- About Us
- Our Work
- Work With MSF
- Public Events
- Press Room
No Refuge, Access Denied: Medical and Humanitarian Needs of Zimbabweans in South Africa
June 2, 2009
© Austin Andrews
Each day, thousands of Zimbabweans cross the border into South Africa, many risking their lives to flee economic meltdown, political turmoil, and a critical lack of access to health care in their country.
In the past several years, the crisis in Zimbabwe has given rise to food insecurity, an unprecedented cholera epidemic, political violence, rampant unemployment, an escalating HIV crisis and the near-total collapse of the health system. This breakdown in Zimbabwe has driven nearly one quarter of the entire population into neighboring countries, particularly South Africa.
And despite claims that Zimbabwe is ‘normalizing’ following the establishment of a Government of National Unity, Zimbabweans continue to cross the border every day, legally and illegally, in massive numbers as a matter of survival.
Upon arrival, many Zimbabweans endure further suffering in South Africa, without access to proper health care, shelter or safety. During their journey to and within South Africa, they are subjected to violence, physical and verbal abuse, police harassment, inhumane living conditions and xenophobic attacks.
The South African Constitution guarantees access to health care and other essential services to all those who live in the country – including refugees, asylum-seekers, and migrants – regardless of legal status. However, in practice, the fear of arrest, deportation, and xenophobia, coupled with a lack of accurate information about their rights, has kept many Zimbabweans from accessing basic services necessary for survival. Today, Zimbabweans are still often charged exorbitant fees to access public facilities despite policies to the contrary, turned away from hospitals when they need admission, discharged prematurely, or subjected to harsh treatment by health staff in the public services.
In 2007, Médecins Sans Frontières (MSF) opened two projects to respond to the specific health needs of Zimbabweans seeking refuge in South Africa. MSF mobile clinics, operating in and around Musina town at the border with Zimbabwe, in addition to a fixed MSF clinic at the Central Methodist Church in Johannesburg, provide general primary health care, referrals to existing hospitals or specialized medical facilities, and other humanitarian assistance, including shelter, water and food.
MSF medical teams treat 4,000-5,000 Zimbabweans each month, mainly for respiratory tract infections, including a substantial proportion of tuberculosis; sexually transmitted infections; gastrointestinal and diarrhoeal conditions; and stress-related ailments. More than 30% of HIV tests performed are positive. Yet, this is just the tip of the iceberg. There are thousands more Zimbabweans who never come forward to access MSF or other health services, choosing instead to protect themselves by becoming invisible in South African society.
© Sara Hjalmarsson/MSF
Because many patients have endured multiple traumatic events and exhibit symptoms of post traumatic stress, MSF also provides psychological support in both Musina and Johannesburg. In addition, MSF teams treat a rising number of survivors of sexual violence and see a worrying increase in the number of unaccompanied children traveling from Zimbabwe into South Africa.
The recent announcement by the South African Department of Home Affairs that a new system will be put in place to regularize the legal status of Zimbabweans in South Africa, and to stop the systematic deportation of Zimbabweans, is a welcome departure from the government’s previous policy of aggressive harassment, arrest, and deportation. Whether the fate of vulnerable Zimbabweans in South Africa will improve depends upon how and when these new policies will be put into practice.
This report highlights the plight of Zimbabweans seeking refuge in South Africa, the appalling conditions in which they live, and their ongoing lack of access to adequate protection, shelter, and basic services, particularly health care, in South Africa.
Zimbabweans under attack: a chronology of desperation
We Are Here Because We Were Fleeing Suffering in Zimbabwe
© Dirk-Jan Visser
Over the past several years, an estimated three million Zimbabweans have crossed the Limpopo River into South Africa. The situation has become particularly acute in the past year and a half.1
In Zimbabwe, currently the most food aid dependent country in the world, seven million people out of the remaining population of nine million are presently food insecure;2 Africa’s worst cholera outbreak in more than 15 years struck 100,000 people, killing over 4,300;3 15% of the adult population is HIV-positive;4 94% of the population is unemployed;5 and several reports have claimed thousands were beaten and intimidated by government security and paramilitary forces during last year’s electoral cycle. The cholera epidemic was widespread, affecting all provinces, and the general case fatality rate (CFR) was above 5% even after an emergency response was established, whereas the rate for a controlled epidemic is defined by a rate of one percent or less. This signaled a near total lack of capacity of public services, including water, sanitation, and health systems, to cope.
Political instability and mismanagement led to economic free fall with skyrocketing inflation exceeding a staggering 89 sextillion percent.6 The economic collapse brought about a virtual standstill in industrial and agricultural production, severe shortages of essential goods, and a near-collapse of basic infrastructure and public services, including the once-vaunted health system. MSF has been working in Zimbabwe since 2000 and witnessed a continuous deterioration of the humanitarian situation during this period.7
The establishment of a Government of National Unity in February 2009 has led some to speculate that the situation in Zimbabwe has ‘normalized’ and Zimbabweans who fled to neighboring countries should now return home. But the political and economic situation in Zimbabwe today is far from stable and the health system continues to exist in a state of near-collapse. As a result, Zimbabweans will continue to flee to South Africa in desperation and will require both guaranteed protection and proper assistance to address their medical and humanitarian needs.
© Austin Andrews
No Refuge: Access Denied
The South African government’s response
Neglect and deportation
Despite the fact that many Zimbabweans risk their lives to flee Zimbabwe, the South African government has historically characterized Zimbabweans in the country as ‘voluntary economic migrants’ and aggressively deported them. Until recently, approximately 17,000 Zimbabweans were deported each month by South African authorities, according to United Nations and the South African Department of Home Affairs (DHA) figures.
According to DHA, in Musina alone, more than 30,000 Zimbabweans applied for asylum from July to December 2008. Just 53 (0.1%) were granted refugee status.8 In addition to granting refugee status to very few people, regular bottlenecks in the asylum-seeking process created a situation where a large concentration of people lived in inhumane conditions while awaiting documentation.
The government’s aggressive deportation strategy, combined with a lack of legal status and a dysfunctional asylum-seeking process, has hampered the ability of Zimbabweans to realize their rights and access the assistance to which they are entitled under national and international law. As a result, Zimbabweans have been more vulnerable to abuse by police, immigration officials, criminals, and employers.
In April 2009, under pressure from numerous non-governmental organizations, legal, and human rights groups, the DHA announced plans to enact new measures to regularize the legal status of Zimbabweans in South Africa. Zimbabwean nationals would be eligible for a special dispensation permit under Section 31(2)(b) of the Immigration Act, which would allow them to stay in the country legally for up to 12 months and to have the right to work, study, and to access health care and other basic services. However, they would not have the right to housing or to social grants.9 At the same time, the DHA announced a moratorium on deportations of Zimbabwean nationals. In May 2009, a second announcement was made allowing Zimbabweans a 90-day ‘visa-free entry’ into South Africa.
These positive policy steps are significant and if implemented appropriately, taking the specific humanitarian needs of Zimbabweans in South Africa into full consideration, may fundamentally change the dire conditions under which Zimbabweans currently live in South Africa. However, they have yet to translate into significant changes on the ground for the majority of Zimbabweans. Experience in the past month reveals several concerns and potential pitfalls, including:
Gaps in access to health care
Since 1996, South Africa has had a policy of free primary health care services for everyone in the public health system. The South African Constitution guarantees the right to access to health care for all. In September 2007, the Department of Health (DOH) released a Revenue Directive10 reaffirming that refugees and asylum-seekers with or without a permit have the right to access health services and should be treated for free at any primary health care facility and exempted from hospital admission fees if without appropriate resources. They are also entitled to access any antiretroviral therapy (ART) service point, and treatment should be free.
In addition to this, the HIV & AIDS and STI Strategic Plan for South Africa (2007-2011) includes migrants, refugees, and asylum-seekers with or without legal documents, and the DOH released a statement in April 2007 clarifying that patients do not need to be in possession of a South African identity book in order to access ART in particular.11
© Austin Andrews
Despite such guarantees, it is clear that these policies are not uniformly applied. Zimbabweans attending MSF clinics in both Musina and Johannesburg have explained that they face significant barriers trying to access public health structures. Zimbabweans attempting to access the health system by themselves are often either harassed or hindered from obtaining the services they need, particularly in hospitals. Those that are granted admission, usually in the event of a life threatening emergency, are often charged exorbitant fees and discharged prematurely, including when they are still very sick and vulnerable.
And now that the legal status of Zimbabweans may primarily be granted through an exemption in the Immigration Act, it is not clear whether these guarantees will still be considered applicable for all Zimbabweans in need of health services.
‘Once they know you are foreign, the treatment is different’
Crossing the Border
© Dirk-Jan Visser
Violence, chronic disease, and epidemic outbreaks in Musina
A harsh arrival on the banks of the Limpopo River is the first experience of South Africa for many Zimbabweans. It is here where scores of Zimbabweans are beaten, robbed, and sometimes raped by criminal gangs known as the ‘gumagumas.’ For newly arrived Zimbabweans who do not have an established network in Musina town, there are few options for shelter. They seek refuge in churches, along the railroad, and in the surrounding bush. Many others find temporary seasonal work on commercial farms along the border.
Initially, it was difficult for MSF teams to reach Zimbabweans in Musina who needed medical assistance, as most were hiding for fear of arrest or deportation. This dynamic started to shift in July 2008 when a Department of Home Affairs (DHA) Refugee Reception Office opened at Musina Showground, an open field in the centre of Musina town, to enable Zimbabweans to register and have their claims for asylum processed. Large numbers of Zimbabweans began to gather openly in the Showground, the only place in the town where they could avoid being arrested for not possessing asylum-seeking papers or other legal documentation.
In the months that followed, the number of people that started queuing at the Showground to obtain their papers, coupled with major bottlenecks in the asylum-seeking process, resulted in significant needs for basic shelter, water, sanitation, food and health care.
By February 2009, an estimated 4,000 Zimbabweans were sleeping at the Showground each night without any proper shelter, protection, or assistance. It became a de facto refugee camp, yet government authorities refused to recognize it as such. As a result, none of the minimum international standards for such a camp were observed. Thousands of Zimbabweans slept crowded together out in the open, exposed to the harsh sun during the day and the cold at night. They had no access to adequate food, water, sanitation, shelter or health care and efforts by non-governmental organizations (NGOs) to provide basic humanitarian assistance were systematically blocked by local authorities.
In March 2009, despite the ongoing flow of Zimbabweans, the DHA ordered everyone to leave Musina Showground, providing no alternative shelter or protection. Today, people are no longer allowed to sleep at the Showground. If they do so, they are either chased away or detained.
Those Zimbabweans who cannot afford passports or an emergency travel permit continue to cross the border illegally. The number of people arrested at the border and in Musina fluctuates. However, in May 2009, up to 400 people were being detained in unacceptable conditions each day in a detention center.
Shelter remains a pressing concern. While faith based organizations have established a few temporary shelters in Musina where Zimbabweans can stay for three days on average, the conditions of these shelters are inadequate and they are often completely overloaded. However, there is little else available. As winter approaches, some nights there are more than 600 people crowded into a shelter that should not host more than 300 people. As shelters are overburdened, many others hide in the bush.
MSF ran a daily mobile clinic at the Showground until May 2009 when the DHA Reception Office was moved to a private compound; the mobile clinic now operates just outside the Showground. In addition to the daily clinic near the Showground, MSF operates mobile clinics on farms along the border and in specific fixed points in Musina town. Medical teams in and around Musina play an essential role in epidemic surveillance as they provide mobile diagnostic services including rapid testing for HIV, syphilis, and malaria. Samples are sent to the National Health Laboratory Services (NHLS) for TB, cholera, and dysentery detection, limiting the risk of epidemic spread. MSF mobile medical teams also provide general curative services, care for sexual and gender-based violence (SGBV), and psychological support.
Approximately 2,000 consultations are carried out each month. The main illnesses MSF teams diagnose and treat are respiratory tract infections, sexually transmitted infections, particularly HIV, diarrhoeal and gastro-intestinal diseases, and stress related ailments. In addition, there has been a significant increase in the number of cases of sexual violence.
Through its mobile clinics, MSF treats violencerelated injuries, most often rape and sexual assault, as well as beatings, deep knife wounds, broken bones, and whip marks – a combination of trauma experienced during the border-passage from Zimbabwe and in Musina town.
Women and children are particularly vulnerable to brutal attacks by ‘guma-gumas’ (local gangs), Zimbabwean soldiers, and police. Finding immediate care is critically important after a sexual assault to prevent HIV, sexually transmitted infections, hepatitis, and pregnancy. Treatment to prevent HIV infection has to start within 72 hours and emergency contraception is possible within five days. However, of those who manage to seek care in Musina, most do so more than 72 hours after the rape has occurred, explaining that the delay was because they did not know where they could turn for treatment or needed to secure their legal papers before seeking care. May victims also often experience feelings of shame as a result of sexual assault, which prevents them from seeking the treatment they need early enough.
In April 2009, MSF expanded its services for survivors of sexual violence to address this important and unmet need and now has a fixed clinic for survivors of sexual and gender-based violence (SGBV).
More than 75% of clients seen by MSF in April were raped while crossing the border, and nearly 60% were raped by more than one perpetrator. Seventy percent of the time, rapes were perpetrated with an armed threat (gun, knife, etc.) and almost 50% of clients had injuries due to associated violence.
The Department of Health (DOH) does not require survivors of SGBV to report to the police before accessing medical services but in practice many health providers, including in Musina Hospital, are telling survivors they must first lay a charge. This means that emergency medical treatment, including post-exposure prophylaxis to prevent HIV-infection,is often hindered or delayed.
HIV/AIDS and TB in a highly mobile population
High rates of HIV infection among Zimbabweans attending MSF mobile clinics in Musina pose specific challenges. In April 2009, out of 319 HIV tests done 35% of patients tested in MSF mobile clinics in Musina were HIV-positive (positivity rates are particularly high on farms). MSF teams diagnose and treat opportunistic infections and maintain a buffer stock of antiretrovirals (ARVs) for patients who have run out of drugs. Patients on ARVs, and those clinically eligible for antiretroviral therapy (ART) but not yet initiated, are referred to accredited ART sites. However, patients working on farms are often not allowed by farm owners to leave to attend clinics and cannot afford transportation to town. The fact that the population is highly mobile poses major challenges for follow-up of referrals, treatment adherence, and continuity of care once initiated.
Although there are high levels of suspected TB in and around Musina, only a small number of the sputum samples collected return positive for TB. This can be explained by the high TB/HIV co-infection rate (direct sputum microscopy only detects approximately 40% of active TB cases in high HIV prevalence settings) and the lack of availability of more precise methods (there is no access to sputum culture at the Musina NHLS lab). Still, for those who have a confirmed TB diagnosis, there are long turn-around times for receiving lab results and follow-up is a challenge. By the time the MSF team receives a positive result, patients have usually moved on from Musina and there is no way to trace them.
© Rachel Cohen/MSF
In October 2008, MSF medical teams at the Showground in Musina town started to notice an increase in the number of cases of acute watery diarrhea and reported this to local health authorities. There were also sporadic cases of bloody diarrhea. Considering the lack of clean water and basic sanitation facilities available for Zimbabweans at the Showground at the time, MSF had grave concerns that diarrhoeal diseases could spread rapidly to the thousands of people staying at this makeshift ‘refugee camp’.
The following month, a cholera outbreak was confirmed in Beitbridge, just across the border in Zimbabwe. The MSF team in Beitbridge was reinforced by an emergency medical team and a major shipment of medical and logistical supplies was sent to Beitbridge Hospital to create on-site treatment capacity on the Zimbabwean side of the border. Days later a cholera outbreak was confirmed in Musina itself. MSF began screening people at the Showground and other sites to identify those with potential signs of cholera for treatment and/or referral to Musina Hospital. MSF also carried out hygiene promotion, water and sanitation improvements, and education and awareness raising activities. In Limpopo Province MSF diagnosed and either treated or referred hundreds of cholera cases.12
The graph below shows the increase in the number of cases of acute watery diarrhea at the Showground in the month of November and the appearance of suspected cholera cases once the outbreak was confirmed in Limpopo (epidemic surveillance of acute watery diarrhea at the Showground illustrates that several cases were very likely cholera prior to week 46 but they were not diagnosed as such until the DOH declared the outbreak and announced a new case definition).
‘There were 13 men watching us all the time and they raped us every day’
© Austin Andrews
Searching for Safety
Central Methodist Church in Johannesburg
Although there are tens of thousands of Zimbabweans living in Musina at any given time, the majority do not stay long. Johannesburg is the final destination for most Zimbabweans. Today, Johannesburg’s inner-city is home to millions of refugees, asylum-seekers, and migrants of all nationalities.
The Central Methodist Church in downtown Johannesburg provides a ‘safe haven’, where thousands of Zimbabweans seek refuge each night, either in the Church itself or on the street in front. People live in crowded, unhygienic conditions, filling nearly every inch of available space inside the five story building. Up to 2,000 people sleep on pews, stairs, and the hard floor of the Church. Outside on the footpath, hundreds and sometimes thousands of Zimbabweans who cannot squeeze into the Church sleep among cardboard boxes, as close to the building as they can get.
Since December 2007, MSF has operated a fixed clinic connected to the Central Methodist Church, and works in close collaboration with the Church community to provide basic health services and referral of patients to the public health system for more specialized medical treatment. In addition to providing basic health care, the key aim of the MSF clinic is to actively facilitate access for Zimbabweans to existing health services in Johannesburg.
In the past year, the number of consultations has steadily increased, starting with 750 patients per month in early 2008 and reaching more than 2,700 patients in March 2009. Initially, the MSF clinic was primarily frequented by Church residents. However, today more than 50% of the Zimbabwean patients are from outside the Church area – an indication of the poor access to healthcare elsewhere in the area for Zimbabweans.
As with the mobile MSF clinics in Musina, the main diagnoses at the MSF clinic at the Central Methodist Church are respiratory tract infections, sexually transmitted infections, diarrheal and gastro-intestinal conditions, and stress-related ailments. Minor therapeutic procedures are also carried out (dressing, injections, sutures). There is a small dispensary and on-site lab at the clinic, where rapid tests are carried out and samples are taken for analysis at the NHLS.
However, in the last several months, the Central Methodist Church has increasingly come under threat. In February and March 2009, Zimbabweans in and around the Church were faced with a police raid and legal action by neighboring businesses. Due to increased overcrowding in both the Church and sidewalks outside, businesses complained that the thousands of Zimbabweans and the unhygienic and cramped environment were bad for business. Consequently, they erected a large, imposing iron gate in front of the Church building. This effectively barred Zimbabweans directly from the Church, leaving them exposed to the violence on the streets.
Communicable diseases and outbreak response
As in any overcrowded and unhygienic setting, people staying in the Central Methodist Church in Johannesburg are exposed to a serious risk of communicable disease outbreaks. This risk is mitigated, at least in part, by effective collaboration between MSF and the Gauteng Department of Health (DOH). MSF carries out epidemic surveillance and prevention, and works with the DOH to intervene rapidly in case of epidemic outbreaks.
In response to the November 2008 cholera outbreak, MSF, in collaboration with the DOH, organized an emergency response to help prevent the spread of cholera and ensure quick access to treatment for patients presenting with cholera symptoms. The emergency response included active case finding; rapid detection and referral of patients through a network of Church residents and community leaders; isolation of symptomatic patients and treatment of moderate cases at a small oral rehydration unit; and referral of severe cases to hospital. MSF also carried out hygiene promotion and information and education campaigns in high risk areas and places with large concentrations of Zimbabweans, such as bus stations, taxi ranks, food distribution points, and densely populated residential buildings.
MSF teams introduced key measures to improve the hygiene and sanitation conditions both inside and outside the Church by providing mobile latrines, repairing the toilet system inside the Church, deploying special cleaning and disinfection teams and providing hand-washing points and containers at entrance points where food vendors could clean their cooking tools.
MSF also collaborates closely with the DOH in response to other communicable diseases diagnosed. In March 2009, a patient living at the Central Methodist Church was diagnosed with meningococcal meningitis. The diagnosis was confirmed the following day, close contacts were identified by MSF staff, and prophylaxis provided by DOH was administered within 24 hours. The health education teams from both MSF and DOH met and coordinated activities to ensure that the population living in and around the Church were well informed about the disease.
Facilitating access to secondary and specialized care
One of the main aims of the MSF clinic in Johannesburg is to facilitate access to health care for Zimbabweans who are otherwise not accessing the health system due to fear of arrest, deportation, discrimination, or poor treatment. Each month, MSF refers approximately 80 patients to secondary and specialized services in Johannesburg, primarily for TB treatment and other chronic diseases, ART initiation for HIV, emergencies related to trauma, comprehensive care for victims of sexual violence, and acute severe conditions such as pneumonia requiring hospital-level care.
The key to ensuring patients are admitted when referred is a confirmed diagnosis, an MSF referral letter, and the accompaniment of an MSF ‘social assistant.’ MSF also subsidizes hospital fees, a major barrier for Zimbabweans who cannot afford to pay for the treatment they urgently need and are still charged high amounts.
This system works well for the few who are able to access services through MSF. However, there are thousands of Zimbabweans in need of health services who face major obstacles, as illustrated by testimonies from MSF patients and health workers.
The plight of unaccompanied children
During the past year, MSF has witnessed a steady increase in the number of unaccompanied children coming to Musina and to the Central Methodist Church in Johannesburg.
At the Central Methodist Church there has been a sharp increase in the number of unaccompanied minors arriving – particularly in the first half of 2009. As of May 2009 there were 150 children between seven and 18 years staying at the Church. These children are extremely vulnerable and exposed to many forms of abuse.
To respond to this critical situation, MSF started a special counseling program for unaccompanied minors. Three counselors work with the children, providing emotional, educational and psychological support. Children frequently ask for help to find a place where they feel more protected and where living conditions are more suitable. Many children battle to sustain themselves in this situation, sometimes leading to very worrying behavior and survival strategies.
MSF has repeatedly expressed concerns to the Department of Social Development and UNICEF about the situation the children face, providing a list of names and relevant details about each individual child. Despite the fact that key organizations and agencies are fully aware of the extreme vulnerability of this group, no viable solution has yet been proposed or implemented.
Xenophobic violence erupts
In May 2008, targeted xenophobic attacks erupted in Alexandra township. The violence rapidly spread across Johannesburg and to several other cities and provinces in South Africa (Gauteng, Western Cape, and Kwa-Zulu Natal), killing 62 people, injuring 670 and causing the displacement of approximately 100,000 foreign nationals, including large numbers of Zimbabweans.
In the immediate aftermath of the violent attacks, MSF provided emergency medical assistance, treating approximately 150 violence related injuries, including gun shot wounds, stab wounds, lacerations, burns, and other injuries in the first days of the emergency in Alexandra, Diepsloot, and other areas affected by the violence.
In the subsequent weeks, as the violence subsided, mobile MSF teams provided health care, blankets, plastic sheeting, and hygiene kits in 15 community halls, police stations, and churches to which people fled for safety in Johannesburg, and later in seven temporary ‘camps’ established by the government. The main pathologies treated were those related to displacement, such as diarrhea, respiratory infections, and stress-related illnesses.
From May to September, a total of 11,000 medical consultations and an additional 11,000 mental health consultations were carried out in the camps in Johannesburg and Pretoria, as well as in Cape Town, where MSF also responded to the needs of displaced foreign nationals in Khayelitsha. In addition, MSF distributed 10,000 blankets and 10,000 hygiene kits.
The xenophobic attacks of May 2008 were preceded by several significant events witnessed by MSF, the most striking of which was a violent police raid on the Central Methodist Church in January 2008. During the night of 31 January 2008, police raided the Central Methodist Church and detained approximately 350 people who were seeking refuge there. The MSF team gained access to the detainees taken to Johannesburg Central Police Station and were able to assess their health conditions.
The team found suspected fractured ribs, possible lung contusions, patients with chronic illnesses, and patients on treatment for HIV and TB, who lost their treatment during the arrest. Police refused MSF’s repeated requests for patients in need of referral to be immediately taken to hospital. After a rapid civil society response, a court interdict eventually resulted in the detainees being released.
‘Everyone is failing to protect us’
Struggling To Survive In The Shadows
Zimbabweans continue to face an economic crisis, political instability, and poor access to basic services, including health care, in their country. They flee to South Africa as a matter of survival. On arrival in South Africa they do not find refuge, but instead are faced with an unacceptable continuation of their suffering, without access to proper health care, shelter, or safety.
MSF medical teams witness the daily failure of both the South African government and UN agencies to ensure that the basic medical and humanitarian needs of vulnerable Zimbabweans are met. The South African Constitution guarantees access to health care and other essential services to all who live in the country – including refugees, asylum seekers, and migrants – regardless of legal status.
But in reality, Zimbabwean patients continue to be rejected, charged exorbitant fees, subjected to long delays or inappropriate treatment, or prematurely discharged, placing health care out of reach for many. This is a breach of medical ethics and violates the Constitution.
The government of South Africa must do more to ensure that health staff is properly informed about the rights of refugees, asylum-seekers, and migrants to access the public health system, regardless of legal status. In addition, it is essential that secondary and specialized care is free for those Zimbabweans who cannot afford it, as no patient in need of health care should be denied access for financial reasons.
Every day, MSF teams treat sick and vulnerable Zimbabweans who are falling through the cracks in South Africa: victims of violence; people with basic ailments as well as life-threatening chronic diseases such as HIV and TB; and people with psychological conditions linked to the trauma they have endured. MSF provides counseling and psychosocial support for particularly vulnerable patients, especially unaccompanied children and survivors of sexual violence, and responds to emergency needs resulting from xenophobic attacks and disease outbreaks when they arise.
Government and relevant UN agencies must take special urgent steps to ensure that emergency medical care for survivors of sexual violence is not hindered or delayed and that unaccompanied children have access to shelter, protection, counseling, legal documentation, health care, education, and other basic rights.
While there have been positive developments in the past months to regularize the legal status of Zimbabweans in South Africa and to stop deportations of Zimbabweans, these measures have yet to translate into tangible improvements in the lives of most Zimbabweans seeking refuge in South Africa. Until this happens, Zimbabweans will continue to suffer, struggling to survive in the shadows of South African society.