South Africa: Covid-19 - Are Foreign Nationals Being Left Behind?

Some foreign nationals in South Africa, their community leaders, human rights lawyers and activists are concerned that their health needs are falling through the cracks. This was compounded during lockdown with some foreign nationals claiming they were refused healthcare and others now concerned they will be excluded from the vaccine rollout.

Access to vaccines

Initially, in January when Health Minister Dr Zweli Mkhize started public briefings on the country's vaccine rollout strategy, he kept referring to South Africans and citizens in his speeches. In an interview with SABC news, Mkhize said that vaccines will be limited to South African citizens, since the country "does not have the capacity to assist undocumented foreign nationals".

But President Cyril Ramaphosa later said vaccines will be made available to all adults living in South Africa regardless of citizenship or resident status.

Then, at the end of February, Mkhize told MPs in the National Council of Provinces that the government must still draw up plans for vaccination of undocumented foreign nationals. "The issue really is that we need everyone to come through and get registered in the process, and then we will deal with unexpected situations at the point that we have to deal with them," Mkhize reportedly said. "So, we will have to deal with the issue of undocumented citizens as we come across them."

Many not tested

According to the Zimbabwe Migration Support Network (ZiMSN), an organisation representing Zimbabwean nationals in the country, accessing healthcare services is difficult without valid documents, even medical emergencies.

"Hundreds of Zimbabwean nationals with medical conditions were refused treatment by local hospitals and clinics because they don't have proper documents as their permits expired during lockdown," ZiMSN chairman, Chris Mapingure, tells Spotlight. He says some pregnant migrants were charged exorbitant fees to deliver babies in public facilities. Mapingure said they received reports of a Zimbabwean man who was denied surgery in a hospital in Gauteng, and he was told to sign an admission of debt before they would perform any form of surgery.

"Another challenge that migrants encounter when requiring health care services in South Africa is the lack of proper information," said Mapingure. "For example, during the COVID-19 period, there was not any form of communication about foreign nationals, whether they could test in government testing centres. The lack of accurate information about their rights has barred many Zimbabweans from accessing healthcare services, assuming that testing centres were meant only for local peoples," he says.

"Even now the department of health has not yet come up with a clear clarification about vaccination arrangements for foreigners," Mapingure adds. "That alone gives us sleepless nights. Foreigners were also prevented [from receiving] food parcels that were being distributed [by government] with preference given to local citizens."

Mapingure says the South African government must be clear and extend the vaccination roll-out to all who live in South Africa.

Renewing papers

"Everybody in South Africa is entitled to access healthcare regardless of their nationality or documentation status. No one may be refused emergency treatment because everybody may access healthcare," says Jessica Lawrence, an attorney with Lawyers for Human Rights.

"Free healthcare is received by South African citizens, so anybody who goes to public health facilities will be means tested in order to check if they qualify for free healthcare. Foreign nationals are not entitled to free healthcare if they are undocumented. Undocumented persons have to pay for healthcare," says Lawrence.

According to her, many foreign nationals could not renew their permits when Home Affairs offices temporarily closed. "So no one has been able to renew their papers. The Department of Home Affairs instructed that those whose documentation expired during lockdown, are automatically extended until 31 March 2021."

"However, we have noticed that many healthcare facilities don't know about this automatic extension. We are concerned that the lack of communication between government departments will result in foreign nationals being excluded from the vaccine rollout," Lawrence said.

"We believe everybody that is living in South Africa is eligible for vaccination when it becomes available in their communities. We are currently engaging with the Department of Health to ensure that foreign nationals are part of the vaccination programme, including those that are undocumented," says Lawrence.

A 59-year-old Zimbabwean woman who wanted to remain anonymous for fear of victimisation tells Spotlight she has lived in South Africa for the past two decades and has been on chronic medication for the past three years.

"Local clinic nurses don't have problems when assisting foreigners with their medical needs," she says. "Challenges are experienced at referral hospitals, as we are subjected to abuse. I was once turned away at the Port Elizabeth Provincial Hospital because of lack of a valid permit to stay in the country. The snubbing of foreigners at hospitals is discouraging patients from accessing healthcare services with potentially fatal consequences."

'Same Constitutional right'

"We are concerned that the COVID-19 vaccine would be rolled out soon, but the [government] has not referred to migrants in its plan. It is critical that migrants are included in the vaccine roll-out strategy because they form part of the population of this country and they have the same constitutional right as citizens to access health care services," says Sibusisiwe Ndlela, an attorney with SECTION27.

"As members of our population, their participation is the key to achieving population immunity. It would truly be futile to arbitrarily exclude entire categories of persons in our population from being able to access the vaccine when the primary goal is to immunise as many people as possible," says Ndlela.

Ndlela says SECTION27 has been inundated with requests from foreign nationals who have been denied access to healthcare services.

She also points out that according to the Constitution everyone, including foreign nationals, may access health care services. "However, the Minister and the MEC for Health in the respective provinces have the power to determine fees for the services. Under the Gauteng provincial regulations, the migrants who qualify for subsidisation may be subjected to a means test to determine their ability to afford health care services," says Ndlela.

"Xenophobic language and inflammatory as well as reckless comments by public officials suggesting that migrants have overburdened specifically the Gauteng provincial health care system is unproven," she says. "But a more pressing issue is the documentation of migrants, which are periodically issued to them by the Department of Home Affairs. Migrants, who are asylum seekers or refugees are issued visas that reflect their status. However, with the serious backlog at the Department of Home Affairs, migrants often present documents that are no longer valid and are then turned away from health care facilities."

Responses from Western Cape and Gauteng

Western Cape Health Department spokesperson Mark van der Heever says foreign nationals with valid permits are assessed through the means test, the same as South African citizens.

"They would also qualify for certain statutory free services, such as free services to children under 6 years and free maternal care. If the person's permit has expired and is accompanied by a letter from the Department of Home Affairs or a relevant authority, the patient may be considered to be assessed per the means test," he says. "Failing which, the person is treated as a foreign national and is assessed at the maximum rates and is expected to pay for all services received. Payment arrangements can be considered where necessary. All health care services are free at the primary health care [level] irrespective of nationality or permit status."

"The National Health Act makes it very clear that there are limitations to the resources for Healthcare in South Africa," says Motalatale Modiba, spokesperson for the Gauteng Department of Health. "All citizens including foreign nationals are classified economically in terms of the Uniformed Patient Fees Schedule (UPFS) meaning that there are costs associated with access to healthcare resources in the country. Those who can afford need to pay for the services irrespective of geographic origin, but clinics are free to all regardless of their nationality or status."

Spotlight also put the concerns raised to the national health department, but received no response. The Department of Home Affairs spokesperson David Hlabane also did not respond to requests for comment.

Language barriers

Meanwhile, the national secretary-general of the Somali Community Board of South Africa, Abdirizak Ali Osman, also raised concern over the challenges their members face when accessing healthcare services. Osman says one of the main challenges is that most foreign nationals are not assisted properly because of the language barrier. "In most cases foreigners and locals, they don't understand each other's languages, and that makes it difficult to communicate.

In healthcare facilities where indigenous South African languages are spoken, a migrant may find it difficult to communicate with healthcare workers." Osman said this often leads to communication breakdowns that can affect the quality of healthcare foreign nationals receive. "I think it is high time that the health department considers employing health workers who can speak foreign languages," he said.

Asked about the language problem, van der Heever says: "The department has a dedicated telephonic interpretation service available at all times. Any patient requiring consultation in their mother tongue language can access it by informing the treating health personnel [member] that they require it."

Asked about the approach in Gauteng, Modiba said: "The department is strengthening information system in its facilities by communicating in line with the 11 Official languages and for those who don't understand local languages English, which is an international language, is used to communicate with them."

But according to Osman, the problems go far wider than language. "The majority of foreign nationals never tested for COVID-19 because they were not aware of their legal rights, while others feared arrest or deportation because their papers expired," he says. "We trust that South African healthcare workers will not discriminate when the COVID-19 vaccine is available. We believe in order to combat the spread of COVID-19, the government must treat everyone equally and vaccinate every citizen regardless of their immigration status."

*Note: Sibusisiwe Ndlela from SECTION27 is quoted in this article. Spotlight is published by SECTION27 and the Treatment Action Campaign, but is editorially independent - an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.

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