May 12, 2010
South Africa 2010 © Finbarr O'Reilly /REUTERS
The reality is grim for thousands of survival migrants and refugees arriving and existing on the margins in South Africa.
In June 2009, Doctors Without Borders/Médecins Sans Frontières (MSF) released a report, No Refuge, Access Denied, which outlined the severe risks Zimbabweans took in order to cross the border, the dangerous conditions under which they lived once they reached South Africa, and their lack of access to health care.
Almost one year later, their situation remains dire. They still lack access to proper health care, shelter, and safety, while facing violence, police harassment, and xenophobic attacks. Formal legal status in the country is often difficult to obtain, if not impossible. Gangs prey on them when they cross the border. Many of these migrants and refugees, as well vulnerable South Africans, face further threats as they live in appalling conditions, particularly in derelict buildings in Johannesburg where they seek shelter.
MSF has been running two projects in South Africa since 2007 to respond to the health needs of survival migrants and refugees. The MSF clinic in Musina near the border with Zimbabwe and the MSF clinic in Johannesburg provide primary health care, mental health support, and referrals to hospitals and specialized facilities, including for chronic conditions such as HIV/AIDS and tuberculosis. In Musina, staff also run mobile clinics to nearby farms where many of these vulnerable migrants work.
This document focuses on the perilous journey undertaken by many people crossing into South Africa and the appalling living conditions they later face, as well as what MSF sees as their precarious health situation. As a medical organization, MSF continues to express grave concern for the health and lives of thousands of survival migrants and refugees.
Musina: Fleeing hardship and crossing into uncertainty and legal limbo
Despite the establishment of Zimbabwe’s Government of National Unity in February 2009, people there are still living in a state of a humanitarian crisis and continue to flee daily across the border into South Africa. An average of 300 people a day, largely Zimbabweans, apply for asylum at Musina Department of Home Affairs Refugee Reception Office.
Among them are many unaccompanied minors, who are particularly vulnerable and have specific health, as well as safety and security needs. Most children cross the border alone—either because their parents send them to South Africa to earn money to subsidize their family, or to join relatives who have already arrived in South Africa. Many come looking for an education.
Getting into South Africa is a journey full of hurdles for everyone trying to cross the border from Zimbabwe. Obtaining a passport costs US $150, rendering it out of reach for the majority who are unemployed. People are forced to cross irregularly through the Limpopo River and the forest, placing themselves at risk of falling victim to violent criminals on both sides of the border. While the Department of Home Affairs promised a year ago to create a special dispensation permit to ease the process for migrants crossing the border, this has never been implemented.
In Musina, people can apply for asylum in South Africa in one day. This allows them to move on to other parts of the country before needing to attend an interview which determines whether or not they are granted refugee status. Some try to find temporary work on farms near the border. Less than one percent of applicants are granted refugee status at the end of the procedure. Those rejected have no formal legal status even if they cannot be deported at the moment.
Today, as there is no alternative provided, many people use the asylum procedure to have at least a formal status in the country temporarily. When those people return to their country of origin they lose their status as an asylum-seeker. This happens to many Zimbabweans who return home to bring money and goods to their families.
Sexual violence at the border
Sexual and gender-based violence has been occurring consistently along the border between Zimbabwe and South Africa for years now with virtually no coherent action by the relevant authorities. Criminal gangs known as guma guma rob women and men of their belongings before raping them. Often, more than one perpetrator will rape every woman in a group of people who have traveled together hoping for safety in numbers. Men are often forced to rape wives, sisters or aunts and if they dare refuse, they are raped by the guma guma.
When these severely traumatized people seek help, police in Musina are often unwilling to open a case of rape or indecent assault, saying the incident did not occur in South Africa but on the Zimbabwean side of the border and that the opening of the case would amount to a waste of resources as the survivors often move on to other parts of South Africa within days of the incident. However, at least 83 percent of the cases of sexual violence seen by MSF in the last three months occurred in South Africa. The large majority of these cases happen as people cross the border irregularly—a problem that would be eliminated if people could cross the border legally without a passport but with some other form of documentation.
Since the beginning of this year MSF has treated 103 survivors of sexual violence, 71 people since March 1 alone. Of these cases, 45 of the survivors were women and 26 men. Of these victims, 69 were Zimbabweans, one was Mozambican, and one was South African. Eight women are pregnant as a possible consequence of their rape. Only 56 percent of these cases were reported within 72 hours of the incident occurring, meaning only about half of those treated were able to receive post-exposure prophylaxis to prevent the possible transmission of HIV/AIDS within the required first crucial 72 hours after the incident.
Access to health care: Treating HIV/AIDS and tuberculosis
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)