their father,” he said.

The third applicant, a 30-year old boxing coach from Zimbabwe was declared “undesirable” in South Africa and has been banned from returning until 2024.

He has a two year old son and was paying for the flat where the boy was living with his mother, paid maintenance and saw him every day.

In April 2019 he was apprehended at the airport and in terms of a new directive he was declared undesirable for “overstaying” and deported. He can only return to South Africa legally in April 2024.

“I was forced by the policewoman and her superior, and by Passport Control officials, to buy a one-way air ticket to Zimbabwe. I was given no opportunity to make representations … if I did not leave that day, I would be incarcerated and I preferred to leave rather than to sit in jail.”

He admits that he returned to South Africa later in 2019 but did not pass “through passport control.”

“This was the only way I could continue to provide for [my son] and remain part of his life.”

He has also requested the court that this new directive, be declared invalid and set aside as it denies people access to a administrative action if they wish to dispute the finding that they are undesirable.

No date has yet been set for the hearing

www.samigration.com

 


Ongoing closure of reception offices leaves refugees and asylum seekers in undocumented limbo

Ongoing closure of reception offices leaves refugees and asylum seekers in undocumented limbo

Daily Maverick - 20 September 2021

South Africa is a signatory to international refugee treaties, treaties incorporated into its legal system through the Refugees Act. This gives refugees and asylum seekers protection under the Bill of Rights. But the ongoing closure of refugee reception offices means that many are in complete limbo.

Since the declaration of the national state of disaster, which was followed by the national lockdown, all public and private offices and institutions were closed down, except the ones that provide essential services.

Offices of the Department of Home Affairs were among those that were closed and its services were limited to ensuring repatriations of South African citizens and permanent residents who were stranded abroad and to allow foreign nationals to depart the country. Closure of these offices meant that permits and visas couldn’t be issued or renewed. Under different levels of the lockdown, certain crucial civil and immigration services were, however, gradually re-opened. 

Back in March 2020, the Department of Home Affairs issued a directive that all visas and permits that expired or were due to expire on, before, or after 25 March 2020 should be deemed valid. This blanket extension, which ran from 26 March to 31 July 2020, implied that all immigration visas and refugee (or asylum-seeker) permits that expired during the said period remained valid.

Still, the date of blanket extension was periodically extended. First, it was extended to 30 September 2020, then to 31 January 2021 and again to 31 March 2021. Owing to the second wave of Covid-19, it is expected that this date will be extended further. More importantly, blanket extensions imply that foreign nationals’ expired visas and permits are deemed to be valid if they did expire around or during the lockdown.

Public and private offices or institutions should therefore take notice that the permits of refugees and asylum seekers are deemed valid and they shouldn’t be turned away when trying to access important services. All the rights, benefits and obligations of refugees and asylum seekers should remain the same and that they shouldn’t be penalised when it is clear that their permits expired during the lockdown.

It is not disputable that the refugee reception offices have been closed since the start of the lockdown and remain closed until the minister decides otherwise.

It is therefore surprising that organs of the state are reluctant to accept the permits of refugees and asylum seekers on the grounds that they are expired. The South African Social Security Agency (Sassa) has been turning away refugees who want to apply for renewal of social grants or social relief of distress, and the traffic departments have been refusing to renew professional driving permits.

Refugees and asylum seekers have been struggling to register businesses with the Companies and Intellectual Property Commission, and to apply for trading licences with municipal offices and for admission to basic or higher education. Some employers are reluctant to recruit refugees or asylum seekers whose documents have expired or to renew their employment contracts. They also find it difficult to open new bank accounts.

These frustrations add to the existing problems refugees and asylum seekers face when trying to access public services. Findings of my 2018 doctoral study indicated that asylum seekers are, for example, traditionally excluded from social grants to avoid the high impermissible costs that may be incurred by the state should they be included in various socio-economic programmes. This exclusion is grounded in the notion that 90% of asylum seekers are economic migrants or job seekers who do not fall within or deserve refugee protection. Unsurprisingly, Covid-19 relief measures weren’t extended to refugees and asylum seekers despite the latter being the most vulnerable group.

The salient question that we have to ask ourselves is: to what extent are refugees and asylum seekers entitled to socio-economic rights and benefits, public services or Covid-19 relief measures? Indeed, this is a controversial question complicated by the national understanding that refugees and asylum seekers are in the country to benefit from the fruits of democracy.

The question refugees and asylum seekers ask themselves is whether the department values their well-being as much as it does that of citizens.

This view disregards the fact that South Africa acceded to international refugee treaties and incorporated these treaties into its legal system through the Refugees Act 130 of 1998 (as amended). This act provides that refugees are entitled to all rights in the Bill of Rights, except those rights that are expressly reserved for citizens. Sections 26, 27, 28(1)(c), and 29 of the Constitution provide “everyone” with the right of access to adequate housing (or shelter), healthcare services, sufficient food (or basic nutrition), sufficient water, social assistance and social security as well as education. This seems to indicate that refugees and asylum seekers are entitled to socio-economic rights or services.

The Refugees Act, read through the lens of these constitutional provisions, signals South Africa’s intention to offer effective protection to refugees and asylum seekers, to respond to their suffering caused by past persecutions in their home countries, or by disasters occurring in South Africa. The onus rests on South Africa to restore their self-reliance, participation and agency as well as to protect their dignity. This can only be done if they are given access to public services. Documenting refugees and asylum seekers and timely renewal of documents are core mechanisms to make such access possible.

Unlike other foreign nationals, refugees and asylum seekers are, irrespective of the temporary nature of their stay, not required to be self-reliant and economically independent in order to be admitted to the country. Rather, they are admitted because of humanitarian reasons and should thus be offered the necessary humanitarian protection.

However, during this lockdown, institutions providing public services have relied on the expiry of permits of refugees and asylum seekers to deny them the services they are entitled to — services that they need to lead a dignified life. The denial of such services — on the basis of the expiry of a permit — is inconsistent with the ministerial directives issued by the minister of Home Affairs for compliance with the lockdown regulations.

The question refugees and asylum seekers ask themselves is whether the department values their well-being as much as it does that of citizens. The refugee reception offices have been closed on the grounds that long queues at these offices may facilitate the spread of the Covid-19 virus if people don’t adhere to social distancing, wearing of masks, and sanitising of hands. However, we see the same queues (or crowds) at the offices of Home Affairs serving citizens. There is always a huge crowd with not much social distancing.

Refugees and asylum seekers feel that the closure of refugee reception offices works to frustrate their access to services and not to protect them. Furthermore, they feel that the closure will cause a huge backlog that the department will find hard to recover from. It should be noted that for many years the department has been unable to clear the backlog of refugee status appeals, certification applications and appeals thereof and, in 2019, had to approach the United Nations High Commissioner for Refugees for help. When the lockdown began in March 2020, the issue of the backlog had not yet been resolved.

In light of the above, the refugee reception offices should reopen and serve refugees and asylum seekers to avoid future irregularities stemming from accumulated backlogs. The reopening will restore hope for refugees and asylum seekers for access to services they deserve

www.samigration.com

Since the declaration of the national state of disaster, which was followed by the national lockdown, all public and private offices and institutions were closed down, except the ones that provide essential services.

Offices of the Department of Home Affairs were among those that were closed and its services were limited to ensuring repatriations of South African citizens and permanent residents who were stranded abroad and to allow foreign nationals to depart the country. Closure of these offices meant that permits and visas couldn’t be issued or renewed. Under different levels of the lockdown, certain crucial civil and immigration services were, however, gradually re-opened. 

Back in March 2020, the Department of Home Affairs issued a directive that all visas and permits that expired or were due to expire on, before, or after 25 March 2020 should be deemed valid. This blanket extension, which ran from 26 March to 31 July 2020, implied that all immigration visas and refugee (or asylum-seeker) permits that expired during the said period remained valid.

Still, the date of blanket extension was periodically extended. First, it was extended to 30 September 2020, then to 31 January 2021 and again to 31 March 2021. Owing to the second wave of Covid-19, it is expected that this date will be extended further. More importantly, blanket extensions imply that foreign nationals’ expired visas and permits are deemed to be valid if they did expire around or during the lockdown.

Public and private offices or institutions should therefore take notice that the permits of refugees and asylum seekers are deemed valid and they shouldn’t be turned away when trying to access important services. All the rights, benefits and obligations of refugees and asylum seekers should remain the same and that they shouldn’t be penalised when it is clear that their permits expired during the lockdown.

It is not disputable that the refugee reception offices have been closed since the start of the lockdown and remain closed until the minister decides otherwise.

It is therefore surprising that organs of the state are reluctant to accept the permits of refugees and asylum seekers on the grounds that they are expired. The South African Social Security Agency (Sassa) has been turning away refugees who want to apply for renewal of social grants or social relief of distress, and the traffic departments have been refusing to renew professional driving permits.

Refugees and asylum seekers have been struggling to register businesses with the Companies and Intellectual Property Commission, and to apply for trading licences with municipal offices and for admission to basic or higher education. Some employers are reluctant to recruit refugees or asylum seekers whose documents have expired or to renew their employment contracts. They also find it difficult to open new bank accounts.

These frustrations add to the existing problems refugees and asylum seekers face when trying to access public services. Findings of my 2018 doctoral study indicated that asylum seekers are, for example, traditionally excluded from social grants to avoid the high impermissible costs that may be incurred by the state should they be included in various socio-economic programmes. This exclusion is grounded in the notion that 90% of asylum seekers are economic migrants or job seekers who do not fall within or deserve refugee protection. Unsurprisingly, Covid-19 relief measures weren’t extended to refugees and asylum seekers despite the latter being the most vulnerable group.

The salient question that we have to ask ourselves is: to what extent are refugees and asylum seekers entitled to socio-economic rights and benefits, public services or Covid-19 relief measures? Indeed, this is a controversial question complicated by the national understanding that refugees and asylum seekers are in the country to benefit from the fruits of democracy.

The question refugees and asylum seekers ask themselves is whether the department values their well-being as much as it does that of citizens.

This view disregards the fact that South Africa acceded to international refugee treaties and incorporated these treaties into its legal system through the Refugees Act 130 of 1998 (as amended). This act provides that refugees are entitled to all rights in the Bill of Rights, except those rights that are expressly reserved for citizens. Sections 26, 27, 28(1)(c), and 29 of the Constitution provide “everyone” with the right of access to adequate housing (or shelter), healthcare services, sufficient food (or basic nutrition), sufficient water, social assistance and social security as well as education. This seems to indicate that refugees and asylum seekers are entitled to socio-economic rights or services.

The Refugees Act, read through the lens of these constitutional provisions, signals South Africa’s intention to offer effective protection to refugees and asylum seekers, to respond to their suffering caused by past persecutions in their home countries, or by disasters occurring in South Africa. The onus rests on South Africa to restore their self-reliance, participation and agency as well as to protect their dignity. This can only be done if they are given access to public services. Documenting refugees and asylum seekers and timely renewal of documents are core mechanisms to make such access possible.

Unlike other foreign nationals, refugees and asylum seekers are, irrespective of the temporary nature of their stay, not required to be self-reliant and economically independent in order to be admitted to the country. Rather, they are admitted because of humanitarian reasons and should thus be offered the necessary humanitarian protection.

However, during this lockdown, institutions providing public services have relied on the expiry of permits of refugees and asylum seekers to deny them the services they are entitled to — services that they need to lead a dignified life. The denial of such services — on the basis of the expiry of a permit — is inconsistent with the ministerial directives issued by the minister of Home Affairs for compliance with the lockdown regulations.

The question refugees and asylum seekers ask themselves is whether the department values their well-being as much as it does that of citizens. The refugee reception offices have been closed on the grounds that long queues at these offices may facilitate the spread of the Covid-19 virus if people don’t adhere to social distancing, wearing of masks, and sanitising of hands. However, we see the same queues (or crowds) at the offices of Home Affairs serving citizens. There is always a huge crowd with not much social distancing.

Refugees and asylum seekers feel that the closure of refugee reception offices works to frustrate their access to services and not to protect them. Furthermore, they feel that the closure will cause a huge backlog that the department will find hard to recover from. It should be noted that for many years the department has been unable to clear the backlog of refugee status appeals, certification applications and appeals thereof and, in 2019, had to approach the United Nations High Commissioner for Refugees for help. When the lockdown began in March 2020, the issue of the backlog had not yet been resolved.

In light of the above, the refugee reception offices should reopen and serve refugees and asylum seekers to avoid future irregularities stemming from accumulated backlogs. The reopening will restore hope for refugees and asylum seekers for access to services they deserve

www.samigration.com