The anti-immigrant movement blocks foreigners from health care

A community clinic north of Johannesburg has become the front line of a battle in South Africa over whether foreigners have access to public health facilities.

What began as a small local action in one area in 2022 has spread, with activists from the ostensibly anti-migrant group Operation Dudula picketing some hospitals and clinics in Gauteng and KwaZulu-Natal provinces. They check IDs and stop anyone who is not a South African from entering.

“Dudula” means to remove something with force in the Zulu language.

Despite some arrests, the authorities seem unable to prevent the pickets.

The location of their latest campaign is in Dieplsoot, a poor town of more than 200,000 people near the country’s commercial center.

On a cool, spring Thursday morning, Siselokule Moyo, dressed in a teal skirt, a thick windbreaker and a black headscarf, left early for the clinic.

The Zimbabwean, who has lived in South Africa since 2006, went there as she often did to take her medication for a chronic illness.

But this time when I got to the gate, things were different.

Two men wearing white t-shirts emblazoned with the words “Operation Dudula – Mass Deportation” were stationed at the entrance. They insisted that everyone present their documents before being allowed inside.

“I said I have a passport. They said they don’t take passports. They only want IDs,” Ms Moyo said, hiding her irritation behind a polite smile.

Although this was a potential flashpoint, there was a strange calm and resignation as people knew that Operation Dudula activists had been violent in the past.

Anyone who could not produce a South African identity card was turned away.

Walking slowly from the entrance, Mrs Moyo joined a group of women by the roadside, small children strapped to their backs, waiting in uncertainty as to what would happen next.

Tendai Muswawa, a woman in her 40s, faced the same fate.

“I was standing in line and then they said they (only) need people with ID. Me, I don’t have ID. I have a passport, I’m from Mozambique. So I can’t get my medicine because I don’t have ID,” she said.

Ms Muswava, dressed in a bright orange winter sweater and a white hat, looked desperate.

“I just feel like they’re doing what they want because it’s their country. I don’t have a say. For now, I have to follow what they say. I have no choice.”

South Africa is home to about 2.4 million migrants, just under 4% of the population, according to official figures. Most come from neighboring countries such as Lesotho, Zimbabwe and Mozambique, which have a history of providing migrant labor to their rich neighbour.

Xenophobia has long been a problem in South Africa, accompanied by occasional outbreaks of deadly violence, and anti-immigrant sentiment has become a key political talking point.

Started as a campaign, Operation Dudula, which has at times been accused of using force to get its point across, is now a political party with ambitions to contest local government elections next year.

Party leader Zandile Dabula insists what her organization is doing in government clinics in Johannesburg and other parts of the country is justified.

“We want to prioritize South Africans. Emergency care – we understand you need to be treated – but if you are illegal, you need to be handed over to law enforcement,” she told the BBC.

When challenged by the fact that many migrants are in the country legally, she turns to the argument that South Africans should be prioritized because there are minimal resources.

“Life comes first, we don’t deny that, but it can’t be a free-for-all. We can’t take care of the whole globe. We don’t have enough.”

The Constitution guarantees the right of access to health care for everyone in the country, regardless of nationality or immigration status.

But Ms Dabula says the public health system, which serves almost 85% of the population, is overwhelmed.

She says some people have to wake up at 04:00 to join long lines at the local clinic because they know that if they don’t get there on time, there will be no medicine left.

South Africa is a deeply unequal society, with much of the country’s wealth held in just a few hands. Unemployment and poverty levels are high and migrants, who often live in poor communities, are blamed by some for the plight of the people.

The methods of Operation Dudula have found sympathy among some Diepsloot residents.

One of them, South African Sipho Mohale, described the Operation Dudula campaign as a “positive change”.

“Last time I was here, the line was very long. But this time it only took me a few minutes to get my stuff and get out,” he said.

Another resident, Jennifer Shingange, also welcomed the presence of the activists in Diepsloot.

“As South Africans, we used to come to the clinic only to find that the drugs we needed were not available. But since foreign nationals stopped using the clinic, there has been a difference,” she said.

Ironically, some South Africans have not been spared from the anti-migrant campaign.

They were also turned away from public health facilities because they could not produce an identity card – it is estimated that more than 10% of South Africans do not have the proper documents to prove their nationality.

But it is the violation of the constitution in the actions of Operation Dudula that angers activists on the other side of the dispute.

“To have a group that is not sanctioned by the state making decisions about who goes in and who goes out is deeply problematic,” said Fatima Hassan, a human rights lawyer with the Health Justice Initiative.

“Unless the government deals with this situation very soon, it will lose its ability to enforce law and order.”

Deputy Health Minister Joe Faahla told the BBC his government was opposed to targeting foreign nationals or anyone else trying to use local clinics and hospitals.

“We don’t agree with this approach because health is a human right. As much as we understand the fact that service provision needs to be properly organized, you can’t organize it through bullying methods,” he told the BBC.

Several major political parties, including the Economic Freedom Fighters and the Democratic Alliance, also condemned Operation Dudula.

But a recent attempt to bring him to court by the South African Human Rights Commission failed on a technicality, effectively allowing the group to continue its campaign.

Several members of Operation Dudula have been arrested in recent weeks for blocking the entrances to public health facilities. They were later released with a warning. However, the police action did not seem to deter the group.

Ms Hassan believes tougher action is needed, saying “the police and the military should have been there on the first day to prevent (the picketing) because it’s just lawlessness”.

Dr Phaahla said this measure was being explored, but police said resources were “stretched in terms of being able to monitor and intervene promptly when such incidents occur”.

As the state vacillates over what to do, Operation Dudula appears bold and is turning its attention to public schools, saying it is part of a campaign to combat illegal immigration.

But in Diepsloot, the group’s action leaves people without the medical care they need.

Ms Muswava, who was rejected, is now looking for alternatives. Despite her meager means, she is considering going into the private sector.

“I think I’m going to have to go to the doctor. I’m going to pay the money. I’m going to have to make sacrifices to get it,” she said.

She had no idea how much it would cost her.

“I don’t have any money, but I’ll have to make a plan.”