South Africa hosted approximately 2.4 million international migrants as of 2022, accounting for 3.9% of the population. Most come from the Southern African Development Community region including Zimbabwe, Mozambique, Lesotho, Malawi - countries with which South Africa shares deep economic, cultural, and historical ties. Statistics South Africa (Stats SA) notes explicitly that immigrants "play a role in South Africa's economy, contributing to economic growth, and diversity."
By comparison, 8.1 million South Africans have moved between provinces according to the same Stats SA report. Internal migration, therefore, accounts for a substantially larger movement of people within South Africa than international migration, and both forms of population mobility require effective planning and resource allocation, including for health services.
Xenophobia has a history within democratic South Africa dating back to the early 1990s. Increasing anger and frustration with unemployment, poor service delivery and a sense of abandonment by government is channelled towards migrants and refugees, driven by misinformation. This has led to violence in many forms and created a climate of fear among migrant and refugee communities.
Follow us on WhatsApp | LinkedIn for the latest headlines
Organised anti-immigrant groups orchestrating this violence and attacks have promoted an unauthorised 30 June 2026 deadline for undocumented migrants to leave the country. Although framed as targeting "illegal" migrants, such rhetoric and related actions have heightened fear among migrant communities more broadly and may place both documented and undocumented migrants, and even South Africans who may be perceived as foreign, at risk.
The arbitrary 30 June 2026 deadline does not provide a lawful or constructive response to the underlying societal challenges of unemployment, service delivery, and public safety. Rather, this is a dangerous development that could potentially lead to violence targeting African migrants in particular. It is critically important that the response to migration challenges upholds human dignity, constitutional values and the rule of law, while recognising the longstanding social, economic and cultural ties that connect South Africa to the broader continent.
South Africa finds itself with a myriad of challenges. Many of these affect the health of individuals, families and communities, often referred to as the social determinants of health. Unemployment stands at over 40% by the expanded measure, and most municipalities are in financial distress or outright collapse.
Communities across the country feel unsafe, unserved, and abandoned by institutions that are supposed to serve them. The cause of this crisis is not foreign nationals but instead lies in state failure, corruption, and compounding inequality.
Much of the hostility directed at migrants is driven by misinformation that goes unchallenged in political discourse and in the media. Misinformation is not harmless. When false claims about migrants burdening hospitals or draining grants circulate unchallenged, they create conditions for xenophobic groups to block access to health facilities for migrants and refugees - as well as anyone perceived as an "outsider" - including some South Africans.
This is in direct violation of constitutional rights and undermines access to essential health services. It is also inconsistent with the November 2025 Gauteng High Court ruling requiring state authorities to provide safe and unhindered access to public healthcare facilities, the interdict granted in Kopanang Africa Against Xenophobia v Operation Dudula, and the government's stated position on healthcare access.
However, departments of health nationally and provincially have largely failed to develop clear, enforceable policies in response. There is no available evidence that migrants place a disproportionate burden on public health facilities. Médecins Sans Frontières research and National Department of Health data actually suggest that migrants - particularly undocumented migrants - actively avoid health facilities out of fear of arrest or deportation. They are more likely to delay seeking care than to overuse it, often at greater cost to their health and to the health system when they eventually present with advanced illness.
In response to ongoing confusion and barriers to healthcare access, Collective Voices for Health Access has developed a practical guide to assist migrants and refugees, as well as healthcare providers, in understanding their right to access healthcare in South Africa.
President Ramaphosa addressed the nation on migration on 7 June 2026 making the following key commitments:
· "Our country - like many others throughout history - is a product of migration. It is the reason for our diversity and contributes to our vibrancy.
· South Africa is committed to protect, uphold and advance the human rights of all people in our country, whether citizens or foreign nationals.
· The responsibility for enforcing immigration laws rests with the state and the state alone. · We will and must not allow groups to use the legitimate concerns of South Africans to destabilise our country through inciting lawlessness and violence.
· As South Africa, we will continue working with our sister countries to build an Africa in which people move by choice and not by desperation."
Nevertheless, there is scepticism about whether the government will follow through on its commitments. We note that the address, while condemning vigilantism, also frames illegal immigration as a significant driver of South Africa's economic difficulties - a framing not supported by available evidence, and one that risks reinforcing the narrative that is fueling the current climate of fear. We need to remain vocal in ensuring that migrants and refugees are protected from violence, and that government is held to account for the commitments it has made.
Xenophobia is a serious public health issue
Violence, intimidation and exclusion cause direct physical and psychological harm, disrupt access to healthcare, undermine disease prevention and treatment programmes, and weaken social cohesion. These impacts affect not only migrants and refugees but communities as a whole.
The escalating xenophobic activities of organised groups, against the backdrop of the unlawful 30 June 2026 deadline, carry a serious risk of large-scale violence being directed at refugees and migrants.
We are particularly concerned about:
· The deliberate spread of misinformation about the numbers, legal status, and economic impact of migrants - including false claims about migrants' impact on the public health system that largely go unchallenged in public discourse.
· The physical blocking of access to hospitals, clinics, and other health facilities by organised groups, in direct violation of constitutional rights and the November 2025 Gauteng High Court interdict in Kopanang Africa Against Xenophobia v Operation Dudula.
· The slow enforcement of court orders by the South African Police Service, which creates a dangerous gap between what the law provides and what migrants and refugees experience on the ground.
· The failure of National and Provincial Departments of Health to develop and implement clear policies on healthcare access for migrants and refugees, leaving healthcare workers exposed and migrants unprotected.
Sign up for free AllAfrica Newsletters
Get the latest in African news delivered straight to your inbox
· The ongoing risk that political leaders will use legitimate economic grievances to scapegoat migrants - as has preceded every episode of mass anti-immigrant violence in South Africa's democratic history, including 2008, 2015, and 2019.
We call for:
1. Effective and immediate government action to protect refugees and migrants from violence, intimidation and harassment - including the full and visible enforcement of existing court orders and the law.
2. Urgent action to address of misinformation about refugees and migrants including accurate information about healthcare burden, grant access, and economic impact set out in this statement. Government, health authorities, and media all have a responsibility to state the facts clearly and consistently.
3. Immediate development and implementation of clear healthcare access policies in all National and Provincial Departments of Health, reflecting the constitutional and legal right of all people on South African soil to access emergency and essential healthcare, regardless of documentation status. Healthcare workers must be supported and trained to apply these policies without fear.
4. The sensitive and dignified treatment of all refugees and migrants whether documented or undocumented, in all interactions with the state, law enforcement, health facilities, and the public.
5. An end to the scapegoating of migrants and refugees for the structural challenges South Africa faces. Unemployment, collapsing services, and poverty have identifiable causes. Directing public frustration toward migrants and refugees does not address those causes.
6. Fair and equitable access to healthcare for all migrants and refugees, in line with constitutional rights, court findings, and South Africa's international obligations.
Statement prepared by: Prof Hassan Mahomed and Dr Rebecca Walker
