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Stranded: Thomas Nukeri, formerly from Mozambique, has not been taking his antiretrovirals because he cannot afford food and taking them on an empty stomach makes him feel dizzy and unable to stand. (Photos: Madelene Cronje)

Xenophobia violates Health Act and migrants' rights to care

Amy Green
Refugees run the border crossing gauntlet of lions, rivers, rape and theft hoping for a better life.

Shinyajo Mabunda screwed his eyes up at the hot and persistent January sun. His body was weak with thirst, hunger and exhaustion but he placed one foot in front of the other, watching the dust rise from the footsteps of his four companions moving slowly in front of him.

A herd of zebra was grazing in the distance as Mabunda swept his eyes over the vast land around him, looking for signs of human life, which he and his fellow Mozambicans wanted desperately to avoid – almost as desperately as the dangerous animals.

It was 1993 and the group had crossed the border into South Africa through the Kruger National Park. The risk would be worth the opportunities.

“I wouldn’t say we slept on the journey; we could not risk it with the wild animals,” says Mabunda, sitting in the dusty yard of his home in Mavela village, Tzaneen, Limpopo. “But we would sometimes rest our backs against the trees.”

His bare feet rest on his plastic slip-on shoes as he looks back at his large family settled in the shade of a huge bougainvillea, a cloud of bright pink above their heads. “We didn’t see any lions but we heard them.”

Mabunda had first come to the country in 1967 looking for employment on the mines. After 10 years of work he went back to his family in Gaza province, only to find the Mozambican civil war had left him without a home or possessions. “All my cattle had been seized when I was away.” He frowns.

Coming back to South Africa after 14 years of living in poverty seemed to him his only option.

Xenophobia worse in cities
Many migrants come to the country through dangerous routes such as the Kruger National Park or the Limpopo River in search of work, according to Mpilo Nkomo from the Limpopo branch of the International Organisation of Migration (IOM).

“It is very difficult to estimate the numbers, given that only some are accounted for at the ports of entry, and many travelling without documentation avoid authorities at all costs.”

In a 2013 report, the African Centre for Migration and Society at Wits University estimates that there were at least three million migrants in South Africa in 2010.

This influx of people, and a growing negative attitude towards them, fuelled the outbreak of xenophobia in 2008, during which more than 60 people were killed and several hundreds injured in attacks on foreigners, according to the organisation Anti-Xenophobia Action South Africa.

Xenophobia is most pronounced in big cities such as Johannesburg and Cape Town, says Nkomo.

“The attacks are more visible, probably due to the belief by the communities that migrants come to take their jobs, wives, and are criminals … It is competition for limited resources.”

Institutionalised xenophobia
These attitudes have been cited as a major barrier to foreigners getting basic health services despite the National Health Act stipulating that “foreign patients without any documentation or permits shall not be refused emergency medical treatment”.

This is especially true in Gauteng where, contradicting the Act, a guideline document was circulated to health workers last year, which “requires a migrant patient without documentation to pay in full before accessing healthcare services”, says Thifulufheli Sinthumule from the Consortium for Refugees and Migrants in Aouth Africa.

“This resulted in many migrants being denied healthcare, including emergency service.”

He says this kind of “institutionalised xenophobia” has “totally sent the wrong message to society that nonnationals are burdening our health system, which is not a true reflection of reality and could influence xenophobia”.

The negative health implications could be far-reaching, says Sinthumule, particularly if a migrant is HIV infected or has tuberculosis that, without treatment, he or she could transmit to others.

Find ways to benefit
“It would be better to sensitise the local population to accept the trend of migration and perhaps find ways to benefit from it – like they already do in some rural communities,” he says.

Sinthumule says that migration has become a global phenomenon and discouraging it “has not proven to yield desired results in any part of the world”.

“Enabling migration policies and asylum management would be key in ensuring that the spirit of the Constitution is lived by all who live in South Africa.”

He adds: “Migration can benefit the host country but only if well managed.”

Nkomo says that, in many rural areas, migrants “integrate” themselves into communities by “participating in and contributing to community activities and sharing burdens such as funeral expenses”.

“Migrants also contribute to community development with their skills or financial resources and these host communities see value in their presence.”

Mavela is just one such rural community where migrants have found refuge from xenophobia and exploitation – and can get access to health services.

Road to Mavela
After Mabunda survived the three-day walk through the Kruger National Park, a family near the border, known for their kindness to migrants, took him in so he could rest for two weeks and recover from dehydration and exhaustion after the trip.

He then “jumped on a truck” transporting farm workers further into Limpopo and ended up near Mavela. The chief at the time became aware of a new person living in the area. After meeting Mabunda, the chief asked the induna, Edward Halahala, to make sure he was taken care of.

Halahala gave Mabunda a piece of land on which he could build a house for his family. This is where Mabunda still resides.

He does not have any documentation and is unsure of his age, but says with a wry smile: “I am old.”

His leans forward, exposing a balding head as he speaks. “The clinic here has always been good to me and my family.”

His oldest daughter, married and living in Mozambique, was worried about her pregnancy. She travelled to her father’s home and gave birth at the clinic – after which she returned to her country.

Mother and daughter in Mavela
Even South Africans who don’t have documents and live in cities, including those in Gauteng where xenophobia is pronounced, often travel to more rural areas to procure health services.

Another Mavela resident, Thembi Ndlovu, was born in Zimbabwe but came to South Africa in 2002 to look for work as she could not eke out a living in her country with its “crumbling economy”.

Her only daughter followed suit some years later and is living in Johannesburg.

Ndlovu, who is now married to a South African man, lives in his Mavela house but when her daughter got pregnant she worried about being turned away from Johannesburg hospitals.

“Just before nine months I told her to come this side,” she says.

Ndlovu’s daughter gave birth in Mavela, recovered with her mother for a few months, and returned to her life in Johannesburg.

“But I worry about her. The man who impregnated her is not helping her; she is on her own,” Ndlovu says.

Risk of exploitation
Nkomo says that undocumented migrants are vulnerable to exploitation because of their tenuous legal status in the country.

“South Africa has the second largest economy on the continent and this influences migration here as migrants perceive that the grass is greener this side – only to discover once they are in South Africa that the grass is not as green as they thought.”

Ndlovu found a job as a domestic worker in Johannesburg, “the city of gold”, she says with a frown.

But she left after two years because she “could not take it any longer”.

“I would wake up at six in the morning and finish at nine at night, sometimes with no breaks and very little food,” she says.

“The lady [I worked for] knew I was from outside so she said to me I can’t complain of no rest. There’s nothing I could do.”

Women especially vulnerable
Female migrants are particularly vulnerable to sexual exploitation, exposing them to sexually transmitted infections, which makes it all the more urgent they be able to get access to health services, according to Nkomo.

Ndlovu says that just after crossing the border from Zimbabwe she was “used by men” on several occasions. “They promised to help me and buy me food and I had nothing. I had no money to get to Johannesburg to look for work.”

But these men did not help her. She says she was lucky that one of them gave her R30, which she used for transport.

Nkomo says people take incredible risks to get to South Africa and, hopefully, to live safely once here.

“The notorious groups of people, commonly known as gumagumas, rob migrants of their valuables such as cellphones, money, clothes and footwear,” he says.

“Additionally, migrants often do not get to their destinations because they are arrested and detained for deportation and, in the process, they lose a lot of precious time they could employ in some productive activities.”

Wild animals and strong currents
He says most of these migrants, after being deported, immediately make the hazardous journey back to South Africa, risking being “mauled by wild animals such as lions” or drowning in the Limpopo River and being “mauled by crocodiles”.

Sitting on a mat outside the small house she and her South African husband share in Mavela, Ndlovu recounts the tale of crossing the border. “We crossed the river there by Beitbridge,” she says, fingering her red-painted toe nails. “We started with 14 people but there were only six of us left when we got to South Africa.”

One was a woman travelling with a baby on her back. Ndlovu explains that the current was strong and the woman felt she was being taken.

Acting on a desperate impulse the woman untied the baby from her back and threw it at one of the men further along in front of her.

“He didn’t know what to do and ended up throwing it back in the water,” Ndlovu looks at the ground. “But I try not to think about that.”

Legal immigrants also suffer
Rebecca Maluleke, a training co-ordinator employed by the Limpopo health organisation Choice Trust, had heard about an immigrant in Mavela who was not taking his HIV medication.

She knocks on the wonky door of the ramshackle hut and after a few minutes the skeletal figure of Thomas Nukeri emerges.

His tattered shirt barely covers the bones visible under his skin. His eyes are sunken and he moves slowly, as if each step is an effort.

She struggles to hold back a gasp.

They greet each other and settle on two broken chairs. Nukeri tells her he has been living in South Africa since 1983 after crossing the border with Mozambique into the Kruger National Park. He was adopted by a local family and for this reason has a South African identity document.

But, he tells Maluleke, his document has been torn in half and needs to be replaced before he can apply for a social grant from the government.

“I worked on the farms until 2004 when I started to get sick,” he says, wrapping his arms tightly around his shivering body, even though the sun is hot and high in the sky.

He was diagnosed with HIV and began treatment. He tells Maluleke he has never worked properly again and sometimes herds cattle to make some money.

“Do you have family or friends to help you?” asks Maluleke.

“No. I’ve never had a wife and the rest of my family has passed away. It’s just my mother back in Mozambique. There is an old lady around here who sometimes comes to check up on me.”

Maluleke smiles at the wasted figure of Nukeri and says: “Why, I’ll marry you, Thomas!”

She laughs and Nukeri manages a small grin. 

Maluleke becomes serious and asks why he is not taking his HIV treatment.

“I don’t have food and the pills make me feel sick if I take them alone,” he says. “I get dizzy and can’t stand.”

Maluleke explains that he will feel better if he takes his pills regularly and makes notes in her notebook – another name on the list of people in need.

“We’ll see what we can do,” she says, standing up to leave. “We’ll be coming to check on you and bring some food.”

They shake hands and part ways.

As she walks along the dusty road to her car, Maluleke wonders why Nukeri stays in South Africa when he is clearly not well and living in poverty. She shakes her head and clicks her tongue. “It must be worse back home.”

No food
Ndlovu has had numerous negative experiences in her many years in South Africa, but still feels her life is better here than it would be in Zimbabwe.

“We’ve got everything here compared to Zimbabwe,” she says. “Like food. We’ve got it here and back there there is no food.”

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immigrantsillegal immigrantsTzaneenAfrican Centre for Migration and Society (ACMS)