Seven hundred schoolchildren from two Cape Town schools staged a violent protest a few weeks ago. Their demand: that foreign classmates leave the school and the country. That scene sits at the center of a World Refugee Day opinion piece published in the Mail & Guardian on June 20 by three South African health academics.
The authors are Professor Hassan Mahomed of Stellenbosch University’s Division of Health Systems and Public Health, Dr Martina Lembani of the University of the Western Cape’s School of Public Health, and Yeukai Chideya, a researcher at Stellenbosch’s Institute for Life Course Health Research. This year’s day, observed every 20 June, carries the theme of the “right to seek safety as a common safeguard for all of us.” They argue that host countries have to back it with action.
A history of movement in both directions
During apartheid, South Africans fled to neighbouring countries that gave them protection. At the same time, the migrant labour system, the mining sector above all, drew workers in from those same neighbours. Since the democratic transition, more people have arrived from elsewhere in Africa, escaping conflict, persecution and poverty. Statistics South Africa put the number of migrants and refugees at about 2.4 million in 2022.
Xenophobic violence against African migrants has recurred since the early 1990s. The authors point to very high unemployment and frustration in poor communities, and say misinformation has fed the belief that migrants take jobs. “The facts do not support this,” they write. Organised groups have demanded that all “illegal” immigrants leave by 30 June 2026, and in practice refugees and asylum seekers are targeted too. The authors call the word “illegal” inappropriate, since South Africa’s bureaucracy has been slow to process migrants, and say documented and undocumented are the correct terms.
Clinics
The Constitution guarantees health services to everyone regardless of documentation. The Immigration Act of 2002 muddies that by requiring providers to check a patient’s legal status before treating them. Add rising xenophobia, the authors say, and undocumented migrants, and increasingly all black African foreigners, are being shut out.
They accept that the public health system is overburdened, with staff shortages, medicine stock-outs and failures of leadership in some areas. Blaming migrants is wrong, they argue. Research indicates foreigners use public services at a much lower rate than citizens, because of language barriers, the “migrant health effect” and fear of being attacked at clinics. In 2014, the Western Cape government reported that migrants made up about 1.6% of total hospitalisation, against an estimated 3% share of the national population.
Extremist groups have recently called for a ban on migrant access to public health facilities. Civil society organisations such as Collective Voices for Health Access have challenged exclusions in court, but the authors say the gap between the law and migrants’ experience keeps widening.
Children and schools
Many refugee children were born and raised in South Africa and know no other home. Research cited by the authors shows xenophobic attacks and discrimination expose them to emotional and physical harm and damage their sense of belonging. The authors urge the Department of Basic Education to add lessons on who refugees are, why people seek refuge, and the value of inclusion, empathy and peaceful coexistence.
South Africa has hosted refugees and asylum seekers for more than three decades. Many South Africans, civil society groups and faith groups still stand with them, the authors write, showing the compassion and ubuntu that underpin the country’s democracy.
