6 March 2019

South Africa: Dying in Johannesburg

analysis

Assumani Matondo Nibizi shuffled into the dull recreation room at Nazareth House, a care facility in Yeoville, Johannesburg. He moved with a noticeably uneasy and painful limp, a result of the oedema caused by his untreated kidney failure.

Surrounded by miniature statues of Mary Magdalene and other religious ornaments, Nibizi, 33, an asylum seeker from the Democratic Republic of the Congo (DRC), has resigned himself to his fate. With his cheeks quivering and speaking softly through a translator, he said: “I have accepted it because they have said I am a foreigner and I can’t get further treatment.”

Both of his kidneys have been damaged as a result of renal failure and he suffers from hypertension. Yet Nibizi, like a number of other asylum seekers and refugees, has been denied dialysis and other life-saving treatment, because of his legal status in South Africa. Nibizi’s patient discharge file says he doesn’t qualify for dialysis treatment because he is “a foreigner”.

“It is just the meaning of the life that I am living now. It is very hard for me,” he said. “Disease can happen to anyone, but to be discriminated [against] just because you are not a South African citizen, it just [makes me feel] so bad. Anything can happen to anyone, in a similar situation, when you are sick, you expect to get care.”

Nibizi is indigent and relies on the charity of the Jesuit Refugee Services. But even with their help, he is unable to afford the cost of private healthcare, with dialysis treatment estimated to cost between R2 000 and R4 000 a session. Making matters worse is that he has lost his asylum seeker permit and has been unable to raise the estimated R1 000 to pay the fine to replace it.

His only hope now, he said, is to return to his mother in his hometown of Uvira in South Kivu in the DRC, from which he fled when just a teenager because of the violence there. “Remaining here in South Africa, I will end up dying and I will have no one to bury me. But if I can go back home and if I die there, my mother can bury me,” he said.

Refugees with valid papers don’t pay

Section 27 of the Constitution is clear. It states that “everyone” has the right “to have access to healthcare services”. Subsection 3 goes on to say that “no one may be refused emergency medical treatment”. Despite this, the Gauteng Department of Health recently published a circular that critics have labelled as contrary to the Constitution.

The circular includes instructions on how to treat refugees, asylum seekers and migrants within the Gauteng healthcare system. Dr Medupe Modisane, the acting deputy director general for hospital services in the department, said “non-South African citizens” would be classified as full fee paying patients. An exception is made for refugees “with valid documents”.

The department failed to answer a list of detailed questions, sending instead a version of the newly passed circular. “All non-South Africans should be classified as full paying patients, except refugees with valid documents, who will be classified according to means test. The means test includes assessing their income to determine the amount they should pay,” Modisane said.

He added that the fees for the services had to be paid upfront or following the discharge of the patient.

Businesslive has reported that the Department of Health instructed provinces to withdraw the instruction to charge migrants the maximum rates. Businesslive quoted the department’s deputy director general for national health insurance (NHI), Anban Pillay, as saying a junior official who didn’t have the authority to introduce changes drew up the circular.

Although the new circular says refugees with valid papers don’t have to pay for healthcare services and medicine, many people who apply for asylum wait years – sometimes more than a decade – for home affairs to finalise their refugee applications, leaving them in a state of limbo.

‘Most of us, we are dying’

Mama Yvette Mbayo-Ndaya, 58, is one such person. She fled the DRC with her three children more than 10 years ago and has been renewing her asylum seeker permit regularly while waiting for a decision on her refugee application.

“To renew the paper every time is a problem, it’s a big problem. Since I came here, I am still an asylum seeker. From 2007 until today, I never get the status. I fell sick. I have heart failure, I have kidney failure … now, when it comes to dialysis, nothing,” she said.

Rummaging through her handbag, Mbayo-Ndaya pulls out empty pill boxes and slips from the pharmacy. “Appointment to appointment, they don’t give me any medication. My medication is finished. I have to buy the medication myself … I buy one tablet, one tablet … because I don’t have the money to buy all the medication.”

She struggles to walk as her feet are swollen and painful from the renal failure. “I never chose to come here. I never knew that one day I would suffer like this. It’s making me feel bad,” she said. “When they are not doing dialysis, most of us, we are dying.”

Like Nibizi, Mbayo-Ndaya says she was denied the life-saving dialysis treatment because of her status as an asylum seeker in South Africa. “They say no, when I went to the hospital, they said they can’t help me with dialysis because I am not a South African,” she said in exasperation.

Gauteng member of the executive council for health Gwen Ramokgopa said there was a shortage of funding in the province’s hospitals, blaming it on a supposed influx of migrants, according to The Sowetan. Health Minister Aaron Motsoaledi made similar claims last year when he said migrants were causing “overcrowding” at state hospitals.

Shortage of resources

Sasha Stevenson, the head of health at Section27, a public interest law centre advocating for access to health, blamed the denial of dialysis treatment on the “dire shortage” of resources and organ donors.

“It is a legislated recognition, basically, that there is a dire shortage of organs and organ donors. But it is the one place where the line is extremely clearly drawn between South Africans and everybody else,” she said.

Section 61 of the National Health Act states that: “An organ may not be transplanted into a person who is not a South African citizen or a permanent resident of the republic without the minister’s authorisation in writing.”

Stevenson said: “That is what I think is used to justify the refusal for dialysis treatment. It’s a difficult case because there is such a clear shortage … The broader issue is that there is widespread denial to all sorts of health services for people who aren’t South African, and that is largely against the law.”

She added that a document called the uniform patient fee schedule essentially classifies refugees, asylum seekers and undocumented people from Southern African Development Community states as being the same as South African citizens.

Medical professionals discriminatory and xenophobic

“What happens a lot is that hospitals kind of take advantage of the uncertainty. They take advantage of people’s lack of knowledge and they take advantage of the fact that they haven’t had any clear directive provided to them that says you must provide these services.

“It’s really horrible. The indignity people have to live with is really awful. And part of the problem is that the failure of our immigration system contributes to this. If people didn’t have to wait nine, 10 years to have a determination on their refugee status ... But because of that failure, you are on asylum forever, you lose your papers … and then you slip into this big group of people who are completely powerless,” said Stevenson.

Abigail Dawson, spokesperson for the Consortium for Refugees and Migrants South Africa (Cormsa), said there were often cases of unlawful practices reported in South African healthcare facilities.

“Reports on people being denied access to healthcare, being unlawfully charged for services and victim to discriminatory and xenophobic attitudes of professionals is recurrent,” she said. “These haphazard and discriminatory practices result in people who have a legitimate claim to access healthcare services being left to suffer in a country that has granted them protection.”

DA Gauteng shadow member of the executive council for health Jack Bloom blamed the treatment Nibizi and Mbayo-Ndaya received on a lack of resources in the healthcare system and the grey areas into which refugees and asylum seekers fall.

“You’re not a citizen. Full stop. They’re not going to ask if you’re a refugee or an asylum seeker. You’re a foreigner to them,” he said. “The reality is that if you’re a refugee or asylum seeker, nobody is going to sit there and tell you what your rights are.

“Unfortunately, dialysis is rationed because there is such a shortage of resources. With dialysis, they turn a lot of people away. You put somebody on dialysis, then you take somebody off. That’s the reality, unfortunately.”

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