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Ensuring health and access to health care for migrants: A right and good public health practice

01 July 2018

According to the United Nation’s 2017 International Migration Report, South Africa is host to an estimated four million migrants. This figure is set against a backdrop of a history of migration into South Africa that was marked by exploitative labour arrangements between South Africa and its neighbouring countries. This history is often treated with a ‘historical amnesia’ of the contribution of migrants to the South African economy and society. Migrants and particularly African migrants are met with a distrust and hostility that appears as xenophobia.

This hostility is also reflected in South Africa’s public health system, which does not adequately incorporate the reality of migration and health, nor address the needs of migrants. The South African Immigration Act is silent on the health rights and needs of migrants, placing them in a vulnerable situation and often leading to their exclusion from the public health system. This situation is worse for undocumented migrants, given their insecure legal status.

In contrast, recent media reports have often focused on ‘how an influx of health migrants’ has placed a strain on the country’s ability to deliver health care to its nationals. Some provincial health departments have lamented the strain on their limited resources due to the demand for services from migrants. These media reports and official pronouncements create conditions for refugees, asylum seekers and undocumented migrants to be denied access to health care services in public hospitals and clinics on the basis of their nationality or legal status. This was described by Crush and Tawonzera in 2011 as a form of ‘medical xenophobia’.

Denying migrants access to health care constitutes a violation of the internationally recognized right to access health care services, a right that is also enshrined in South Africa’s national law. The Bill of Rights in the South African Constitution enshrines equal rights for all persons in the country and affirms values of human dignity, equality and freedom. Migrants are covered by these constitutional rights, including the right to life, to dignity, freedom and security, to access information and to just administrative action. Section 27 of the Constitution guarantees everyone the right to basic health care, affirming that “everyone has the right to have access to health care services, including reproductive health care” and that “no one may be refused emergency medical treatment”.

The violation of migrants’ rights to access health care has grave consequences. For example, in 2015, a migrant woman lost her premature baby, allegedly due to denial of access to health care. In another incident, a migrant woman was forced to give birth at a bus station after allegedly being denied access to two hospitals in Gauteng province. Such denials of care violate rights. They have a gendered, racial and class impact, with poor, black women bearing the brunt of this discrimination.

Beyond the state’s legal obligation to provide access to health care services, there are public health reasons for providing health care services to migrants. The difficult journeys undocumented migrants, asylum seekers and refugees have had to make from their countries to South Africa may have exposed them to health problems, including communicable diseases. Treating these conditions makes public health sense as we live in a shared social space. The health of the local population is linked to that of the migrant population, given their integration into the wider community.

I would therefore argue that the South Africa state should develop a comprehensive multi-sectoral approach to migration and health, beyond infectious diseases and border control. Both the National Health Act and the Immigration Act should explicitly provide for migrant health care. The Immigration Act needs to be amended to adequately reflect the health rights of documented and undocumented migrants. The law should be supported by a comprehensive national policy, that also details how undocumented migrants should be treated, and that is applied universally across all provinces.

We need to advocate for and train health workers to implement migrants’ health rights. Such training, as a collaboration of the South African Department of Health and the Health Professions Council of South Africa, should create and foster an understanding among healthcare professionals of migrants’ health rights and needs. It should also include health administrators, as they are a point of entry for migrants attempting to access health care services.

These measures are necessary as a public health care system that excludes migrants creates conditions for poor public health for all. It increases the vulnerability of migrants, generates and magnifies discrimination and inequalities in health and violates migrants’ constitutional rights to access health care.

This is not just a health and human rights issue. It is also a matter of social justice. Migrant labour, often low wage, has been integral to South Africa’s society and economy, raising the profitability and savings of local business and consumers. It is also a matter of good public health practice. Delivering equitable access to care for migrants can reduce the health and social costs of disease, improve social cohesion, protect public health and human rights and contribute to healthier migrants in healthier local communities.

Ncumisa Willie: Research Advisor, South African Human Rights Commission, South Africa

Source: Equinet Africa (Online)

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