Wilfrid Laurier University Scholars Commons @ Laurier

Southern African Migration Programme Reports and Papers

2013

No. 64: Soft Targets: Xenophobia, Public Violence and Changing Attitudes to Migrants in South Africa After May 2008

Jonathan Crush Balsillie School of International Affairs/WLU, [email protected]

Sujata Ramachandran Southern African Migration Programme

Wade Pendleton University of Cape Town

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Part of the African Studies Commons, Economics Commons, and the Migration Studies Commons

Recommended Citation Crush, J., Ramachandran, S., Pendleton, W. (2013). Soft Targets: Xenophobia, Public Violence and Changing Attitudes to Migrants in South Africa After May 2008 (rep., pp. i-73). Waterloo, ON: Southern African Migration Programme. SAMP Migration Policy Series No. 64.

This Migration Policy Series is brought to you for free and open access by the Reports and Papers at Scholars Commons @ Laurier. It has been accepted for inclusion in Southern African Migration Programme by an authorized administrator of Scholars Commons @ Laurier. For more information, please contact [email protected]. the Southern african Migration prograMMe

Soft targetS: Xenophobia, public Violence and changing attitudeS to MigrantS in South africa after May 2008

Migration policy SerieS no. 64 Soft targetS: Xenophobia, public Violence and changing attitudeS to MigrantS in South africa after May 2008

Jonathan cruSh, SuJata raMachandran and Wade pendleton

SerieS editor: prof. Jonathan cruSh

Southern african Migration prograMMe (SaMp) 2013 acknoWledgeMentS

The 2010 SAMP survey was funded by the Canadian IDRC and OSISA and imple- mented by Citizen Surveys. We would like to thank Vincent Williams, Donald Taylor, Roxane de la Sorbenièrre, Abel Chikanda, Christa Schier, Sachil Singh, Cassandra Eberhardt and Bronwen Dachs for their assistance with research design, implementation and analysis. Our thanks also to Edgard Rodriguez and Paul Okwi of IDRC.

© Southern African Migration Programme (SAMP) 2013 ISBN 978-1-920596-05-7 First published 2013 Production by Bronwen Dachs Müller, Cape Town

All rights reserved. No part of this publication may be reproduced or transmitted, in any form or by any means, without prior permission from the publisher.

Printed by Megadigital, Cape Town contentS page eXecutiVe SuMMary 1 introduction 9

SurVey Methodology 14 profile of reSpondentS 14

South african national identity 18 beliefS about Migration 20 iS Xenophobia on the Wane? 24 Xenophobia, race and language 24 Xenophobia and leVelS of education 26 Xenophobia, eMployMent and incoMe 26 Xenophobia and interaction With MigrantS 29 rightS for MigrantS and refugeeS 32 iMMigration policy preferenceS 34 attitudeS toWardS Violence againSt MigrantS 38

WillingneSS to uSe Violence 38 eXplanationS for May 2008 39 liVing in the hotSpotS 41 back to the World cup 46 concluSion 46 endnoteS 48 appendiX: Xenophobia tiMeline 52

Migration policy SerieS 70 liSt of tableS page table 1: characteriSticS of SurVey reSpondentS, 2006 and 2010 15 table 2: econoMic profile of reSpondentS, 2006 and 2010 16 table 3: Monthly houSehold incoMe by race, 2010 17 table 4: occupational profile of reSpondentS, 2006 and 2010 17 table 5: perSonal identity of reSpondentS 18 table 6: criteria for being a ‘true’ South african 19 table 7: iMpreSSionS of South africanS and MigrantS by 19 type and origin table 8: leVelS of econoMic SatiSfaction and diSSatiSfaction 20 table 9: South african perceptionS of Migrant nuMberS 21 table 10: perceptionS of reaSonS Why MigrantS coMe to South africa 21 table 11: perceptionS of Main reaSonS for Migration to South africa 22 table 12: changeS in perceiVed iMpactS of MigrantS on South africa 23 table 13: perceiVed iMpact of MigrantS on South africa by race, 2010 23 table 14: iMpreSSionS of MigrantS by country of origin, 2006 and 2010 24 table 15: leVelS of Xenophobia aMongSt different language groupS 26 table 16: leVelS of Xenophobia by education 26 table 17: leVelS of Xenophobia by eMployMent StatuS 27 table 18: eXperience of being denied eMployMent due to MigrantS 27 table 19: leVelS of Xenophobia aMongSt different groupS, 28 2006 and 2010 table 20: degree of perSonal contact With MigrantS 30 table 21: locationS of perSonal contact With MigrantS 30 table 22: Quality of perSonal interaction With african MigrantS 31 table 23: attitudeS to rightS for citizenS, MigrantS and refugeeS in 32 South africa table 24: changeS in attitudeS to rightS for MigrantS 34 table 25: attitudeS toWardS iMMigration in coMparatiVe perSpectiVe 35 table 26: South african attitudeS toWardS iMMigration 36 table 27: South african attitudeS to iMMigration enforceMent 36 table 28: preferred policy optionS for Migration enforceMent 37 table 29: attitudeS to refugeeS in South africa 38 table 30: likelihood of taking action againSt MigrantS 39 table 31: likelihood of action againSt MigrantS froM 39 neighbouring countrieS table 32: econoMic profile of hotSpotS 42 table 33: leVelS of econoMic diSSatiSfaction in hotSpotS, 2010 42 table 34: attitudeS to May 2008 43 table 35: eXplanationS for May 2008 by hotSpot reSidentS 44 table 36: likelihood of future action againSt MigrantS 44 table 37: likelihood of taking action againSt irregular MigrantS 45 table 38: leVelS of contact With MigrantS in hotSpotS 45 table 39: Quality of perSonal interaction With african MigrantS 46 in hotSpotS table 40: poSt-World cup attitudeS to MigrantS 46

liSt of figureS page figure 1: racial groupS and leVelS of Xenophobia 25 figure 2: houSehold incoMe and leVelS of Xenophobia 28 figure 3: leVelS of Xenophobia by aMount of contact 31 MMIGRATIONigration PPOLICYolicy SERIESerieS NnOo. 4564

eEXXECUTIVEecutiVe SSuUMMARYMMary he post-apartheid history of antipathy towards migrants and refugees ealth workers are one of the categories of skilled profession- is pronounced and well documented. A study by SAMP in 2006 of T als most affected by globalization. Over the past decade, citizens’ attitudes to migrants reached the gloomy conclusion that South there has emerged a substantial body of research that tracks Africa continued to be a society in which xenophobia remained well patterns of international migration of health personnel, Hentrenched. Previous SAMP surveys on citizens’ views and perceptions assesses causes and consequences, and debates policy responses at global painted a similarly grim picture. The results showed that many South and national scales. Within this literature, the case of South Africa is Africans wanted to give few or little rights to migrants, even benefits they attracting growing interest. For almost 15 years South Africa has been were legitimately entitled to. Citizens’ beliefs about migration and migrants the target of a ‘global raiding’ of skilled professionals by several devel- were informed largely if not exclusively by stereotypes, myths and unveri- oped countries. How to deal with the consequences of the resultant out- fied biases. Inter-personal contact and social interaction with migrants was flow of health professionals is a core policy issue for the national gov- similarly limited, though on the rise from previous years. The World Values ernment. Survey, a global longitudinal study of people’s beliefs and values, reinforced This paper aims to to examine policy debates and issues concerning SAMP’s findings by indicating that South Africans were more hostile and the migration of skilled health professionals from the country and to resistant to migrants and refugees than citizens of any other country. furnish new insights on the recruitment patterns of skilled health per- To date, the fiercest expression of this tendency was the May 2008 sonnel. The objectives of the paper are twofold: attacks that rocked South Africa with their sheer scale and intensity. Q +C
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K=H< some South African civil society groups and organizations who found the key stakeholders in the South African health sector, the paper violence unacceptable. Such groups also rallied actively in July 2010 when offers a series of recommendations for addressing the problem of fresh warnings of impending xenophobic violence were reported. skilled health migration. These recommendations are grounded The magnitude of violence witnessed in 2008 has not been repeated. in both South African experience and an interrogation of inter- The risks of a re-occurrence appeared very high in the aftermath of the national debates and ‘good policy’ practice for regulating recruit- 2010 World Cup tournament, but when large-scale violence failed to ment. materialize, some observers maintained that the threats did not exist in the The paper is organized into five sections. Section Two positions first place. Anti-migrant violence in South Africa was explained by govern- debates about the migration of skilled health professionals within a ment as the work of criminal and anti-social elements. South Africans, it wider literature that discusses the international mobility of talent. was emphasized, were not opposed to migrants and refugees or xenopho- Section Three reviews research on the global circulation of health pro- bic. But, has violence directed at migrants and refugees really disappeared fessionals, focusing in particular upon debates relating to the experience from South Africa since the paroxysm of mid-2008? And has prejudice and of countries in the developing world. Section Four moves the focus from intolerance against them experienced a similar decline? international to South African issues and provides new empirical mate- In late 2010, a few months after the World Cup tournament had rial drawn from the survey of recruitment patterns and key interviews ended, SAMP undertook a new nationally representative survey of citizen undertaken with health sector recruiters operating in South Africa. attitudes on migration and xenophobia. The survey was administered in Section Five addresses the questions of changing policy interventions in urban areas in South Africa where many of the violent attacks on migrants South Africa towards the outflow of skilled health professionals and the have concentrated. The exercise to document citizens’ views on migration recruitment of foreign health professionals to work in South Africa. The over time is critical especially given South Africa’s extended record of extreme xenophobia. The research allows us to gauge public sentiments at

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EXECUTIVE SUMMARY a particular point in time, identify possible areas of concern in which inter- vention may be necessary and indicate changes in these views. The main ealth workers are one of the categories of skilled profession- objective of this survey was to understand shifts in views and perceptions als most affected by globalization. Over the past decade, of migration, migrants and refugees since 2006. The survey attempted to there has emerged a substantial body of research that tracks address these questions: patterns of international migration of health personnel, H South Africa? assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is attracting growing interest. For almost 15 years South Africa has been changed since 2008? the target of a ‘global raiding’ of skilled professionals by several devel- oped countries. How to deal with the consequences of the resultant out- sentiments on migration? flow of health professionals is a core policy issue for the national gov- ernment. areas that witnessed violence in mid-2008) and non-affected areas? This paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to and refugees in their communities? furnish new insights on the recruitment patterns of skilled health per- The detailed timeline provided with the 2006 Survey analysis showed sonnel. The objectives of the paper are twofold: that violent episodes involving migrants and refugees as easy targets were Q +C
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F97FI=H growing. The survey results also reflected this hardening of beliefs and ment of skilled professionals from South Africa in the health views across a number of indicators. In 2006, a greater number wanted to sector. The paper draws upon a detailed analysis of recruitment prohibit immigration completely (35%, up from 25% in 1999). Nearly 85% advertising appearing in the South African Medical Journal for felt that South Africa was letting in “too many” immigrants. There was the period 2000-2004 and a series of interviews conducted with strong support for the deportation of all migrants, including those who had private recruiting enterprises. not flouted any immigration rules. In other words, they wanted the forced Q 5G98
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K=H< expulsion of legal migrants too. One in two South Africans backed this key stakeholders in the South African health sector, the paper policy and less than 20% opposed it. Fewer than 20% wanted migrants to offers a series of recommendations for addressing the problem of come to South Africa with their families. The share of South Africans who skilled health migration. These recommendations are grounded wanted electrified border fences grew (to 76% in 2006 from 66% in 1999). in both South African experience and an interrogation of inter- Sixty-seven percent thought migrants consume South African resources national debates and ‘good policy’ practice for regulating recruit- like housing and the same percentage thought migrants engage in criminal ment. activity. One in two South Africans agreed that migrants were carriers of The paper is organized into five sections. Section Two positions diseases compared to 24% in 1999. debates about the migration of skilled health professionals within a South Africans showed a feeble commitment to their humanitarian wider literature that discusses the international mobility of talent. obligations to protect refugees and asylum-seekers fleeing risky circum- Section Three reviews research on the global circulation of health pro- stances in their home countries. Although nearly half of all South Africans fessionals, focusing in particular upon debates relating to the experience accepted the need for refugee protection, another 30% were not in favour of countries in the developing world. Section Four moves the focus from of providing it. Some three-quarters of South Africans did not want to international to South African issues and provides new empirical mate- increase the number of refugees residing in South Africa. One in two rial drawn from the survey of recruitment patterns and key interviews wanted all refugees to live in segregated camps in border areas. Two-thirds undertaken with health sector recruiters operating in South Africa. did not want to grant permanent residence to refugees residing in South Section Five addresses the questions of changing policy interventions in Africa for more than five years. A small number (30%) were in favour of South Africa towards the outflow of skilled health professionals and the giving refugees the right to work in South Africa, a right necessary to meet recruitment of foreign health professionals to work in South Africa. The refugees.

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EXECUTIVESUMMARY from 2006? Strikingly, there were several positive developments since 2006 including: ealth workers are one of the categories of skilled profession- als most affected by globalization. Over the past decade, refugees thereand African has emerged migrants, a substantial there has body been of a researchdrop in thatthe negativetracks assessmentpatterns of these of internationalthree groups. migration of health personnel, H assesses causes and consequences, and debates policy responses at global andgreater national “favourable” scales. Within and fewerthis literature, “unfavourable” the case assessments. of South Africa is attracting growing interest. For almost 15 years South Africa has been theliving target in of South a ‘global Africa. raiding’ The ofcomparable skilled professionals figure for 2010 by several is 57%. devel- oped countries. How to deal with the consequences of the resultant out- flowSupport of health for professionalsthis discriminatory is a core policy policy has issue dropped for the from national nearly gov-50% in ernment.the previous survey. This paper aims to to examine policy debates and issues concerning the60% migration in 2006. of skilled health professionals from the country and to furnish new insights on the recruitment patterns of skilled health per- sonnel.in criminal The objectives activity (50% of the down paper from are 64%twofold: in 2006). Q +C
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EXECUTIVE SUMMARY of education, by 2010 they had fallen for all groups and at a faster rate for less educated citizens. ealth workers are one of the categories of skilled profession- als most affected by globalization. Over the past decade, income, the lower the xenophobia scores. But by 2010, levels of xeno- there has emerged a substantial body of research that tracks phobia increased with increasing income. Those in the lowest income patterns of international migration of health personnel, groups were the least xenophobic. H assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is groups. attracting growing interest. For almost 15 years South Africa has been the target of a ‘global raiding’ of skilled professionals by several devel- were the most opposed to them, suggesting that increased contact oped countries. How to deal with the consequences of the resultant out- between migrants and citizens has a beneficial effect on tolerance and flow of health professionals is a core policy issue for the national gov- prejudicial views. ernment. - This paper aims to to examine policy debates and issues concerning veys shows a small decline in support for highly restrictive immigration the migration of skilled health professionals from the country and to furnish new insights on the recruitment patterns of skilled health per- ban or strong restrictions on immigration declined somewhat, so did sonnel. The objectives of the paper are twofold: support for employment-related immigration. Q +C
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F97FI=H While we see some reason for optimism, South Africa cannot afford to ment of skilled professionals from South Africa in the health become complacent about xenophobia and its pernicious outcomes. Glob- sector. The paper draws upon a detailed analysis of recruitment ally, South Africa is still the country most opposed to immigration where advertising appearing in the South African Medical Journal for nearly 80% of citizens either support prohibition on the entry of migrants the period 2000-2004 and a series of interviews conducted with or would like to place strict limits on it. South Africans want very few private recruiting enterprises. migrants even when jobs are available for them. These attitudes are far Q 5G98
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K=H< more negative compared even to countries that are generally perceived as key stakeholders in the South African health sector, the paper “anti-immigration” with draconian immigration policies. offers a series of recommendations for addressing the problem of skilled health migration. These recommendations are grounded and desire strict measures to prevent it. Some 63% want electrified in both South African experience and an interrogation of inter- fences on the country’s borders, a policy last adopted during the apart- national debates and ‘good policy’ practice for regulating recruit- heid era. ment. The paper is organized into five sections. Section Two positions migration directly and in a negative manner to issues of national secu- debates about the migration of skilled health professionals within a rity. wider literature that discusses the international mobility of talent. - Section Three reviews research on the global circulation of health pro- ments on them at all times, similar to policies during apartheid. fessionals, focusing in particular upon debates relating to the experience - of countries in the developing world. Section Four moves the focus from tinue to want all migrants to be deported, irrespective of their status. international to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews receive police protection. And only 18% want to give them legal pro- undertaken with health sector recruiters operating in South Africa. tection. Refugees fared marginally better with 36% wanting to give Section Five addresses the questions of changing policy interventions in them protection through the police. The recognized vulnerability of South Africa towards the outflow of skilled health professionals and the such migrants to poor treatment, extortion by state officials, and to recruitment of foreign health professionals to work in South Africa. The xenophobic violence makes this a disturbing fact.

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EXECUTIVE(67%SUMMARY to 55% in 2010) though the level is markedly higher than seen in 1999 (45%). ealth workers are one of the categories of skilled profession- variety ofals different most affected reasons, by thoseglobalization. who think Over migrants the past mainly decade, come to commit crimethere has emergedincreased a (14% substantial from 8% body in of2006). research that tracks It is evidentpatterns that South of international African views migration on migration of health are personnel,shaped by unin- Hformed ideas and these beliefs are largely unchanged over time. Although assesses causes and consequences, and debates policy responses at global theand Census national shows scales. that Within less than this 5% literature, of the country’s the case residents of South were Africa born is in anotherattracting country, growing more interest. than 50%For almost of South 15 Africansyears South believe Africa that has foreigners been constitutethe target aof great a ‘global majority raiding’ of the of country’sskilled professionals population. byAs several in 2006, devel- close to 20%oped still countries. think that How each to deal and withevery the migrant consequences living in Southof the Africaresultant entered out- theflow country of health illegally professionals and in violation is a core ofpolicy immigration issue for rules.the national The evaluation gov- ofernment. migrant numbers is similarly bleak. A massive 90% of South Africans feelThis that paperthere areaims too to manyto examine migrants policy (89% debates in 2006). and Onlyissues a concerning small minor- itythe agrees migration that ofthe skilled numbers health of migrantsprofessionals are “right”from the for country South Africaand to (5% fromfurnish 7% new in 2006). insights on the recruitment patterns of skilled health per- sonnel.Like Thethe numbersobjectives of offoreigners, the paper the are perceivedtwofold: effects of migration are weighedQ +C
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EXECUTIVE SUMMARY is assigned to migrants in irregular situations followed by refugees. The unambiguous linkages between citizenship and rights are clearly ealth workers are one of the categories of skilled profession- observed in the survey. Citizens are believed and expected to enjoy a als most affected by globalization. Over the past decade, larger set of rights compared to migrants, irrespective of their standing in there has emerged a substantial body of research that tracks South Africa. So while 87% think that citizens should always have access patterns of international migration of health personnel, to legal protection and only 2% disagree with it, the comparable figures H for refugees are 31% and 25%. Likewise, migrants entering South Africa assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is for short periods are to be given fewer rights. Some 38% agreed that they attracting growing interest. For almost 15 years South Africa has been should be given the right to free speech while the comparable figure for the target of a ‘global raiding’ of skilled professionals by several devel- citizens is 88%. The opinion of many South Africans diverges significantly oped countries. How to deal with the consequences of the resultant out- from the country’s Constitution and Bill of Rights in this respect. As in flow of health professionals is a core policy issue for the national gov- 2006, South Africans were asked to evaluate migrants by their country of ernment. origin. Nigerians received the most unfavourable assessments in both 2006 This paper aims to to examine policy debates and issues concerning and 2010. Migrants from Zimbabwe and Mozambique were not perceived the migration of skilled health professionals from the country and to as favourably as those from other SADC countries. Those from Botswana, furnish new insights on the recruitment patterns of skilled health per- Lesotho and Swaziland were seen most favourably in both years. sonnel. The objectives of the paper are twofold: The violence of May 2008 may not have recurred on the same scale but Q +C
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EXECUTIVEa similarSUMMARY proportion indicated that they would not endorse such actions. showed theirealth approval. workers These are differencesone of the categoriesare erased whenof skilled it comes profession- to offer- ing reasons alsfor mostthe violence. affected byMost globalization. accepted popular Over the explanations past decade, or were apathetic. Forthere instance, has emerged more a than substantial 60% thought body of theresearch violence that occurred tracks because of patterns migrants’ of involvementinternational inmigration crime or of becausehealth personnel, they take jobs Hfrom South Africans or are culturally different. So, while South Africans assesses causes and consequences, and debates policy responses at global expressedand national their scales. discomfort Within with this the literature, violence, the they case held of Southmigrants Africa and refuis - geesattracting responsible growing for interest. it, falling For back almost on migrant 15 years stereotypes South Africa and has falsehoods been tothe justify target it. of a ‘global raiding’ of skilled professionals by several devel- opedThe countries. marginal How urban to locations deal with in the which consequences violence occurred of the resultant in May 2008out- inevitablyflow of health led to professionals the idea that is poverty,a core policy economic issue fordeprivation the national of residents, gov- competitionernment. for resources, poor service delivery, and the presence of large numbersThis paper of migrants aims to wereto examine predisposing policy debates factors. and In otherissues words,concerning it was arguedthe migration that these of skilledaffected health or hotspot professionals areas possessed from the traits country “different” and to from non-affectedfurnish new insightsareas that on made the recruitment them more susceptiblepatterns of toskilled the violence. health per- It also impliedsonnel. thatThe hostilityobjectives to migrantsof the paper would are be twofold: markedly stronger in such areas. OtherQ research +C
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K=H< of low-income earners and higher numbers of working class key stakeholders in the South African health sector, the paper include:offers a series of recommendations for addressing the problem of skilled health migration. These recommendations are grounded- spot inareas both were South marginally African lowerexperience than andin non-affected an interrogation areas, of close inter- to half ofnational respondents debates in andthese ‘good areas policy’ said that practice they forwere regulating satisfied onrecruit- both indices.ment. The paper is organized into five sections. Section Two positions- debatesphobic about than the non-affected migration ones.of skilled health professionals within a wider literature that discusses the international mobility of talent. SectionWhite, Three Coloured reviews and research Indian/Asian on the South global Africans, circulation and of higher-income health pro- fessionals,groups. focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from internationalother South to Africans,South African but fewer issues felt and guilty provides about new it empirical or wanted mate- to do rialsomething drawn from to therepair survey it. of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa.- Sectionents’ considerationsFive addresses theof reasons questions for ofthe changing violence. policy interventions in South Africa towards the outflow of skilled health professionals and the recruitmentmigrants fromof foreign moving health into professionalstheir neighborhood to work and in Southrunning Africa. a business The there, they were less likely to engage in other forms of collective action.

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EXECUTIVE SUMMARY In fact, they were slightly less likely to engage in violence against them (9% versus 11% in unaffected areas). ealth workers are one of the categories of skilled profession- als most affected by globalization. Over the past decade, (due to the higher presence of migrants), the results were similar for there has emerged a substantial body of research that tracks both locations. patterns of international migration of health personnel, H affected areas. assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is Finally, the 2010 Survey included a question on the World Cup tourna- attracting growing interest. For almost 15 years South Africa has been ment and its perceived effects. As the venue of Africa’s first competition, the target of a ‘global raiding’ of skilled professionals by several devel- it was anticipated by some that it would deepen intra-African unity. One in oped countries. How to deal with the consequences of the resultant out- two South Africans agreed that the tournament had a positive impact, by flow of health professionals is a core policy issue for the national gov- enhancing their interest in other countries and 58% felt they could learn ernment. from people of other countries. One in three South Africans also said that This paper aims to to examine policy debates and issues concerning they had a more positive attitude towards migrants, thanks to the World the migration of skilled health professionals from the country and to Cup. At the same time, 41% thought that all migrants should have left furnish new insights on the recruitment patterns of skilled health per- South Africa after the World Cup was over. sonnel. The objectives of the paper are twofold: Overall, these results create a mixed picture, with some hopeful devel- Q +C
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iEntroductionXECUTIVE SUMMARY

enophobiaealth has workers been endemicare one ofin the South categories African of society skilled sinceprofession- at least 1 X1994. alsSuccessive most affected SAMP by surveys globalization. revealed Over growing the past levels decade, of intoler- ance towardsthere migrants has emerged and refugees a substantial and considerable body of research willingness that totracks resort 2 to violence againstpatterns non-citizens. of international In May migration 2008, aof wave health of personnel,xenophobic vio- Hlence unprecedented in scale and ferocity swept the country.3 The xeno- assesses causes and consequences, and debates policy responses at global phobicand national pogrom scales. prompted Within a this strong literature, counter-reaction the case of fromSouth within Africa South is Africanattracting civil growing society. interest. Numerous For almost organizations 15 years publiclySouth Africa protested has been against 4 thethe target violence of a and ‘global assisted raiding’ the of victims skilled and professionals their families. by several In some devel- local media,oped countries. condemnation How toof dealthe violencewith the wasconsequences uncharacteristically of the resultant vociferous, out- particularlyflow of health on professionals the op-ed and is a letterscore policy pages, issue and for many the national South Africansgov- seemedernment. outraged and shamed by the events. Others were more skeptical. An Thisinquest paper into aims the brutalto to examine “necklacing” policy of debates Mozambican and issues Ernesto concerning Nhmuave inthe May migration 2008 promptedof skilled health journalist professionals Justice Malala from the to callcountry South and Africans to xenophobicfurnish new monsters:insights on “We the haverecruitment to call patterns this spade of skilled by its name.health Weper- are xenophobic…sonnel. The objectives Xenophobia of the is our paper own are terrorism. twofold: We must stop the attacks 5 beforeQ they +C
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EXECUTIVE SUMMARY across the land during the World Cup; there is a dark side (if you will forgive the pun) to such passionate love of country ealth workers are one of the categories of skilled profession- – it excludes.11 als most affected by globalization. Over the past decade, With international attention centred on South Africa, the government there has emerged a substantial body of research that tracks deployed the army and organized heavy policing to avert the embarrass- Hpatterns of international migration of health personnel, ment of a second large-scale humanitarian disaster.12 assesses causes and consequences, and debates policy responses at global The official South African response to May 2008 was to deny that and national scales. Within this literature, the case of South Africa is xenophobia was involved or even that it existed at all. Former President attracting growing interest. For almost 15 years South Africa has been Thabo Mbeki even argued that those who claimed that South Africans the target of a ‘global raiding’ of skilled professionals by several devel- were xenophobic were themselves guilty of xenophobia: oped countries. How to deal with the consequences of the resultant out- flow of health professionals is a core policy issue for the national gov- As many were killed or maimed during the dark days of May, ernment. thousands displaced, businesses and homes looted, and homes This paper aims to to examine policy debates and issues concerning and businesses destroyed by arson, I heard it said insistently the migration of skilled health professionals from the country and to that my people have turned or have become xenophobic. The furnish new insights on the recruitment patterns of skilled health per- word xenophobia means a deep antipathy towards or hatred sonnel. The objectives of the paper are twofold: of foreigners. When I heard some accuse my people of xeno- Q +C
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EXECUTIVEunderscoredSUMMARY “an element of denialism” with regard to xenophobia by some officials and stated that the government “was not doing enough to address the issue.”20ealth workers are one of the categories of skilled profession- “serious concern”als most for affected the country. by globalization.21 The country Over report the (preparedpast decade, after an official visit thereto document has emerged the situationa substantial of migrants body of andresearch refugees that bytracks Jorge patterns of international migration of health personnel, HRights of Migrants), advised the South African government to treat the assesses causes and consequences, and debates policy responses at global socialand national integration scales. of allWithin migrants this andliterature, the protection the case of theirSouth human Africa rights is asattracting a requisite growing feature interest. of their Forimmigration almost 15 policy years and,South as Africaa priority, has to been adopt measuresthe target to of make a ‘global such raiding’ integration of skilled and social professionals cohesion by a reality.several22 devel- Migrant oped countries. How to deal with the consequences of the resultant out- flow of health professionals is a core policy issue for the national gov- concernsernment. are raised from many different quarters about migrant insecurity andThis vulnerability paper aims in toa national to examine context. policy debates and issues concerning theThe migration threatened of skilled post-World health Cupprofessionals ethnic cleansing from the didcountry not materialize.and to Doesfurnish this new mean insights that on xenophobic the recruitment violence patterns has disappeared of skilled health or is onper- the wane?sonnel. The The availableobjectives evidence of the paper suggests are twofold: not, as smaller-scale attacks on foreignQ migrants +C
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EXECUTIVE SUMMARY were attacked and looted in Thabong, Welkom and Kutloanong in Free State province over three days in February. Police moved migrants to ealth workers are one of the categories of skilled profession- other areas for safety. als most affected by globalization. Over the past decade, there has emerged a substantial body of research that tracks migrants were looted during a strike at the Impala Platinum Mine in patterns of international migration of health personnel, Phokeng near Rustenburg, North West province, and more than 100 H migrants fled the area. assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is attracting growing interest. For almost 15 years South Africa has been forced more than five Somali traders to close their shops permanently the target of a ‘global raiding’ of skilled professionals by several devel- in Khayelitsha (Western Cape), insisting that this was part of an agree- oped countries. How to deal with the consequences of the resultant out- ment reached after the May 2008 riots. flow of health professionals is a core policy issue for the national gov- ernment. returning from a funeral ransacked a grocery store belonging to three This paper aims to to examine policy debates and issues concerning Bangladeshi migrants. the migration of skilled health professionals from the country and to furnish new insights on the recruitment patterns of skilled health per- sonnel. The objectives of the paper are twofold: of migrant-run stores. Q +C
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F97FI=H ment of skilled professionals from South Africa in the health sector. The paper draws upon a detailed analysis of recruitment Kliptown, Sharpeville residents plundered migrant-run shops, while advertising appearing in the South African Medical Journal for many migrants fled the area. the period 2000-2004 and a series of interviews conducted with private recruiting enterprises. the death of a local woman in Modimolle Township, Limpopo province, Q 5G98
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EXECUTIVE SUMMARY Western Cape, run by Somali, Bangladeshi and Pakistani migrants were firebombedealth in workersJuly 2012 are after one they of the refused categories to pay of protection skilled profession- money to a local gang.als most31 affected by globalization. Over the past decade, there has emerged a substantial body of research that tracks patterns of international migration of health personnel, HAfrica estimated that over 200 Somali-owned shops were closed and assesses causes and consequences, and debates policy responses at global andthat, national in most scales. cases, Within goods thiswere literature, confiscated the and case not of returned.South Africa is attracting growing interest. For almost 15 years South Africa has been thegraphic target ofthreats a ‘global of violence raiding’ againstof skilled foreigners professionals in Mayfair, by several Johannesburg, devel- opedand countries. encouraged How others to deal to with do thethe same.consequences The organization of the resultant distributed out- flowpamphlets of health inprofessionals the area “declaring is a core policy war” againstissue for refugees the national and warninggov- ernment.foreigners that “we are coming for you.” The pamphlets warned that “weThis will paper burn aims your to houses,to examine your policy so-called debates luxury and cars, issues we concerning will kill your thefucken migration (sic) of puppies skilled (children) health professionals and burn down from yourthe country shops” andand threatto - furnishened new to rape insights and killon theforeign recruitment women. patterns of skilled health per- sonnel. The objectives of the paper are twofold: wereQ +C
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K=H< as crimes of murder, robbery and physical assault (see Appendix).key stakeholders in the South African health sector, the paper Againstoffers this a series backdrop, of recommendations the persistent officialfor addressing denial thatthe problem xenophobia of exists inskilled South healthAfrica migration.seems misplaced These recommendationsin the extreme.33 Aare great grounded deal of post-2008in both case-study South evidenceAfrican experience has accumulated and an interrogation to show that of migrants inter- and refugeesnational are debatessubjected and to ‘goodpoor treatment,policy’ practice verbal for abuse regulating and exclusion recruit- from servicesment. by South African citizens and state employees.34 The death in custodyThe paper of Mozambicanis organized into migrant five sections.Emidio Macia Section in Twolate positionsFebruary 2013 afterdebates being about handcuffed the migration by several of skilled officers health to a professionalspolice vehicle within and dragged a downwider literature the street that is simply discusses its the latest international public expression. mobility35 of talent. “incidents”Section Three can reviewsalways beresearch written on off the by global xenophobia-denialists circulation of health as atypical pro- andfessionals, unrepresentative focusing in of particular the South upon African debates population relating at to large. the experienceThis report thereforeof countries seeks in tothe examine developing whether world. South Section Africans Four inmoves general the display focus from atti- tudesinternational and perceptions to South that African are xenophobic issues and providesin nature. new The empirical national mate-attitu- dinalrial drawn survey from undertaken the survey by ofSAMP recruitment in late 2010patterns allows and us key to interviewsassess general levelsundertaken of xenophobia with health and sector identify recruiters which operatinggroups are in most South xenophobic. Africa. In discussingSection Five the addresses results, comparisonsthe questions are of madechanging with policy earlier interventions SAMP surveys in (particularlySouth Africa the towards 2006 survey)the outflow to assess of skilled whether health xenophobia professionals has intensified and the orrecruitment waned. The of reportforeign addresses health professionals three key questions: to work in South Africa. The assertions that xenophobia does not exist in South Africa? 131 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MIGRATION POLICY SERIES NO. 45 Soft targetS: Xenophobia, public Violence and changing attitudeS to MigrantS

EXECUTIVE SUMMARY - gees and what would they like to see happen to migrants in the country? ealth workers are one of the categories of skilled profession- als most affected by globalization. Over the past decade, xenophobic violence of May 2008? there has emerged a substantial body of research that tracks Hpatterns of international migration of health personnel, SurVey Methodology assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is he most recent SAMP xenophobia survey was conducted in Novem- attracting growing interest. For almost 15 years South Africa has been Tber and December 2010. Census enumeration areas were used for the target of a ‘global raiding’ of skilled professionals by several devel- household selection and respondent selection was randomized. Due to oped countries. How to deal with the consequences of the resultant out- resource constraints, the 2010 survey was conducted in urban/metro flow of health professionals is a core policy issue for the national gov- areas (large and small cities, large and small towns) in all nine provinces. ernment. Interviews took place in a variety of settings, depending on where the This paper aims to to examine policy debates and issues concerning randomly-selected dwellings were located. Respondents were all South the migration of skilled health professionals from the country and to African citizens who gave their informed consent to be interviewed. The furnish new insights on the recruitment patterns of skilled health per- 2010 survey used the same questions and indices as the SAMP survey in sonnel. The objectives of the paper are twofold: 2006, with additional questions about xenophobic violence and the World Q +C
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F97FI=H Cup.36 The questionnaire was translated and administered in five South ment of skilled professionals from South Africa in the health African languages: English, Afrikaans, Xhosa, Zulu and Tswana. Field- sector. The paper draws upon a detailed analysis of recruitment workers were fluent in the languages in which interviews were conducted advertising appearing in the South African Medical Journal for and survey participants were able to select one of the above as the pre- the period 2000-2004 and a series of interviews conducted with ferred language for the interview. The final 2010 sample of 2,400 citizens private recruiting enterprises. was weighted to make it nationally representative. All results reported are Q 5G98
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K=H< percentages using the weighted dataset. To compare the results with those key stakeholders in the South African health sector, the paper from 2006, a new dataset was created from the earlier results by deleting all offers a series of recommendations for addressing the problem of rural respondents from the survey file. A total of 2,600 respondents were skilled health migration. These recommendations are grounded included in the 2006 urban dataset. Areas where xenophobic violence in both South African experience and an interrogation of inter- occurred in 2008 were also identified in the 2010 dataset in order to make national debates and ‘good policy’ practice for regulating recruit- comparisons with areas where violence did not occur. ment. The paper is organized into five sections. Section Two positions profile of reSpondentS debates about the migration of skilled health professionals within a wider literature that discusses the international mobility of talent. efore comparing the attitudes of South Africans in 2006 and 2010, it Section Three reviews research on the global circulation of health pro- Bis important to assess how comparable the two sampled groups are in fessionals, focusing in particular upon debates relating to the experience terms of various demographic and socio-economic characteristics. Table 1 of countries in the developing world. Section Four moves the focus from compares the two on a variety of indicators and shows a number of similar- international to South African issues and provides new empirical mate- ities. The sex breakdown in 2006 and 2010 is very similar with roughly half rial drawn from the survey of recruitment patterns and key interviews of the respondents being male and half female. The breakdown by race is undertaken with health sector recruiters operating in South Africa. also very close with a maximum variance of 1%. In both years, around two- Section Five addresses the questions of changing policy interventions in thirds of the sample was Black African, just under 20% were White and South Africa towards the outflow of skilled health professionals and the around 14% were Coloured. Indians/Asians were in a small minority (3%). recruitment of foreign health professionals to work in South Africa. The The first language breakdown is similar, with marginally more Afrikaans, English and Sotho speakers in 2010 and marginally fewer Zulu and Xhosa

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EXECUTIVEspeakers.SUMMARY Finally, the respondents resided in comparable housing and set- tlement types in 2006 and 2010. Some comparative data is also included from the latestealth South workers African are one Census of the (which categories includes of skilled the rural profession- areas and therefore hasals a mosthigher affected proportion by globalization. of Blacks than Over the the urban past sample). decade, there has emerged a substantial body of research that tracks Table 1: CharacteristicsHpatterns of Survey of Respondents, international 2006 migration and 2010 of health personnel, assesses causes and2006 consequences, (%) and 2010debates (%) policy responsesCensus 2011 at global (%) Sex and national scales. Within this literature, the case of South Africa is Male attracting growing interest.49 For almost 1550 years South Africa has49 been Female the target of a ‘global51 raiding’ of skilled professionals50 by several51 devel- Race oped countries. How to deal with the consequences of the resultant out- flow of health professionals is a core policy issue for the national gov- Black 66 65 79 ernment. White 17 18 9 This paper aims to to examine policy debates and issues concerning Coloured 13 14 9 the migration of skilled health professionals from the country and to Indian/Asian 3 3 3 furnish new insights on the recruitment patterns of skilled health per- First languagesonnel. The objectives of the paper are twofold: Zulu Q +C
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F97FI=H24 22 23 Afrikaans ment of skilled20 professionals from 21South Africa in the 13health Xhosa sector. The paper16 draws upon a detailed14 analysis of recruitment16 English advertising appearing14 in the South16 African Medical Journal10 for Sotho the period 2000-200414 and a series15 of interviews conducted8 with Tswana private recruiting7 enterprises. 7 8 Other Q 5G98
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K=H<5 5 12 Type of accommodationkey stakeholders in the South African health sector, the paper House (free-standing)offers a series69 of recommendations67 for addressing the problem of House (attached) skilled health 8migration. These recommendations8 are grounded RDP house in both South7 African experience10 and an interrogation of inter- Apartment/flat national debates4 and ‘good policy’ 5practice for regulating recruit- Shack ment. 11 8 Other The paper is organized1 into five sections.2 Section Two positions Type of settlementdebates about the migration of skilled health professionals within a Formal wider literature that 73discusses the international69 mobility of talent. Section Three reviews research on the global circulation of health pro- Informal 11 12 fessionals, focusing in particular upon debates relating to the experience Mixed 16 19 of countries in the developing world. Section Four moves the focus from Ininternational terms of economic to South and African occupational issues and profile, provides both new groups empirical have roughlymate- equalrial drawn proportions from the in surveyvarious of self-assigned recruitment class patterns categories and key with interviews the majority (aroundundertaken 55% with in bothhealth years) sector describing recruiters themselves operating inas Southlower andAfrica. working classSection and Five a third addresses as middle the class. questions As expected, of changing there policy is a clear interventions racial dimen in- sionSouth to Africa the class towards composition. the outflow In of 2010, skilled for health example, professionals 59% of the and Black the respondentsrecruitment wereof foreign lower health and working professionals class and to 33%work were in South middle Africa. class. TheThe comparable figures for White respondents were 28% and 59%.

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EXECUTIVE SUMMARY Table 2: Economic Profile of Respondents, 2006 and 2010 2006 (%) 2010 (%) ealth workers are one of the categories of skilled profession- Economic class als most affected by globalization. Over the past decade, Lower/Working 56 55 there has emerged a substantial body of research that tracks Middle 32 32 Hpatterns of international migration of health personnel, Upper middle 5 6 assesses causes and consequences, and debates policy responses at global Upper 2 3 and national scales. Within this literature, the case of South Africa is Don’t know 5 4 attracting growing interest. For almost 15 years South Africa has been Monthly income the target of a ‘global raiding’ of skilled professionals by several devel- R20,000 3 3 Q +C
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F97FI=H No answer 18 29 ment of skilled professionals from South Africa in the health Employment status sector. The paper draws upon a detailed analysis of recruitment Employed full-time 29 36 advertising appearing in the South African Medical Journal for Employed part-time 11 13 the period 2000-2004 and a series of interviews conducted with Unemployed (looking for work) 26 24 private recruiting enterprises. Unemployed (not looking) 9 7 Q 5G98
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K=H< Self-employed (formal sector) 5 4 key stakeholders in the South African health sector, the paper Self-employed (informal sector) 2 1 offers a series of recommendations for addressing the problem of Retired 9 5 skilled health migration. These recommendations are grounded Other 9 10 in both South African experience and an interrogation of inter- national debates and ‘good policy’ practice for regulating recruit- There is a difference in the income profile of the two samples with 46% ment. earning less than R3,000 per month in 2006 compared with only 30% in The paper is organized into five sections. Section Two positions 2010. Since the same sampling methodology was used in both 2006 and debates about the migration of skilled health professionals within a 2010, this could represent a shift for the better in urban employment and wider literature that discusses the international mobility of talent. income levels for the urban poor over the four-year period. Regardless, Section Three reviews research on the global circulation of health pro- there is a clear relationship between income and race (Table 3). In the fessionals, focusing in particular upon debates relating to the experience 2010 sample, 38% of Black South Africans earned less than R3,000 per of countries in the developing world. Section Four moves the focus from month compared with only 4% of Whites. And 55% of Blacks earned less international to South African issues and provides new empirical mate- than R6,000 per month compared with just 9% of Whites. Consistent rial drawn from the survey of recruitment patterns and key interviews with the finding of an improvement in income between 2006 and 2010, undertaken with health sector recruiters operating in South Africa. there was also a change in the full- or part-time employment profile (Table Section Five addresses the questions of changing policy interventions in 2). Employment levels were higher in 2010 than 2006 (49% versus 40%) South Africa towards the outflow of skilled health professionals and the and the proportion of unemployed was concomitantly lower (31% in 2010 recruitment of foreign health professionals to work in South Africa. The versus 35% in 2006).

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ETableXECUTIVE 3: MonthlyS HouseholdUMMARY Income by Race, 2010 Income levels Black (%) Coloured (%) Indian/Asian (%) White (%) >R3,000 ealth38 workers are one29 of the categories6 of skilled profession-4 R3,000–R5,999 als17 most affected by29 globalization. Over12 the past decade,5 R6,000–R8,999 there8 has emerged 10a substantial body19 of research that11 tracks R9,000–R11,999Hpatterns4 of international4 migration 13of health personnel,7 R12,000–R15,999assesses causes 2and consequences,3 and debates 15policy responses at7 global R16,000–R19,999and national scales.2 Within this1 literature, the 12case of South Africa13 is R20,000+ attracting growing<1 interest. For2 almost 15 years 9South Africa has14 been the target of a ‘global raiding’ of skilled professionals by several devel- No answer 29 22 14 39 oped countries. How to deal with the consequences of the resultant out- Theflow occupationalof health professionals profile of isthe a coretwo policysamples issue is extremely for the national diverse, gov- which validatesernment. our attempt to survey as broad a cross-section of South Africans as possible.This paper Interestingly, aims to to examinethe only policytwo occupations debates and in issues which concerning there was a dropthe migration between 2006of skilled and 2010health were professionals service work from (6% the to country 1%) and and domestic to workfurnish (8% new to insights 5%) (Table on the 4). recruitment Migrants arepatterns certainly of skilled employed health in per- grow- ingsonnel. numbers The objectivesin both occupations, of the paper which are twofold: could partially account for the reduction.Q +C
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F97FI=H ment of skilled professionals from South Africa in the health Table 4: Occupationalsector. Profile The of Respondents, paper draws 2006 upon and a detailed2010 analysis of recruitment advertising appearing in the South2006 African (%) Medical 2010Journal (%) for Low-skilled the period 2000-2004 and a series of interviews conducted with Service worker private recruiting enterprises. 6 1 Q 5G98
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K=H< Domestic worker 8 5 key stakeholders in the South African health sector, the paper Security 2 2 offers a series of recommendations for addressing the problem of Informal sector 3 3 skilled health migration. These recommendations are grounded Sub-total 19 11 in both South African experience and an interrogation of inter- Semi-skilled national debates and ‘good policy’ practice for regulating recruit- Office worker ment. 6 5 Miner The paper is organized into five sections. 1Section Two positions1 Police/securitydebates about the migration of skilled health2 professionals within2 a Nurse wider literature that discusses the international2 mobility of talent.2 Driver Section Three reviews research on the global3 circulation of health2 pro- Retail/salesfessionals, focusing in particular upon debates4 relating to the experience5 Sub-total of countries in the developing world. Section18 Four moves the focus17 from Skilled international to South African issues and provides new empirical mate- Employer/managerrial drawn from the survey of recruitment patterns4 and key interviews4 Professionalundertaken with health sector recruiters operating2 in South Africa.2 Teacher Section Five addresses the questions of changing3 policy interventions3 in Office manager/supervisorSouth Africa towards the outflow of skilled health3 professionals5 and the Sub-total recruitment of foreign health professionals to12 work in South Africa.14 The Never worked 24 28

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EXECUTIVE SUMMARY South african national identity ealth workers are one of the categories of skilled profession- he 2010 respondents demonstrated high levels of personal affinity with als most affected by globalization. Over the past decade, Tan imagined South African identity. As many as 85% of respondents there has emerged a substantial body of research that tracks agreed that “being South African” was an important part of how they patterns of international migration of health personnel, viewed themselves (Table 5). A majority (82%) said that they were proud H to be South African and a similar number said they wanted their chil- assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is dren to identify themselves as South African as well. The strong levels of attracting growing interest. For almost 15 years South Africa has been national identification varied somewhat by race, with Coloured respond- the target of a ‘global raiding’ of skilled professionals by several devel- ents expressing consistently lower levels of personal affinity with a South oped countries. How to deal with the consequences of the resultant out- African identity. flow of health professionals is a core policy issue for the national gov- ernment. Table 5: Personal Identity of Respondents* Indian/ This paper aims to to examine policy debates and issues concerning Black Coloured White Total Asian (%) (%) (%) (%) the migration of skilled health professionals from the country and to (%) furnish new insights on the recruitment patterns of skilled health per- Being South African is an important part 86 69 87 84 83 sonnel. The objectives of the paper are twofold: of how I see myself Q +C
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F97FI=H I want my children to think of themselves 86 64 86 81 82 ment of skilled professionals from South Africa in the health as South African sector. The paper draws upon a detailed analysis of recruitment It makes me proud to be South African 87 64 86 80 82 advertising appearing in the South African Medical Journal for *Percentage who agree/strongly agree the period 2000-2004 and a series of interviews conducted with private recruiting enterprises. These findings demonstrate the value and significance of national identity Q 5G98
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K=H< for most South Africans. But what is a South African? The two strongest key stakeholders in the South African health sector, the paper indicators were birth-related: some 82% of respondents felt that being born offers a series of recommendations for addressing the problem of in South Africa was the most important criterion for being South African skilled health migration. These recommendations are grounded and 78% indicated that having parents born in South Africa was a neces- in both South African experience and an interrogation of inter- sary condition. Working and contributing to the South African economy national debates and ‘good policy’ practice for regulating recruit- was viewed as a key indicator of a true South African by 69%. Speaking ment. an African language was cited by 64% and being Black by 63%. Around The paper is organized into five sections. Section Two positions 40% felt that a true South African should not hold dual citizenship. These debates about the migration of skilled health professionals within a views are tied to the notion that native groups, i.e. people born within wider literature that discusses the international mobility of talent. South African territory, have a much stronger and possibly exclusivist Section Three reviews research on the global circulation of health pro- claim to South Africa compared to those who were born outside the coun- fessionals, focusing in particular upon debates relating to the experience try. Migrants and refugees, by virtue of their birth outside the country, can of countries in the developing world. Section Four moves the focus from never be accepted as truly South African. In a broader sense, these asser- international to South African issues and provides new empirical mate- tions of South African identity are directly connected to the kinds of rights rial drawn from the survey of recruitment patterns and key interviews and entitlements accorded to different groups in South Africa. undertaken with health sector recruiters operating in South Africa. Citizenship and nationality are clearly strong factors shaping public Section Five addresses the questions of changing policy interventions in attitudes towards the inclusion and exclusion of various communities liv- South Africa towards the outflow of skilled health professionals and the ing in South Africa. In terms of general attitude to their own racial group recruitment of foreign health professionals to work in South Africa. The and to migrant groups, the ratings follow a predictable pattern with all of the South African groups receiving much higher positive evaluations

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EXECUTIVE(TableS UMMARY7). The strongest negative judgments against non-nationals are reserved for irregular migrants, followed by refugees as well as migrants ealth workers are one of the categories of skilled profession- decline in unfavourableals most affected assessments by globalization. of all three Over groups the since past decade,2006. Irregu- lar migrantsthere experienced has emerged the biggest a substantial drop in body unfavourable of research ratings that tracksand the largest increasepatterns in favourableof international ratings migration (16% and of health 6% respectively). personnel, The Himprovement in ratings of refugees/asylum seekers and migrants from the assesses causes and consequences, and debates policy responses at global restand ofnational Africa scales.was virtually Within identical. this literature, Migrants the from case Southernof South AfricaAfrica iselic- itedattracting a bigger growing improvement interest. than For either almost of 15 these years groups South (6% Africa drop has in negative been appraisalsthe target andof a 5%‘global increase raiding’ in ofpositive skilled appraisals). professionals Migrants by several from devel- Europe andoped North countries. America How were to deal the onlywith groupthe consequences whose favourability of the resultantrating did out- not change.flow of healthIn 2006, professionals they were israted a core more policy favourably issue for than the nationalany other gov- group. Inernment. 2010, they had fallen into second place behind migrants from other SouthernThis paper African aims countries. to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to Table 6: Criteriafurnish for new Being insights a ‘True’ Southon the African* recruitment patterns of skilled health per- sonnel. The objectives of the paper are twofold: % Being born in SouthQ Africa +C
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F97FI=H82 Having parents born mentin South of Africa skilled professionals from South Africa in the health78 Working and contributingsector. to the The South paper African draws economy upon a detailed analysis of recruitment69 Speaking an African advertisinglanguage appearing in the South African Medical Journal64 for Being Black the period 2000-2004 and a series of interviews conducted63 with Willing to give up claimsprivate of citizenship recruiting in another enterprises. country 42 *Percentage whoQ agree/strongly 5G98
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K=H< agree key stakeholders in the South African health sector, the paper Table 7: Impressionsoffers of South a series Africans of recommendations and Migrants by Type for and addressing Origin the problem of skilled health migration.Completely favourable These recommendations (%) Completely unfavourable are grounded (%) in both South African2006 experience2010 and an interrogation2006 of2010 inter- national debates and ‘good policy’ practice for regulating recruit- South African groups ment. Blacks 70 65 5 5 The paper is organized into five sections. Section Two positions Whites 55 56 7 4 debates about the migration of skilled health professionals within a Coloureds 45 49 12 7 wider literature that discusses the international mobility of talent. Indians/AsiansSection Three reviews research38 on the42 global circulation20 of health12 pro- Migrant groupsfessionals, focusing in particular upon debates relating to the experience Southern Africansof countries in the developing20 world. Section25 Four moves27 the focus21 from Europeans/Northinternational Americans to South African21 issues and21 provides new24 empirical18 mate- Rest of Africarial drawn from the survey15 of recruitment17 patterns and33 key interviews26 Refugees/asylum-seekersundertaken with health sector19 recruiters21 operating in32 South Africa.27 Irregular migrantsSection Five addresses the6 questions of12 changing policy65 interventions49 in South Africa towards the outflow of skilled health professionals and the Onerecruitment common of explanationforeign health for professionals the escalation to work of xenophobia in South Africa. is the deteThe- riorating economic and social standing of citizens.37 This ought to be reflected in high levels of economic dissatisfaction among South Africans. 191 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MIGRATION POLICY SERIES NO. 45 Soft targetS: Xenophobia, public Violence and changing attitudeS to MigrantS

EXECUTIVE SUMMARY were dissatisfied with their personal economic circumstances as well as ealth workers are one of the categories of skilled profession- overall economic conditions in the country (Table 8). Far more were satis- als most affected by globalization. Over the past decade, fied than dissatisfied with their personal economic situation (45% versus there has emerged a substantial body of research that tracks 14%) and general economic conditions (47% satisfied, 13% dissatisfied). patterns of international migration of health personnel, The number of dissatisfied actually fell by several percentage points H between 2006 and 2010. The respondents were also relatively optimistic assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is about the future. The proportion of those who felt they would be satisfied attracting growing interest. For almost 15 years South Africa has been with their personal economic circumstances in 2015 rose slightly from 55% the target of a ‘global raiding’ of skilled professionals by several devel- to 56% and those who thought they would be dissatisfied fell from 11% to oped countries. How to deal with the consequences of the resultant out- 7%. Similar changes in levels of optimism surrounded views about future flow of health professionals is a core policy issue for the national gov- economic conditions in the country. ernment. This paper aims to to examine policy debates and issues concerning Table 8: Levels of Economic Satisfaction and Dissatisfaction the migration of skilled health professionals from the country and to 2006 2006 2010 2010 furnish new insights on the recruitment patterns of skilled health per- % Satisfied % Dissatisfied % Satisfied % Dissatisfied sonnel. The objectives of the paper are twofold: How satisfied are you with Q +C
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F97FI=H your personal economic 48 19 45 14 ment of skilled professionals from South Africa in the health conditions? sector. The paper draws upon a detailed analysis of recruitment How satisfied are you with overall economic conditions 54 14 47 13 advertising appearing in the South African Medical Journal for in South Africa? the period 2000-2004 and a series of interviews conducted with How satisfied do you think private recruiting enterprises. you will be with your per- 55 11 56 7 Q 5G98
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ETableXECUTIVE 9: South AfricanSUMMARY Perceptions of Migrant Numbers* 2006 (%) 2010 (%) Many people living in Southealth Africa workers are foreigners are one of the categories53 of skilled profession-52 Almost everyone living in alsSouth most Africa affected is a foreigner by globalization. Over9 the past decade,7 Many foreigners living in Souththere Africa has emergedare illegal a substantial body45 of research that44 tracks Almost all foreignersH livingpatterns in South Africaof international are illegal migration21 of health personnel,19 There are tooassesses many foreignerscauses and living consequences, in South Africa and debates89 policy responses 90at global The right numberand national of foreigners scales. are living Within in South this Africa literature, the7 case of South Africa5 is *Percentage attractingwho agree/strongly growing agree interest. For almost 15 years South Africa has been the target of a ‘global raiding’ of skilled professionals by several devel- Overall,oped countries. South AfricanHow to deal perceptions with the of consequences the reasons forof the migration resultant to out- the countryflow of health remain professionals unchanged is since a core 2006 policy except issue in for two the crucial national categories gov- (Tableernment. 10). First, there is a decline in the numbers of those who believe thatThis migrants paper come aims withto to the examine intention policy of engaging debates inand criminal issues concerningactivity, from 64%the migration to 50%. This of skilled belief healthremains professionals strongest amongst from the Black country South and Africans to (atfurnish 56%). new Second, insights the on numbers the recruitment who believe patterns that of migrants skilled healthcome toper- look forsonnel. work The increased objectives from of47% the to paper 54%. are There twofold: is also a widespread belief that migrantsQ +C
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F97FI=H come to South Africa to access medical services (around 40%). This perceptionment of skilledis of interest professionals because from it is Southconsistent Africa with in recentthe health research that showssector. that The there paper is considerable draws upon short-term a detailed movementanalysis of acrossrecruitment borders to accessadvertising healthcare appearing as a result in of the the South collapse African of public Medical health Journal systems for in neighbouringthe period countries. 2000-200438 and a series of interviews conducted with private recruiting enterprises. Q 5G98
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K=H< Table 10: Perceptions of Reasons Why Migrants Come to South Africa* key stakeholders in the South African health sector, the paper 2006 (%) 2010 (%) offers a series of recommendations for addressing the problem of Migrants come to look for work 47 54 skilled health migration. These recommendations are grounded Migrants come for jobsin inboth South South Africa African experience69 and an interrogation70 of inter- Migrants come do businessnational in South debates Africa and ‘good policy’66 practice for regulating66 recruit- Migrants come to accessment. medical services 40 39 Migrants come Theto attend paper schools/universities is organized into five sections.43 Section Two positions45 Migrants comedebates to commit about crime the migration of skilled health64 professionals within50 a *Percentage widerwho agree/strongly literature agree that discusses the international mobility of talent. Note: Multiple response questions Section Three reviews research on the global circulation of health pro- fessionals, focusing in particular upon debates relating to the experience Asked about the main reason why migrants come to South Africa, a more of countries in the developing world. Section Four moves the focus from diverse picture emerges (Table 11). The primary driver is seen as the international to South African issues and provides new empirical mate- search for employment (mentioned by 37%). Other “pull” factors include rial drawn from the survey of recruitment patterns and key interviews having a better life (15%), doing business (8%) and making money (4%). undertaken with health sector recruiters operating in South Africa. Amongst the “push” factors are escaping poverty (13%) and war (8%) at Section Five addresses the questions of changing policy interventions in home, and food insecurity (3%). Job-seeking is clearly seen as the main South Africa towards the outflow of skilled health professionals and the reason for migration. recruitment of foreign health professionals to work in South Africa. The

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EXECUTIVE SUMMARY Table 11: Perceptions of Main Reasons for Migration to South Africa 2006 (%) 2010 (%) ealth workers are one of the categories of skilled profession- Pull factors als most affected by globalization. Over the past decade, To look for work 33 37 there has emerged a substantial body of research that tracks Have a better life 12 15 Hpatterns of international migration of health personnel, Come to do business 13 8 assesses causes and consequences, and debates policy responses at global Come to make money 8 4 and national scales. Within this literature, the case of South Africa is Because the South African economy is strong 4 3 attracting growing interest. For almost 15 years South Africa has been To study 3 2 the target of a ‘global raiding’ of skilled professionals by several devel- To earn a living 1 2 oped countries. How to deal with the consequences of the resultant out- For citizenship 1 1 flow of health professionals is a core policy issue for the national gov- Push factors ernment. This paper aims to to examine policy debates and issues concerning Run away from poverty 10 13 the migration of skilled health professionals from the country and to Escape war in their countries 7 8 furnish new insights on the recruitment patterns of skilled health per- They are hungry/no food in their country 4 3 sonnel. The objectives of the paper are twofold: Other Q +C
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F97FI=H To commit crime 8 14 ment of skilled professionals from South Africa in the health To corrupt South Africa 2 1 sector. The paper draws upon a detailed analysis of recruitment advertising appearing in the South African Medical Journal for Most South Africans continue to believe that migrants and refugees pose the period 2000-2004 and a series of interviews conducted with a real danger to the country's economic and social security. The intensity private recruiting enterprises. of these views has shifted over time (Table 12). For example, there was Q 5G98
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K=H< a considerable growth in negative perceptions between 1999 and 2006. key stakeholders in the South African health sector, the paper By 2006, around two-thirds of South Africans felt that migrants used up offers a series of recommendations for addressing the problem of resources, committed crimes and took jobs from South Africans. Only 25% skilled health migration. These recommendations are grounded felt that migrants brought skills needed by South Africa (down from 58% in both South African experience and an interrogation of inter- in 1999). Between 2006 and 2010, there was a small decline in negative national debates and ‘good policy’ practice for regulating recruit- sentiment, with the numbers who feel that crime was a major impact of ment. migration falling by 12% and those who feel that migrants bring disease The paper is organized into five sections. Section Two positions dropping by 10%. There was a 9% increase in those who feel that migrants debates about the migration of skilled health professionals within a bring needed skills and a 5% increase in those who think they create jobs wider literature that discusses the international mobility of talent. for South Africans. Section Three reviews research on the global circulation of health pro- Although there has been a slight positive movement in attitudes since fessionals, focusing in particular upon debates relating to the experience 2006, negative associations are still higher than they were in 1999. Over of countries in the developing world. Section Four moves the focus from 60% of the respondents feel that migrants use up resources and take jobs international to South African issues and provides new empirical mate- from South Africans. Over half (55%) still associate migration with crime rial drawn from the survey of recruitment patterns and key interviews and over two-thirds feel that migrants do not bring needed skills or create undertaken with health sector recruiters operating in South Africa. jobs for South Africans. Over 60% believe that migrants take jobs from Section Five addresses the questions of changing policy interventions in South Africans. Black South Africans hold the most negative views on vir- South Africa towards the outflow of skilled health professionals and the tually all these indicators and Coloured South Africans the least negative recruitment of foreign health professionals to work in South Africa. The (Table 13). Fully 70% of Black South Africans believe that migrants use up resources (compared with 37% of Coloured and 58% of White South

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EXECUTIVEAfricans).SUMMARY A much larger proportion also associates migrants with “job stealing.” While Black South Africans have the most negative associations, they are alsoealth much workers more willing are one than of the other categories groups toof acceptskilled that profession- migrants bring neededals skills most and affected create by jobs. globalization. Over the past decade, there has emerged a substantial body of research that tracks Table 12: Changes in Perceivedpatterns Impacts of international of Migrants onmigration South Africa* of health personnel, H 1999 (%) 2006 (%) 2010 (%) assesses causes and consequences, and debates policy responses at global Social impactsand national scales. Within this literature, the case of South Africa is Use up resourcesattracting (e.g. water,growing electricity, interest. housing) For almost59 15 years South67 Africa has 63been Commit crimethe target of a ‘global raiding’ of skilled45 professionals67 by several devel-55 Bring diseaseoped countries. How to deal with the24 consequences49 of the resultant39 out- Economic impactsflow of health professionals is a core policy issue for the national gov- Take jobs ernment. 56 62 60 Bring needed skillsThis paper aims to to examine policy58 debates and25 issues concerning34 Create jobsthe for Southmigration Africans of skilled health professionals– from the22 country and27 to *Percentage furnishwho agree/strongly new insights agree on the recruitment patterns of skilled health per- sonnel. The objectives of the paper are twofold: Q +C
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231 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MIGRATION POLICY SERIES NO. 45 Soft targetS: Xenophobia, public Violence and changing attitudeS to MigrantS

EXECUTIVE SUMMARY Table 14: Impressions of Migrants by Country of Origin, 2006 and 2010 Unfavourable (%) Favourable (%) ealth workers are one of the categories of skilled profession- 2006 2010 2006 2010 als most affected by globalization. Over the past decade, Neighbouring countries there has emerged a substantial body of research that tracks Zimbabwe 52 44 12 15 Hpatterns of international migration of health personnel, Mozambique 47 40 14 15 assesses causes and consequences, and debates policy responses at global Botswana 28 24 32 31 and national scales. Within this literature, the case of South Africa is Swaziland 28 23 36 33 attracting growing interest. For almost 15 years South Africa has been Lesotho 27 23 38 32 the target of a ‘global raiding’ of skilled professionals by several devel- Other African countries oped countries. How to deal with the consequences of the resultant out- Nigeria 66 59 7 7 flow of health professionals is a core policy issue for the national gov- Angola 54 48 9 9 ernment. This paper aims to to examine policy debates and issues concerning DRC 54 51 8 9 the migration of skilled health professionals from the country and to Somalia 53 50 10 9 furnish new insights on the recruitment patterns of skilled health per- Ghana 50 45 11 11 sonnel. The objectives of the paper are twofold: Q +C
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EXECUTIVEand SeSothoSUMMARY speakers (5.6) have the lowest SXI scores. These three lan- guages, as well as many of the minority languages, are spoken both in South Africa and neighbouringealth workers states,are one suggesting of the categories that there of skilledis a greater profession- sense of affinity withals migrants most affected who speak by globalization. a “South African” Over the language. past decade, It is quite possible thatthere this hasis also emerged a “rebound a substantial effect” bodyfrom ofMay research 2008. thatOtherwise tracks it is hard to explainpatterns why of thereinternational was little migration or no movement of health amongst personnel, Zulu and HXhosa-speakers. In 2006 the gap between English- and Afrikaans-speakers assesses causes and consequences, and debates policy responses at global wasand 0.7.national This hadscales. fallen Within to 0.2 this by literature,2010 as there the wascase a ofclear South downward Africa isshift inattracting the SXI growingof the latter. interest. For almost 15 years South Africa has been the target of a ‘global raiding’ of skilled professionals by several devel- Figure 1: Racialoped Groups countries. and Levels How ofto Xenophobia deal with the consequences of the resultant out- 6.8 flow of health professionals is a core policy issue for the national gov- ernment. 6.6 This paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to furnish new insights on the recruitment patterns of skilled health per- 6.4 sonnel. The objectives of the paper are twofold: Q +C
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5.6 key stakeholders in the South African health sector, the paper offers a series of recommendations for addressing the problem of skilled health migration. These recommendations are grounded 5.4 in both South African experience and an interrogation of inter- national debates and ‘good policy’ practice for regulating recruit- 5.2 ment. The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a widerBlack literature that Whitediscusses the internationalColoured mobilityIndian/Asian of talent. Section Three reviews researchRacial groups on the global circulation of health pro- fessionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in South Africa towards the outflow of skilled health professionals and the recruitment of foreign health professionals to work in South Africa. The

251 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MIGRATION POLICY SERIES NO. 45 Soft targetS: Xenophobia, public Violence and changing attitudeS to MigrantS

EXECUTIVE SUMMARY Table 15: Levels of Xenophobia amongst Different Language Groups 2006 (SXI) 2010 (SXI) Change ealth workers are one of the categories of skilled profession- Afrikaans 6.6 6.1 -0.5 als most affected by globalization. Over the past decade, Xhosa 6.0 6.0 0.0 there has emerged a substantial body of research that tracks English 5.9 5.9 0.0 Hpatterns of international migration of health personnel, Zulu 6.0 5.7 -0.3 assesses causes and consequences, and debates policy responses at global Ndebele 6.6 5.7 -0.9 and national scales. Within this literature, the case of South Africa is Sotho 6.2 5.6 -0.6 attracting growing interest. For almost 15 years South Africa has been Tswana 5.9 5.4 -0.5 the target of a ‘global raiding’ of skilled professionals by several devel- Tsonga/Shangaan 5.9 5.2 -0.7 oped countries. How to deal with the consequences of the resultant out- Venda 7.0 5.2 -1.8 flow of health professionals is a core policy issue for the national gov- Swazi 6.2 4.8 -1.4 ernment. This paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to Xenophobia and leVelS of education furnish new insights on the recruitment patterns of skilled health per- Another observable shift between 2006 and 2010 is in the relationship sonnel. The objectives of the paper are twofold: between education and levels of xenophobia (Table 16). In 2006, there was Q +C
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EXECUTIVEthe unemployedSUMMARY is no longer as clear cut, with similar SXI scores for both. In both 2006 and 2010, the least xenophobic were those employed part- time. This isealth a counter-intuitive workers are one finding of the sincecategories unstable of skilled employment profession- might be thought toals increasemost affected anxiety by and globalization. blame. Over the past decade, there has emerged a substantial body of research that tracks Table 17: Levels of Xenophobiapatterns by of Employment international Status migration of health personnel, H 2006 (SXI) 2010 (SXI) Change assesses causes and consequences, and debates policy responses at global Employed full-timeand national scales. Within5.7 this literature, the5.5 case of South Africa-0.2 is Employed part-timeattracting growing interest.5.6 For almost 15 years5.2 South Africa has-0.4 been Unemployedthe (looking target for of work) a ‘global raiding’5.8 of skilled professionals5.4 by several-0.4 devel- Unemployedoped (not countries.looking) How to deal5.9 with the consequences5.5 of the resultant-0.4 out- Self-employedflow (formal of health sector) professionals5.5 is a core policy issue5.3 for the national-0.2 gov- Self-employedernment. (informal sector) 5.9 5.9 0.0 Employed (informalThis sector) paper aims to to examine6.5 policy debates5.5 and issues concerning-1.0 the migration of skilled health professionals from the country and to Infurnish the past,new insights South Africanon the recruitment fears about patterns job competition of skilled andhealth loss per- have beensonnel. based The primarilyobjectives on of hearsaythe paper with are verytwofold: few having personal experi- enceQ of +C
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271 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MIGRATION POLICY SERIES NO. 45 Soft targetS: Xenophobia, public Violence and changing attitudeS to MigrantS

EXECUTIVE SUMMARY If the violence of May 2008 was purely a reflection of economic hard- ship and resentment, we might expect levels of xenophobia to have risen ealth workers are one of the categories of skilled profession- amongst the poorer sections of the South African population. In fact, als most affected by globalization. Over the past decade, the opposite is the case. Levels of xenophobia fell amongst nearly all there has emerged a substantial body of research that tracks low-income groups between 2006 and 2010 and increased amongst high- patterns of international migration of health personnel, income groups (Table 19). The greatest drop in the SXI is amongst those H earning less than R3,000 per month and less than R6,000 per month. In assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is other words, in just four years, the relationship between income and xeno- attracting growing interest. For almost 15 years South Africa has been phobia was almost completely reversed. In 2006, the relationship was very the target of a ‘global raiding’ of skilled professionals by several devel- clear: as incomes increased, xenophobia tended to decrease. By 2010, the oped countries. How to deal with the consequences of the resultant out- opposite was the case: levels of xenophobia show a consistent increase with flow of health professionals is a core policy issue for the national gov- increasing income (Figure 2). ernment. This paper aims to to examine policy debates and issues concerning Table 19: Levels of Xenophobia Amongst Different Groups, 2006 and 2010 the migration of skilled health professionals from the country and to Monthly household income 2006 (SXI) 2010 (SXI) Change furnish new insights on the recruitment patterns of skilled health per- R20,000 5.7 6.1 +0.4 private recruiting enterprises. Q 5G98
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K=H< Figure 2: Household Income and Levels of Xenophobia key stakeholders in the South African health sector, the paper offers a series of recommendations for addressing the problem of 6.4 skilled health migration. These recommendations are grounded in both South African experience and an interrogation of inter- 6.2 national debates and ‘good policy’ practice for regulating recruit- ment. 6.0 The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a 5.8 wider literature that discusses the international mobility of talent. 2006

Section Three reviews research on the global circulation of health pro- SXI 2010 fessionals, focusing in particular upon debates relating to the experience 5.6 of countries in the developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- 5.4 rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. 5.2 Section Five addresses the questions of changing policy interventions in South Africa towards the outflow of skilled health professionals and the recruitment of foreign health professionals to work in South Africa. The R20,000 R5,999 R8,999 R11,999 R15,999 R19,999

Income 1 28 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MMIGRATIONigration PPOLICYolicy SERIESerieS NnOo. 4564

EXECUTIVEWhileSUMMARY levels of xenophobia rose steadily between 1999 and 2006 across South African society, this trend seems to have stopped and even reversed in the case ofealth some workers groups are of Southone of Africansthe categories by 2010. of skilledIn other profession- words, the general positiveals most shift affected in levels by of globalization. xenophobia between Over the 2006 past and decade, 2010 was not universal.there Rather, has emerged there were a substantial significant body declines of research amongst that a tracksnumber of different patternsgroups: Colouredof international South migrationAfricans, Afrikaans-speakers,of health personnel, South HAfricans who share a common language with migrants, the less-educated assesses causes and consequences, and debates policy responses at global and,and nationalmost significantly, scales. Within lower-income this literature, South the Africans. case of Levels South ofAfrica xenopho is - biaattracting increased growing amongst interest. Indians/Asians For almost and 15 better-offyears South South Africa Africans. has been the target of a ‘global raiding’ of skilled professionals by several devel- Xenophobiaoped and countries. interaction How to dealWith with Migrant the consequencesS of the resultant out- flow of health professionals is a core policy issue for the national gov- Zimbabweanernment. colleagues say that they rarely heard Shona being spoken in CapeThis Town paper 10 aimsyears to ago; to examinenow they policy hear itdebates every day.and Whileissues concerningthe numbers ofthe migrants migration in Southof skilled Africa health are professionalsmuch lower than from the the popular country imagination and to suggests,furnish new there insights have been on the significant recruitment increases patterns in migration of skilled fromhealth countries per- 40 insonnel. crisis The such objectives as Zimbabwe of the and paper Somalia. are twofold: Zimbabweans, in particular, comeQ from +C
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EXECUTIVE SUMMARY Table 20: Degree of Personal Contact with Migrants 1999 (%) 2006 (%) 2010 (%) ealth workers are one of the categories of skilled profession- From neighbouring countries als most affected by globalization. Over the past decade, A lot of contact 4 18 24 there has emerged a substantial body of research that tracks Some contact 15 33 36 Hpatterns of international migration of health personnel, Little contact 20 22 20 assesses causes and consequences, and debates policy responses at global No contact 60 27 20 and national scales. Within this literature, the case of South Africa is From other African countries attracting growing interest. For almost 15 years South Africa has been A lot of contact 21 the target of a ‘global raiding’ of skilled professionals by several devel- Some contact 35 oped countries. How to deal with the consequences of the resultant out- Little contact 21 flow of health professionals is a core policy issue for the national gov- No contact 24 ernment. This paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to Table 21: Locations of Personal Contact with Migrants furnish new insights on the recruitment patterns of skilled health per- 2006 (%) 2010 (%) sonnel. The objectives of the paper are twofold: In the workplace Q +C
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K=H< Some contact 30 34 key stakeholders in the South African health sector, the paper Little contact 21 22 offers a series of recommendations for addressing the problem of No contact 25 18 skilled health migration. These recommendations are grounded In social settings in both South African experience and an interrogation of inter- A lot of contact 15 19 national debates and ‘good policy’ practice for regulating recruit- Some contact 27 30 ment. Little contact 21 22 The paper is organized into five sections. Section Two positions No contact 39 33 debates about the migration of skilled health professionals within a In shops wider literature that discusses the international mobility of talent. A lot of contact 39 42 Section Three reviews research on the global circulation of health pro- fessionals, focusing in particular upon debates relating to the experience Some contact 28 28 of countries in the developing world. Section Four moves the focus from Little contact 14 14 international to South African issues and provides new empirical mate- No contact 20 16 rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. Where South Africans and migrants interact is probably less important Section Five addresses the questions of changing policy interventions in than the nature of that interaction. If increased contact led directly to South Africa towards the outflow of skilled health professionals and the increased hostility, then we would expect negative attitudes to have recruitment of foreign health professionals to work in South Africa. The reporting positive interactions increased from 32% in 2006 to 39% in 2010 (Table 22). Negative interactions declined from 26% to 14%. This suggests 1 30 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MMIGRATIONigration PPOLICYolicy SERIESerieS NnOo. 4564

EXECUTIVEthat increasedSUMMARY interaction may be having a positive rather than negative impact on levels of xenophobia. ealth workers are one of the categories of skilled profession- Table 22: Quality of Personalals most Interaction affected with by African globalization. Migrants Over the past decade, there has emerged a substantial2006 (%) body of research2010 that (%) tracks Extremely positive patterns of international migration5 of health personnel,8 Positive H 27 31 assesses causes and consequences, and debates policy responses at global Neutral and national scales. Within this literature,42 the case of South 47Africa is Negative attracting growing interest. For almost 1520 years South Africa 11has been Extremely negativethe target of a ‘global raiding’ of skilled professionals6 by several3 devel- oped countries. How to deal with the consequences of the resultant out- Confirmationflow of health ofprofessionals the hypothesis is a core that policy increased issue contactfor the national decreases gov- xeno- phobiaernment. is found in an analysis of SXI scores by amount of contact. The highestThis levels paper of aims xenophobic to to examine sentiment policy are debates found amongstand issues South concerning Africans whothe migrationhave no contact of skilled with health migrants. professionals As the amountfrom the of country contact and increases, to thefurnish level new of xenophobia insights on decreasesthe recruitment (Figure patterns 3). With of regard skilled to health contact per- with migrantssonnel. The from objectives neighbouring of the countries, paper are the twofold: SXI falls from 6.3 for those with no contactQ +C
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SXI The paper is organized into five sections. Section Two positions 5.0 debates about the migration of skilled health professionals within a wider literature that discusses the international mobility of talent. 4.5 Section Three reviews research on the global circulation of health pro- fessionals, focusing in particular upon debates relating to the experience 4.0 of countries in the developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews undertakenNone with healthLittle sector recruitersSome operatingQuite a lot in SouthGreat Africa. deal Section Five addresses the Amountquestions of contact of changing policy interventions in South Africa towards the outflow of skilled health professionals and the recruitment ofNeighbouring foreign health countries professionalsRest to workof Africa in South Africa. The

311 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MIGRATION POLICY SERIES NO. 45 Soft targetS: Xenophobia, public Violence and changing attitudeS to MigrantS

EXECUTIVE SUMMARY To this point, the report has suggested that there has been a positive shift in attitudes towards migrants between 2006 and 2010 and that this has ealth workers are one of the categories of skilled profession- led to a softening of xenophobia. At the same time, it would be incorrect als most affected by globalization. Over the past decade, to conclude that xenophobia is inevitably on the wane and therefore need there has emerged a substantial body of research that tracks not be a continued source of concern. While a comparison of 2006 and patterns of international migration of health personnel, 2010 data provides some reason for optimism, it is also true that South H Africans remain extremely intolerant and that xenophobia is far from assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is being a thing of the past. The following sections of the report therefore attracting growing interest. For almost 15 years South Africa has been focus on the 2010 results and, in particular, current South African atti- the target of a ‘global raiding’ of skilled professionals by several devel- tudes towards rights for migrants, violence against migrants and policy oped countries. How to deal with the consequences of the resultant out- preferences about migration. flow of health professionals is a core policy issue for the national gov- ernment. rightS for MigrantS and refugeeS This paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to outh Africans fundamentally disagree with their own Constitution furnish new insights on the recruitment patterns of skilled health per- Swhen it comes to basic rights for migrants and refugees. They also sonnel. The objectives of the paper are twofold: distinguish between different types of migrant when deciding what rights Q +C
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EXECUTIVEMost SSouthUMMARY Africans think that these basic rights should never be extend- ed to irregular migrants in the country. Only a small minority believe that they deserveealth legal workers protection are one (18%) of the and categories police protection of skilled profession- (20%). And more than als half most think affected that they by globalization. should not be Over given the these past decade, rights at all. This is a disturbingthere has fact emerged considering a substantial that migrants body of inresearch irregular that situations tracks in South Africapatterns already of international face systematic migration harassment of health and personnel, discrimination Hfrom the police. The partial exception some are willing to make is to allow assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is ofattracting South Africans growing are interest. willing Forto make almost this 15 concession years South though Africa another has been one- thirdthe target are completelyof a ‘global opposed.raiding’ of Attitudes skilled professionals towards rights by several for refugees devel- are moreoped countries.generous but How still to verydeal restricted.with the consequences Just 31% thought of the refugees resultant should out- alwaysflow of enjoy health legal professionals protection isand a core 36% policy that they issue should for the always national enjoy gov- police protection.ernment. As many as a quarter felt that refugees should never be enti- tledThis to protection. paper aims While to to examinehalf thought policy refugees debates should and issues always concerning have access the migration of skilled health professionals from the country and to socialfurnish services. new insights South on Africans the recruitment are willing patterns to be slightly of skilled more health generous per- to migrantssonnel. The who objectives are living of in the the paper country are legallytwofold: and on a short-term basis. OnlyQ 12% +C
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331 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MIGRATION POLICY SERIES NO. 45 Soft targetS: Xenophobia, public Violence and changing attitudeS to MigrantS

EXECUTIVE SUMMARY Table 24: Changes in Attitudes to Rights for Migrants* Temporary residents Refugees Irregular migrants ealth workers are one of the categories of skilled profession- (%) (%) (%) als most affected by globalization. Over the past decade, 2006 34 10 3 Freedom of speech there has emerged a substantial body of research that tracks 2010 38 20 8 patterns of international migration of health personnel, 2006 31 7 2 H Voting rights assesses causes and consequences, and debates policy responses at global 2010 30 13 7 and national scales. Within this literature, the case of South Africa is Right to legal 2006 50 26 13 attracting growing interest. For almost 15 years South Africa has been protection 2010 48 31 18 the target of a ‘global raiding’ of skilled professionals by several devel- 2006 50 28 14 Protection by police oped countries. How to deal with the consequences of the resultant out- 2010 54 36 22 flow of health professionals is a core policy issue for the national gov- Access to social 2006 25 14 6 ernment. services 2010 50 28 16 This paper aims to to examine policy debates and issues concerning 2006 67 53 42 the migration of skilled health professionals from the country and to Treatment for HIV 2010 65 55 44 furnish new insights on the recruitment patterns of skilled health per- *Percentage “Should always be granted” sonnel. The objectives of the paper are twofold: Q +C
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F97FI=H ment of skilled professionals from South Africa in the health iMMigration policy preferenceS sector. The paper draws upon a detailed analysis of recruitment o the positive shifts in xenophobic sentiment between 2006 and advertising appearing in the South African Medical Journal for D2010 translate into a softening of previous preferences for draconian the period 2000-2004 and a series of interviews conducted with restrictions on migration and migrants? The Fifth Wave of the World Val- private recruiting enterprises. ues Survey (WVS) asked a representative sample of the citizens of a large Q 5G98
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EXECUTIVEotherS countryUMMARY polled in the WVS, in either the North or the South, has a citizenry so opposed to immigration.43 ealth workers are one of the categories of skilled profession- Table 25: Attitudes Towardsals most Immigration affected in Comparativeby globalization. Perspective Over the past decade, Prohibitthere has emergedPlace strict a substantiallimits Let bodypeople ofin asresearch Let inthat anyone tracks who Country immigrationpatterns of internationalon entry migrationlong as jobsof health are personnel,wants to enter H(%) (%) available (%) (%) assesses causes and consequences, and debates policy responses at global South and national scales. Within this literature, the case of South Africa is South Africaattracting growing30 interest. For48 almost 15 years16 South Africa has6 been India the target of23 a ‘global raiding’23 of skilled professionals25 by several30 devel- Ghana oped countries.18 How to deal 39with the consequences36 of the resultant7 out- Zambia flow of health11 professionals is30 a core policy issue44 for the national15 gov- Brazil ernment. 11 33 47 9 China This paper8 aims to to examine21 policy debates51 and issues concerning20 Indonesia the migration6 of skilled health15 professionals from72 the country and8 to Thailand furnish new 5insights on the recruitment16 patterns65 of skilled health14 per- Malaysia sonnel. The 2objectives of the 8paper are twofold:72 18 North Q +C
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351 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MIGRATION POLICY SERIES NO. 45 Soft targetS: Xenophobia, public Violence and changing attitudeS to MigrantS

EXECUTIVE SUMMARY want more resources to be expended by the South African government on border enforcement but only a quarter are willing to accept tax increases to ealth workers are one of the categories of skilled profession- fund increased policing. Nearly half want it to be compulsory for migrants als most affected by globalization. Over the past decade, to carry identity documents with them at all times, again a requirement there has emerged a substantial body of research that tracks not seen since apartheid. While there is less support for fining employers patterns of international migration of health personnel, - H ing for all migrants. A minority of South Africans are actively opposed to assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is attracting growing interest. For almost 15 years South Africa has been 20% oppose migrants having to carry identity documents with them at all the target of a ‘global raiding’ of skilled professionals by several devel- times and 18% oppose electrification of borders. oped countries. How to deal with the consequences of the resultant out- flow of health professionals is a core policy issue for the national gov- Table 26: South African Attitudes Towards Immigration ernment. Let people in Let in anyone Prohibit Place strict as long as jobs who wants to This paper aims to to examine policy debates and issues concerning immigration limits on entry are available enter (%) (%) the migration of skilled health professionals from the country and to (%) (%) furnish new insights on the recruitment patterns of skilled health per- 2010 sonnel. The objectives of the paper are twofold: Strongly agree/Agree 36 63 15 8 Q +C
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EXECUTIVEbe muchSUMMARY higher if migrants’ claims are correct that the police engage in systematic extortion of bribes in exchange for their freedom. Despite the ineffectivenessealth of workers the deportation are one of policy the categories in achieving of skilled its stated profession- ends, it enjoys wide alssupport most amongstaffected theby globalization. South African Over population. the past Nearly decade, a quar- ter of Souththere Africans has emerged support athe substantial expulsion body of all of foreign research nationals that tracks from the country patterns(Table 28). of internationalThe percentages migration of those of who health strongly personnel, support the Hdeportation of migrants who are not contributing to the South African assesses causes and consequences, and debates policy responses at global economyand national or have scales. committed Within this crimes literature, are as highthe case as 62% of South and 74%Africa respec is - attracting growing interest. For almost 15 years South Africa has been halfthe targetof the ofcitizens a ‘global oppose raiding’ the ofissuing skilled of professionalsIDs to irregular by severalmigrants. devel- Active oppositionoped countries. to all Howof these to deal policies with is the low consequences by comparison. of the resultant out- flow of health professionals is a core policy issue for the national gov- Table 28: Preferredernment. Policy Options for Migration Enforcement This paper aims to to examine policy debatesSupport and (%)issues concerningOppose (%) Control-orientedthe migration policies of skilled health professionals from the country and to Deport all migrantsfurnish who new commit insights serious on crimesthe recruitment patterns of74 skilled health8 per- Deport all migrantssonnel. not The contributing objectives to SA of economy the paper are twofold: 62 18 Deport all migrantsQ who +C
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EXECUTIVE SUMMARY South Africans want to send refugees back to their country of origin when the conditions improve there. South Africans clearly want to take in a very ealth workers are one of the categories of skilled profession- small number of refugees and only in the short-term. A quarter approves als most affected by globalization. Over the past decade, the right to employment for refugees, though more than 35% are opposed. there has emerged a substantial body of research that tracks The desire for controls on entry and residence are starkly apparent with patterns of international migration of health personnel, H refugees should be corralled in camps near the border (with 32% opposed). assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is attracting growing interest. For almost 15 years South Africa has been Table 29: Attitudes to Refugees in South Africa the target of a ‘global raiding’ of skilled professionals by several devel- Support (%) Oppose (%) oped countries. How to deal with the consequences of the resultant out- Grant asylum to those escaping war and persecution 38 23 flow of health professionals is a core policy issue for the national gov- Increase refugee intake in South Africa 11 57 ernment. Grant permanent residence to refugees in South Africa for > 5 years 18 44 This paper aims to to examine policy debates and issues concerning Send refugees back when they are no longer at risk 56 13 the migration of skilled health professionals from the country and to Refugees must live in special camps near the border 31 32 furnish new insights on the recruitment patterns of skilled health per- Use government budget to look after refugees 14 46 sonnel. The objectives of the paper are twofold: Allow refugees can work in South Africa 25 35 Q +C
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K=H< key stakeholders in the South African health sector, the paper WillingneSS to uSe Violence offers a series of recommendations for addressing the problem of n the past, a significant minority of South Africans have expressed skilled health migration. These recommendations are grounded Iwillingness to take the law into their own hands when they are aware in both South African experience and an interrogation of inter- of irregular migrants in the country.44 The 2010 survey results suggest national debates and ‘good policy’ practice for regulating recruit- this is still the case. The numbers who are likely/very likely to report a ment. suspected irregular migrant are still significant: more than a third said they The paper is organized into five sections. Section Two positions would report the person to the police and a quarter would report them to debates about the migration of skilled health professionals within a employers and local community associations (Table 30). As many as 15% wider literature that discusses the international mobility of talent. said they would combine with others to force the person to leave the area Section Three reviews research on the global circulation of health pro- and 11% would be prepared to use violence against the person. The num- fessionals, focusing in particular upon debates relating to the experience bers willing to use violence actually increased between 2006 and 2010 and of countries in the developing world. Section Four moves the focus from the proportion of those unlikely to use violence declined. These findings international to South African issues and provides new empirical mate- suggest that the events of May 2008 have had very little impact on those rial drawn from the survey of recruitment patterns and key interviews South Africans who are prepared to use violence against migrants. Given undertaken with health sector recruiters operating in South Africa. the opportunity and motivation, they would act again. Section Five addresses the questions of changing policy interventions in South Africa towards the outflow of skilled health professionals and the recruitment of foreign health professionals to work in South Africa. The

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ETableXECUTIVE 30: LikelihoodSUMMARY of Taking Action Against Migrants % Likely % Unlikely ealth workers are2006 one of the 2010categories of2006 skilled profession-2010 Report them to police als most affected by40 globalization.36 Over the41 past decade,39 Report them to employerthere has emerged31 a substantial27 body of research46 that tracks45 Report themH to communitypatterns association of international34 migration27 of health45 personnel,45 Combine toassesses force them causes to leave and consequences,15 and debates15 policy 61responses at 73global Use violenceand against national them scales. Within this9 literature,11 the case of77 South Africa72 is attracting growing interest. For almost 15 years South Africa has been Thethe targetrespondents of a ‘global were raiding’also asked of skilledwhether professionals they would bytake several part indevel- actions againstoped countries. migrants How from to other deal Southernwith the consequencesAfrican countries. of the Around resultant one out- in fourflow Southof health Africans professionals said it was is a likely/very core policy likely issue that for thethey national would combine gov- withernment. others to stop migrants moving into their neighbourhood and oper- atingThis a business paper aims in theto to area examine (Table policy 31). Given debates the and upsurge issues inconcerning attacks on migrantthe migration businesses of skilled in the health last fiveprofessionals years, the from willingness the country of a and significant to minorityfurnish new of South insights Africans on the torecruitment prevent them patterns operating of skilled is alarming. health per-These hostilesonnel. attitudesThe objectives pertain of the to migrantpaper are entrepreneurs twofold: from neighbouring countriesQ +C
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EXECUTIVE SUMMARY 2008? To what do they attribute the violence? Do they feel that it was ealth workers are one of the categories of skilled profession- justifiable? als most affected by globalization. Over the past decade, Many respondents said they were disturbed by the scale and intensity of there has emerged a substantial body of research that tracks violence and felt it was excessive and unjustified. Close to half (44%) said patterns of international migration of health personnel, they personally feel guilty about the violence. Just over half (54%) believe H that migrants do not deserve the destructive and aggressive actions they assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is experience in South Africa. The same number said they oppose the use attracting growing interest. For almost 15 years South Africa has been of violence against migrants and 43% felt the violence was unjustified. In the target of a ‘global raiding’ of skilled professionals by several devel- other words, around half of the respondents had a negative response to the oped countries. How to deal with the consequences of the resultant out- attacks as expressed in feelings of guilt and opposition to the violence. This flow of health professionals is a core policy issue for the national gov- leaves the other half. ernment. While the world at large was outraged by the xenophobic attacks, the This paper aims to to examine policy debates and issues concerning same cannot be said of half of the South African population. Around a the migration of skilled health professionals from the country and to third seemed indifferent to what had happened and a minority thought of furnish new insights on the recruitment patterns of skilled health per- it in positive terms. For example, 28% said they did not feel any guilt, while sonnel. The objectives of the paper are twofold: 14% felt that migrants deserved this treatment. Eleven percent said they Q +C
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lEiXECUTIVEVing in theSUMMARY hotSpotS

ne analysisealth ofworkers 138 wards are one affected of the bycategories the May of 2008 skilled violence profession- found Othat theyals most shared affected certain by commonglobalization. characteristics Over the past (based decade, on 2001 Census data),there including has emerged high levels a substantial of economic body deprivation,of research that above tracks aver- age percentagespatterns of males, of international high levels migration of informal of housinghealth personnel, and high levels Hof language diversity (including different South African and foreign lan- assesses causes and consequences, and debates policy responses at global 46 guages).and national scales. Within this literature, the case of South Africa is - ployment,attracting growing a higher interest. proportion For ofalmost residents 15 years in absolute South Africa poverty, has a been higher proportionthe target ofof ayouth, ‘global lower raiding’ educational of skilled levels, professionals or a higher by percentageseveral devel- of for- eignoped residents. countries. The How researchers to deal with therefore the consequences concluded thatof the “violence resultant is out- not adequatelyflow of health explained professionals by poverty, is a core unemployment policy issue foror thethe presencenational gov-of large numbersernment. of migrants.” In addition, the violence could not be attributed to “poorThis papereconomic aims conditions,to to examine competition policy debates for resources and issues or concerning poor service delivery,the migration as these of skilled factors health were alsoprofessionals present infrom many the communitiescountry and to where violencefurnish new was insightsnot perpetrated on the recruitment or where it patternswas prevented.” of skilled health per- sonnel.The 2010The objectives survey allows of the us paperto build are ontwofold: this analysis of affected wards (“hotspots”)Q +C
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EXECUTIVE SUMMARY about their personal economic conditions five years hence (57% versus 54%). The hotspot profile is not identical to the general population but ealth workers are one of the categories of skilled profession- nor is it significantly worse. als most affected by globalization. Over the past decade, there has emerged a substantial body of research that tracks Table 32: Economic Profile of Hotspots Hpatterns of international migration of health personnel, Hotspots (%) Other areas (%) assesses causes and consequences, and debates policy responses at global Economic class and national scales. Within this literature, the case of South Africa is Lower/working 62 52 attracting growing interest. For almost 15 years South Africa has been Middle 31 42 the target of a ‘global raiding’ of skilled professionals by several devel- Upper 2 3 oped countries. How to deal with the consequences of the resultant out- Don’t know 5 3 flow of health professionals is a core policy issue for the national gov- Monthly income ernment. R20,000 1 5 advertising appearing in the South African Medical Journal for No answer 26 28 the period 2000-2004 and a series of interviews conducted with Employment status private recruiting enterprises. Employed full-time 38 36 Q 5G98
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K=H< Employed part-time 16 11 key stakeholders in the South African health sector, the paper Unemployed (looking for work) 19 22 offers a series of recommendations for addressing the problem of Unemployed (not looking) 4 4 skilled health migration. These recommendations are grounded Self-employed (formal sector) 3 5 in both South African experience and an interrogation of inter- Self-employed (informal sector) 1 3 national debates and ‘good policy’ practice for regulating recruit- ment. Table 33: Levels of Economic Dissatisfaction in Hotspots, 2010 The paper is organized into five sections. Section Two positions Hotspots Hotspots Other areas Other areas debates about the migration of skilled health professionals within a % satisfied % dissatisfied % satisfied % dissatisfied wider literature that discusses the international mobility of talent. How satisfied are you with your 45 14 48 19 Section Three reviews research on the global circulation of health pro- personal economic conditions? fessionals, focusing in particular upon debates relating to the experience How satisfied are you with of countries in the developing world. Section Four moves the focus from overall economic conditions 47 12 54 14 international to South African issues and provides new empirical mate- in South Africa? rial drawn from the survey of recruitment patterns and key interviews How satisfied do you think you will undertaken with health sector recruiters operating in South Africa. be with your personal economic 57 6 54 8 Section Five addresses the questions of changing policy interventions in conditions in five years' time? South Africa towards the outflow of skilled health professionals and the How satisfied do you think you will be with overall economic conditions 54 6 56 7 recruitment of foreign health professionals to work in South Africa. The in South Africa in five years' time?

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EXECUTIVECross-tabulatingSUMMARY hotspot and non-hotspot areas with a variety of variables, including perceptions of why migrants come to South Africa, whether migrants fromealth some workers countries are one are of preferred the categories to those of skilled from others,profession- rights for migrantsals and most attitudes affected to by policiesglobalization. to control Over migration,the past decade, shows only minor differencesthere hasof opinion.emerged Thea substantial SXI confirms body thatof research these areasthat tracksare not significantlypatterns more xenophobic. of international The scores migration (to two of decimalhealth personnel, places) are 5.82 H(hotspots) and 5.76 (non-hotspots). Rounded to one decimal place (as in assesses causes and consequences, and debates policy responses at global theand restnational of this scales. report) Within the scores this literature, would be thean identicalcase of South 5.8. For Africa purposes is ofattracting comparison, growing a score interest. of 5.8 For is almostlower than 15 years the WhiteSouth Africaand Coloured has been and Indian/Asianthe target of a populations ‘global raiding’ as a of whole, skilled and professionals lower than by all several income devel- groups overoped R9,000 countries. per Howmonth. to Indeal other with words, the consequences two years after of May the 2008resultant the comout-- munitiesflow of health that experienced professionals the is violencea core policy were issuecertainly for theno morenational xenophobic gov- thanernment. the population at large and were actually less xenophobic than other largeThis groups paper of aimsSouth to Africans. to examine policy debates and issues concerning theSignificant migration ofnumbers skilled ofhealth hotspot professionals residents (57%from theof thecountry total) and said to they opposedfurnish new the insightsviolence onof theMay recruitment 2008 while patternsonly 12% of said skilled they health supported per- it. sonnel. The objectives of the paper are twofold: (TableQ 34). +C
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EXECUTIVE SUMMARY data does not mean that these were the actual causes of the violence but does suggest that myths and stereotypes about migrants were, and remain, ealth workers are one of the categories of skilled profession- strong in these communities and that these myths fuel a culture of blaming als most affected by globalization. Over the past decade, the victim for the events of May 2008. there has emerged a substantial body of research that tracks Hpatterns of international migration of health personnel, Table 35: Explanations for May 2008 by Hotspot Residents assesses causes and consequences, and debates policy responses at global Hotspots (%) Other areas (%) and national scales. Within this literature, the case of South Africa is Migrants cause crimes in South Africa 70 61 attracting growing interest. For almost 15 years South Africa has been Migrants take jobs from South Africans 58 59 the target of a ‘global raiding’ of skilled professionals by several devel- Migrants are culturally different 64 58 oped countries. How to deal with the consequences of the resultant out- Migrants cheat South Africans 66 51 flow of health professionals is a core policy issue for the national gov- Migrants use health services for free 63 51 ernment. Migrants take RDP houses 57 50 This paper aims to to examine policy debates and issues concerning Migrants steal South African women 57 50 the migration of skilled health professionals from the country and to Migrants do not belong in South Africa 62 54 furnish new insights on the recruitment patterns of skilled health per- The police do not protect migrants 23 29 sonnel. The objectives of the paper are twofold: South African criminals are to blame 31 33 Q +C
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F97FI=H ment of skilled professionals from South Africa in the health The most relevant question is what residents of hotspots said they would sector. The paper draws upon a detailed analysis of recruitment do about migrants in their communities. Just over a quarter said they advertising appearing in the South African Medical Journal for would be prepared to take part in action to stop migrants from moving into the period 2000-2004 and a series of interviews conducted with the neighbourhood and operating a business in the area (Table 36). These private recruiting enterprises. were both a few percentage points higher than the rest of the population. Q 5G98
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ETableXECUTIVE 37: LikelihoodSUMMARY of Taking Action Against Irregular Migrants* Hotspots % Other areas % Report them to police ealth workers are one of the34 categories of skilled profession-36 Report them to employerals most affected by globalization.26 Over the past decade,28 Report them to communitythere association has emerged a substantial24 body of research that29 tracks Combine toH force them topatterns leave of international migration15 of health personnel,16 Use violenceassesses against causesthem and consequences, and debates9 policy responses11 at global *Percentage andlikely/very national likely scales. Within this literature, the case of South Africa is attracting growing interest. For almost 15 years South Africa has been Finally,the target there of ais ‘global the issue raiding’ of how of muchskilled interaction professionals people by several in the devel- hotspots haveoped countries. with migrants. How Weto deal might with expect the consequences that residents of the of hotspotsresultant comeout- intoflow contactof health with professionals migrants more is a core often policy than issuethose for not the in nationalhotspots, gov- simply becauseernment. there has been an assumption that the hotspot areas included largeThis numbers paper ofaims foreign to to migrants. examine Inpolicy fact, debateswhen it andcomes issues to migrantsconcerning from neighbouringthe migration countries, of skilled healthan identical professionals proportion from of the the country hotspot and and to non- hotspotfurnish newpopulations insights (40%)on the saidrecruitment they had patterns little or of no skilled contact health (Table per- 38). Thesonnel. hotspot The objectivesresidents have of the less paper contact are twofold:with migrants from elsewhere in AfricaQ than +C
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South Africa towards the outflow of skilled health professionals and the recruitment of foreign health professionals to work in South Africa. The

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EXECUTIVE SUMMARY Table 39: Quality of Personal Interaction with African Migrants in Hotspots Hotspots (%) Other areas (%) ealth workers are one of the categories of skilled profession- Extremely positive 7 8 als most affected by globalization. Over the past decade, Positive 32 31 there has emerged a substantial body of research that tracks Neutral 47 48 Hpatterns of international migration of health personnel, Negative 12 10 assesses causes and consequences, and debates policy responses at global Extremely negative 2 3 and national scales. Within this literature, the case of South Africa is attracting growing interest. For almost 15 years South Africa has been the target of a ‘global raiding’ of skilled professionals by several devel- back to the World cup oped countries. How to deal with the consequences of the resultant out- his report began with references to the meaning of the World Cup and flow of health professionals is a core policy issue for the national gov- Tthe Jansen argument that it promoted the worst kind of chauvinistic ernment. nationalism. The 2010 survey included a question on the World Cup and This paper aims to to examine policy debates and issues concerning its perceived impact. The question simply attempted to gauge whether this the migration of skilled health professionals from the country and to tournament had a positive impact on citizens and their attitudes towards furnish new insights on the recruitment patterns of skilled health per- other groups, including people from other countries and migrants from sonnel. The objectives of the paper are twofold: African countries. Over half (58%) of the respondents said that since the Q +C
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EXECUTIVEfor theS UMMARYshift in attitudes: the legacy of the appalling violence of May 2008 itself, the leavening impact of the World Cup and positive experiences of interactionealth with workers the outside are one world, of the and categories political of leadership skilled profession- that owns the problemals and most comes affected down by heavily globalization. on any evidence Over the of past xenophobia. decade, All three explanationsthere has are emerged unconvincing. a substantial While body half ofof research the respondents that tracks had feelings of guiltpatterns about of international May 2008 and migration thought of it health was unacceptable, personnel, the Hother half were either indifferent or would not be bothered if the same assesses causes and consequences, and debates policy responses at global thingand national happened scales. again. Within While this many literature, South the Africans case of felt South that Africa the World is Cupattracting had made growing them interest. more aware For almost of and 15interested years South in other Africa countries, has been 41% stillthe targetfelt that of alla ‘global migrants raiding’ should of leave skilled once professionals the event byitself several was over. devel- And theoped third countries. explanation How tois adeal complete with the non-starter. consequences There of has the been resultant a singular out- failureflow of of health political professionals leadership isto a “own” core policy the problem issue for and the take national any ameliora gov- - tiveernment. action. Mbeki set the tone in his extraordinary denial of xenophobia in a commemorationThis paper aims of to the to examinevictims of policy the May debates 2008 and violence. issues concerningXenophobia- denialismthe migration seems of to skilled have healthhardened professionals into an orthodoxy from the in country the ruling and party.to furnishThere new are insights two plausible on the reasons recruitment for the patterns softening of skilledof attitudes health between per- 2006sonnel. and The 2010. objectives One is ofthe the violence paper areitself, twofold: and the widespread (if tempo- rary)Q mobilization +C
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EXECUTIVE SUMMARY Indeed, the counter-intuitive picture here is clear: the more you earn, the more intolerant and threatened you are by migrants and refugees. And at ealth workers are one of the categories of skilled profession- the centre are a hard core more than willing to put their attitudes into als most affected by globalization. Over the past decade, action. Twenty-seven percent said they are likely to take part in actions there has emerged a substantial body of research that tracks to prevent migrants from moving into their neighbourhood or operating a patterns of international migration of health personnel, business in the area. Fifteen percent would combine to force an irregular H migrant to leave the community and 9% would resort to violence to do so. assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is With this level of willingness to take violent action against migrants and attracting growing interest. For almost 15 years South Africa has been refugees, it is perhaps not surprising that attacks and assaults have contin- the target of a ‘global raiding’ of skilled professionals by several devel- ued throughout the country since 2008 and are certainly not confined to oped countries. How to deal with the consequences of the resultant out- those hotspots that exploded in an orgy of violence back then. As long as flow of health professionals is a core policy issue for the national gov- migrants are blamed for what happens to them, as long as the police vic- ernment. timize and extort rather than offer protection, as long as South Africans This paper aims to to examine policy debates and issues concerning do not feel migrants are entitled to police and legal protection, and as long the migration of skilled health professionals from the country and to as Ministers continue to deny the reality of xenophobia in the country, furnish new insights on the recruitment patterns of skilled health per- migrants will remain “soft targets.” sonnel. The objectives of the paper are twofold: Q +C
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F97FI=H endnoteS ment of skilled professionals from South Africa in the health sector. The paper draws upon a detailed analysis of recruitment 1 F. Nyamnjoh, Insiders and Outsiders: Citizenship and Xenophobia in Contempo- advertising appearing in the South African Medical Journal for rary Southern Africa (London: Zed Books, 2006); M. Neocosmos, From Foreign the period 2000-2004 and a series of interviews conducted with Natives to Native Foreigners: Explaining Xenophobia in Post-Apartheid South Africa private recruiting enterprises. (Dakar: Codesria, 2010); D. Matsinhe, Apartheid Vertigo: The Rise in Discrimina- Q 5G98
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K=H< tion Against Africans in South Africa (Burlington: Ashgate Publishing, 2011). key stakeholders in the South African health sector, the paper - offers a series of recommendations for addressing the problem of phobia in South Africa” International Migration 38 (2000): 103-34; J. Crush et skilled health migration. These recommendations are grounded al, The Perfect Storm: The Realities of Xenophobia in Contemporary South Africa, in both South African experience and an interrogation of inter- SAMP Migration Policy Series No. 50, Cape Town, 2008. national debates and ‘good policy’ practice for regulating recruit- Go Home or Die Here: Violence, Xenopho- ment. bia and the Reinvention of Difference in South Africa- The paper is organized into five sections. Section Two positions sity Press, 2008); J. Crush and S. Ramachandran, “Migration, Xenophobia and debates about the migration of skilled health professionals within a Journal of Human Development and Capabilities 11(2010): wider literature that discusses the international mobility of talent. 209-28; L. Landau, ed, Exorcising the Demons Within: Xenophobia, Violence and Section Three reviews research on the global circulation of health pro- Statecraft in Contemporary South Africa fessionals, focusing in particular upon debates relating to the experience 2012). of countries in the developing world. Section Four moves the focus from 4 D. Everatt, ed, South African Civil Society and Xenophobia (Johannesburg: Strat- international to South African issues and provides new empirical mate- egy & Tactics, 2010). rial drawn from the survey of recruitment patterns and key interviews 5 “No Justice for Burning Man” Mail & Guardian 30 July 2010; J. Malala, “We Are undertaken with health sector recruiters operating in South Africa. Xenophobic Monsters” Times Live 30 May 2010. Section Five addresses the questions of changing policy interventions in 6 F. Kruger, “Are Patriotic Fervour and Xenophobia Two Sides of the Same Coin?” South Africa towards the outflow of skilled health professionals and the Mail & Guardian 5 July 2010. recruitment of foreign health professionals to work in South Africa. The 7 A. Desai and G. Vahed, “World Cup 2010: Africa’s Turn or the Turn on Africa?” Soccer & Society 11(2010): 154-67. 8 “Foreign Nationals Displacing Themselves” Mail & Guardian 7 July 2010. 1 48 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MMIGRATIONigration PPOLICYolicy SERIESerieS NnOo. 4564

9E XECUTIVEConsortiumS UMMARY for Refugees and Migrants in South Africa (CoRMSA), “Real Threats of Mass Xenophobic Violence after World Cup” Press Statement, 11 May 2010. ealth workers are one of the categories of skilled profession- 10 S. Ndlovu-Gatsheni,als most “The affected World Cup,by globalization. Vuvuzelas, Flag-Waving Over the past Patriots decade, and the Burden of Buildingthere South has Africa”emerged Third a substantial World Quarterly body of 32 research (2011): that 279-93. tracks patterns of international migrationTimes Live of 14 health July 2010. personnel, HMail & Guardian 12 July 2010. assesses causes and consequences, and debates policy responses at global 13 Addressand of national the President scales. of Within South Africa,this literature, Thabo Mbeki,the case at of the South National Africa Tribute is in Remembranceattracting growing of the interest.Victims ofFor Attacks almost on15 yearsForeign South Nationals, Africa Tshwanehas been at http://www.info.gov.za/speeches/2008/08070410451001.htm.the target of a ‘global raiding’ of skilled professionals by Ironically,several devel- Mbeki pennedoped a column countries. about How xenophobia to deal with in 2001the consequences urging South ofAfricans the resultant “to be out-vigi- lant againstflow of anyhealth evidence professionals of xenophobia is a core againstpolicy issuethe African for the nationalimmigrants. gov- It is fundamentallyernment. wrong and unacceptable that we should treat people who come to us as friendsThis paper as though aims to they to examine are our enemies”;policy debates see T. and Mbeki, issues “Our concerning Commit- ment theto Africa” migration ANC of skilledToday 1(18) health (May professionals 2001). from the country and to furnish new insights on the recruitment patternsCity of skilled Press 15 health June per-2010. 15 “Politicianssonnel. Peddlers The objectives of Xenophobia of the paperFear” areCity twofold: Press 9 July 2010. 16 B. Maclennan,Q +C
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K=H< 20 Ibid. key stakeholders in the South African health sector, the paper 21 African Peeroffers Review a series Mechanism, of recommendations Country Review for addressing Report: Republic the problem of South of Africa, Novemberskilled 2006, health p. 24.migration. These recommendations are grounded in both South African experience and an interrogation of inter- national debates and ‘good policy’ practice for regulating recruit- ment. The paper is organized into five sections.Mail & Section Guardian Two 12 positions July 2010. 24 T. Sibanda,debates “Zimbabwean about the migration Thrown of offskilled Train health in Xenophobic professionals Attack within in a South Africa”wider SW literatureRadio Africa that News discusses 7 July the 2010. international mobility of talent. 25 “All CalmSection at KyaThree Sands” reviews Mail research & Guardian on the 22 global July 2010. circulation of health pro- 26 T. Khamango,fessionals, “Kya focusing Sands in Attacks particular not upon Xenophobia-Related” debates relating to Mail the &experience Guardian 20 Julyof 2010.countries in the developing world. Section Four moves the focus from 27 T. Neethling,international “No Easy to South Way to African End Xenophobia issues and inprovides SA” Business new empirical Day 14 Novem mate-- ber 2012.rial drawn from the survey of recruitment patterns and key interviews 28 Ibid. undertaken with health sector recruiters operating in South Africa. 29 The targetingSection Five and addressesmurder of the Somali questions shopkeepers of changing has becomepolicy interventions an epidemic inin some Southparts of Africa the country. towards Attacks the outflow on Asian, of skilled especially health Bangladeshi, professionals shopkeep and the- ers hasrecruitment also been ofon foreign the increase; health seeprofessionals Y. Park and to P.work Rugunanan, in South “VisibleAfrica. Theand Vulnerable: Asian Migrant Communities in South Africa” Report for Atlantic

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EXECUTIVE SUMMARY Philanthropies and Strategy & Tactics, Johannesburg, nd; A. Charman and L. Piper, “Xenophobia, Criminality and Violent Entrepreneurship: Violence ealth workers are one of the categories of skilled profession- Against Somali Shopkeepers in Delft South, Cape Town, South Africa” South als most affected by globalization. Over the past decade, African Review of Sociology 43(2012): 81-105. there has emerged a substantial body of research that tracks 30 CoRMSA, “CoRMSA Condemns Attacks on Foreign Nationals in Botshabelo” patterns of international migration of health personnel, 10 July 2010. H 31 “In Two Days, Eight Spaza Shops Petrol-Bombed in the Cape Flats” West Cape assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is News 16 July 2012. attracting growing interest. For almost 15 years South Africa has been Sowetan the target of a ‘global raiding’ of skilled professionals by several devel- 4 October 2012. oped countries. How to deal with the consequences of the resultant out- 33 T. Polzer Ngwato and K. Takabvirwa, “Just Crime? Violence, Xenophobia and flow of health professionals is a core policy issue for the national gov- Crime: Discourse and Practice” SA Crime Quarterly 33(2010): 3-10. ernment. This paper aims to to examine policy debates and issues concerning Living in South Africa” Sociology 44 (2010): 233-50; B. Dodson, “Locating the migration of skilled health professionals from the country and to Xenophobia: Debate, Discourse, and Everyday Experience in Cape Town, South furnish new insights on the recruitment patterns of skilled health per- Africa” Africa Today sonnel. The objectives of the paper are twofold: Q +C
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K=H< 23(2011): 458-88; S. Buckland, “From Policy to Practice: The Challenges to key stakeholders in the South African health sector, the paper Educational Access for Non-Nationals in South Africa” International Journal of offers a series of recommendations for addressing the problem of Educational Development 31(2011): 367-73; J. Crush and G. Tawodzera, Medical skilled health migration. These recommendations are grounded Xenophobia: Zimbabwean Access to Health Services in South Africa SAMP Migra- in both South African experience and an interrogation of inter- tion Policy Series No 54, Cape Town, 2011; L. Gebre, P. Maharaj and N. Pillay, national debates and ‘good policy’ practice for regulating recruit- “The Experiences of Immigrants in South Africa: A Case Study of Ethiopians ment. in Durban, South Africa” Urban Forum- The paper is organized into five sections. Section Two positions South African debates about the migration of skilled health professionals within a Review of Sociology 42(2011): 83-101; P. Rugunanan and R. Smit, “Seeking Ref- wider literature that discusses the international mobility of talent. uge in South Africa: Challenges Facing a Group of Congolese and Burundian Section Three reviews research on the global circulation of health pro- Refugees” Development Southern Africa 28(2011): 705-18; S. Singh, “Xenopho- fessionals, focusing in particular upon debates relating to the experience bia and Crime: Foreign Nationals Awaiting Trial in a South African Prison” of countries in the developing world. Section Four moves the focus from Acta Criminologica 24(2011): 31-47; L. Vromans, R. Schweitzer, K. Knoetze and international to South African issues and provides new empirical mate- A. Kagee, “The Experience of Xenophobia in South Africa” American Journal rial drawn from the survey of recruitment patterns and key interviews of Orthopsychiatry 81(2011): 90-3; T. Monson, “Alibis for the State? Producing undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in Attacks in South Africa” Geopolitics 17(2012): 455-81; O. Rusinga, R. Maposa South Africa towards the outflow of skilled health professionals and the and D. Tobias, “Contested Alien Spaces and the Search for National Identity: recruitment of foreign health professionals to work in South Africa. The A Study of Ethnicity in Light of Xenophobic Violence on Migrants in South Africa” Migration and Development 1(2012): 206-15; J. Steinberg, “Security and

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EXECUTIVEDisappointment:SUMMARY Policing, Freedom and Xenophobia in South Africa” British Journal of Criminology 52(2012): 345-60. 35 F. Parker, “Cops Dragealth Man workers to Death are one – Forof the Stopping categories Traffic” of skilled Mail & profession- Guardian 1 March 2013; K. Sosibo,als most “Emidio affected Macia’s by globalization. Death: No Over Way tothe Treat past adecade, Neighbour” Mail & Guardianthere 15 March has emerged 2013. a substantial body of research that tracks 36 Crush, The Perfectpatterns Storm. of international migration of health personnel, HViolence and Xenophobia in South Africa: Developing Consensus, assesses causes and consequences, and debates policy responses at global Movingand to nationalAction scales. Within this literature, the case of South Africa is I. Eigelaar-Meets,attracting growing G. Eva interest. and C. For Poole, almost “Xenophobia 15 years South and ViolenceAfrica has in been South Africa:the A target Desktop of a Study‘global of raiding’ the Trends of skilled and professionalsa Scan of Explanations by several devel-Offered” oped countries. How to deal with the consequences of the resultant out- Ratele,flow “Why of health the Wretched professionals Kill isin a Democraticcore policy issueSouth for Africa: the national Reflections gov- on Rejuvenationernment. and Reconstruction” Social Change 40(2010): 15-27. 38 J. Crush, ThisA. Chikanda paper aims and to B. to Maswikwa, examine policy “North-South debates andand issuesSouth-South concerning Medi- cal Tourism:the migration The Case of skilled of South health Africa” professionals In R. Labonte, from the V. Runnels,country and C. Packerto and R.furnish Deonandan, new insights eds., onTravelling the recruitment Well : Essays patterns in Medical of skilled Tourism health (Ottawa: per- sonnel. The objectives of the paper are twofold: 39 Crush, TheQ Perfect +C
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K=H< A. Mayda and M. Mendola, “What Drives Individual Attitudes Towards Immigrationkey stakeholders in South inAfrica?” the South Working African Paper, health Department sector, the of Econom paper - offers a series of recommendations for addressing the problem of 44 Crush, The Perfectskilled Storm health. migration. These recommendations are grounded 45 See Endnotesin 2 bothto 4. South African experience and an interrogation of inter- national debates and ‘good policy’ practice for regulating recruit-- ers’ in Contemporaryment. South Africa” Migration Issue Brief No. 3, Forced Migra- The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a wider literature that discusses the international mobility of talent. Section Three reviews research on the global circulation of health pro- fessionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in South Africa towards the outflow of skilled health professionals and the recruitment of foreign health professionals to work in South Africa. The

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EXECUTIVE SUMMARY Appendix: Xenophobia tiMeline ealth workers are one of the categories of skilled profession- 2008 als most affected by globalization. Over the past decade, July there has emerged a substantial body of research that tracks Hpatterns of international migration of health personnel, on fire when he returns to his South African wife and children. Incident occurs close to where assesses causes and consequences, and debates policy responses at global Nhamuave was “necklaced” in May. and national scales. Within this literature, the case of South Africa is attracting growing interest. For almost 15 years South Africa has been Station, and later to Albert Park. Migrants say they do not feel safe to return to their homes the target of a ‘global raiding’ of skilled professionals by several devel- without adequate protection. oped countries. How to deal with the consequences of the resultant out- camp to Lindela Centre where they refuse to provide personal details to officials prior to flow of health professionals is a core policy issue for the national gov- deportation. ernment. This paper aims to to examine policy debates and issues concerning obligations under international law. the migration of skilled health professionals from the country and to furnish new insights on the recruitment patterns of skilled health per- August sonnel. The objectives of the paper are twofold: connection with May’s xenophobia attacks, including Northwestern province (7), KwaZulu- Q +C
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F97FI=H Natal (52), Free State (15), Gauteng (139), Western Cape (164), Eastern Cape (43) and ment of skilled professionals from South Africa in the health Northern Cape (1). A total of 1 446 charges have been laid. sector. The paper draws upon a detailed analysis of recruitment advertising appearing in the South African Medical Journal for the period 2000-2004 and a series of interviews conducted with returning from Soetwater safety camp. Somali community says he is eighth Somali migrant to private recruiting enterprises. be killed since returning to the community. Q 5G98
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EXECUTIVE S UMMARY bludgeoned to death. She observes: “Thereealth appears workers to be are a dangerous one of the pattern categories of targeted of skilled attacks profession- on foreigners, especially, but not exclusivelyals most involving affected Somalis.” by globalization. Over the past decade, there has emerged a substantial body of research that tracks patterns of international migration of health personnel, demandingH they close their shops or face another bout of violence. assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is - grants believing they are responsible. Twelve shops are looted and damaged while many migrantsattracting are forced growingfrom their interest. homes. Police For almostlater confirm 15 years suspect South is South Africa African. has been the target of a ‘global raiding’ of skilled professionals by several devel- to raise opedawareness countries. about xenophobia. How to deal with the consequences of the resultant out- flow of health professionals is a core policy issue for the national gov- ernment. This paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to - curity infurnish safe sites; new say insightsthey are terrifiedon the ofrecruitment becoming victims patterns of violence of skilled again. health per- sonnel. The objectives of the paper are twofold: expressed byQ ordinary +C
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F97FI=H citizens that foreign nationals should leave the country”. Claims underly- ing causes as “dissatisfactionment of skilled over migration professionals policy”, fromcompetition South over Africa housing, in the jobs, health and “influx of immigrants”. sector. The paper draws upon a detailed analysis of recruitment advertising appearing in the South African Medical Journal for November the period 2000-2004 and a series of interviews conducted with - tion Amakhaya Ngokuprivate and recruiting threaten its enterprises. migrant fundraiser, alleging “makwerekwere” develop- ment will displaceQ 5G98
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K=H< them. key stakeholders in the South African health sector, the paper murdered after heoffers returns a series to his home.of recommendations for addressing the problem of skilled health migration. These recommendations are grounded in both South African experience and an interrogation of inter- national debates and ‘good2009 policy’ practice for regulating recruit- ment. January The paper is organized into five sections. Section Two positions mob thatdebates attacks aboutthem with the bushmigration knives. ofTen skilled others healthsuffer serious professionals injuries. Police within say ait is not clear if incident was motivated by xenophobia. But Chairperson of International Refugee Service widerOsman literature says attackers that said: discusses “we want the amakwerekwere”. international mobility of talent. Section Three reviews research on the global circulation of health pro- fessionals, focusing in particularFebruary upon debates relating to the experience of countries in the developing world. Section Four moves the focus from includinginternational lack of preparation, to South co-ordination African issues and communication and provides betweennew empirical various agenciesmate- and betweenrial drawn civil society from andthe statesurvey structures, of recruitment in government’s patterns humanitarian and key interviews response. Poor living conditionsundertaken in camps with for health large numberssector recruiters of displaced operating persons is inrevealed. South Africa. violence,Section resulting Five in two addresses deaths. the questions of changing policy interventions in South Africa towards the outflow of skilled health professionals and the shack, whichrecruitment is then deliberatelyof foreign sethealth on fire. professionals Four others manageto work to in escape South but Africa. flee to Thecom- munity hall, as they are too scared to return home.

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EXECUTIVE SUMMARY March their shacks ask to be “repatriated to Somalia or to a different country” because they “don’t ealth workers are one of the categories of skilled profession- feel safe in South Africa anymore”. als most affected by globalization. Over the past decade, there has emerged a substantial body of research that tracks - Hpatterns of international migration of health personnel, tant role by instigating or failing to stop violence. assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is April attracting growing interest. For almost 15 years South Africa has been months, allowing them to seek employment, education and heath care legally in South Africa. the target of a ‘global raiding’ of skilled professionals by several devel- Also announces moratorium on deportation of Zimbabwean migrants. oped countries. How to deal with the consequences of the resultant out- flow of health professionals is a core policy issue for the national gov- Says despite official suspension, police are detaining thousands of Zimbabweans in extremely ernment. poor conditions at Musina military base. This paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to They are returned to South African military base in Musina and detained again. furnish new insights on the recruitment patterns of skilled health per- May sonnel. The objectives of the paper are twofold: Q +C
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F97FI=H more than a year after episode of large-scale violence. It is revealed threat of violence against ment of skilled professionals from South Africa in the health sector. The paper draws upon a detailed analysis of recruitment castigated for “doing nothing” during the mid-2008 attacks. advertising appearing in the South African Medical Journal for attacks, only 70 have been finalized with guilty verdict. Says no proactive measures or inquir- the period 2000-2004 and a series of interviews conducted with ies have been set up to prevent repeat of such episodes. private recruiting enterprises. Q 5G98
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K=H< killing one and injuring two others. Witnesses say assailants did not loot shop or demand any key stakeholders in the South African health sector, the paper money. offers a series of recommendations for addressing the problem of skilled health migration. These recommendations are grounded in both South African experience and an interrogation of inter- June national debates and ‘good policy’ practice for regulating recruit- ment. owners advising them to leave within seven days. Seven shops are forcibly closed. The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a Centre after unidentified men accost him telling him to return to his country. wider literature that discusses the international mobility of talent. Section Three reviews research on the global circulation of health pro- before Equality Court to seek financial compensation and apology from police for failing to protect them during violent attacks in March 2008. fessionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from increase prices similar to local traders. international to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in South Africa towards the outflow of skilled health professionals and the Somali traders and pelt stones to force them to increase their food prices. Four shops are dam- recruitment of foreign health professionals to work in South Africa. The aged in Langrug and Mooiwater informal settlements and one migrant injured.

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EXECUTIVE SUMMARY July Local police say attack not motivated by xenophobia but believe it to be a robbery attempt. ealth workers are one of the categories of skilled profession- and burned during protestsals most against affected poor bygovernment globalization. service Over delivery. the Thirtypast decade, migrants seek refuge at local police therestation. has Some emerged 100 migrants a substantial are displaced. body of research that tracks patterns of international migration of health personnel, vulnerableH and live in high-risk areas. assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is August attracting growing interest. For almost 15 years South Africa has been - tion hasthe been target carried of out. a ‘global raiding’ of skilled professionals by several devel- oped countries. How to deal with the consequences of the resultant out- flow of health professionalsSeptember is a core policy issue for the national gov- ernment. This paper aims to to examine policy debates and issues concerning refugeesthe attacked migration and displaced of skilled during health service professionals delivery protests from in theJuly. country and to furnish new insights on the Octoberrecruitment patterns of skilled health per- sonnel. The objectives of the paper are twofold: are threatenedQ by +C
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F97FI=H local residents to leave or face dire consequences. ment of skilled professionals from South Africa in the health robbing South Africans.sector. The paper draws upon a detailed analysis of recruitment advertising appearing in the South African Medical Journal for November the period 2000-2004 and a series of interviews conducted with Basotho migrants’private shacks, recruiting accusing thementerprises. of accepting lower wages and stealing jobs from Q 5G98
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K=H< Square, Maseru, key and stakeholders take refuge in in local the sports South field African and community health sector, hall. Freedomthe paper Front Plus Party says violenceoffers a is series due to of “poor recommendations border controls”. forDisplaced addressing migrants the describe problem South of Africans as “veryskilled rough” healthand say “theymigration. treat us These like shit”. recommendations are grounded migrants are forciblyin both evicted. South African experience and an interrogation of inter- national debates and ‘good policy’ practice for regulating recruit-- tion into conductment. of farmers and labour brokers in De Doorns. The paper is organized into five sections. Section Two positions debates about the migrationDecember of skilled health professionals within a wider literature that discusses the international mobility of talent. informationSection on anti-migrant Three reviews attacks. research on the global circulation of health pro- - vices in fessionals,South Africa. focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from being attackedinternational by mob lookingto South for “rapistsAfrican and issues murderers” and provides following new death empirical in area. mate- rial drawn from the survey of recruitment patterns and key interviews particularlyundertaken against refugees with healthand migrants. sector Attacks recruiters against operating non-nationals in South in South Africa. Africa are Section Five addresses the questions of changing policy interventions in Their Families. Justice Minister describes attacks as “matter of shame” for all South Africans. South Africa towards the outflow of skilled health professionals and the brothersrecruitment and sisters, who of usuallyforeign bear health the brunt professionals of ill-treatment to workmore thanin South foreigners Africa. from otherThe

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EXECUTIVE SUMMARY more humanely. ealth workers are one of the categories of skilled profession- violence against migrants in De Doorns. Concludes that Zimbabweans were not accepting als most affected by globalization. Over the past decade, lower wages and there were really labour shortages (and not employment ones as had been there has emerged a substantial body of research that tracks speculated). patterns of international migration of health personnel, H store looted. Migrants allege local traders are instigating attacks to force them to close their assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is businesses. attracting growing interest. For almost 15 years South Africa has been the target of a ‘global raiding’ of skilled professionals by several devel- 2010 oped countries. How to deal with the consequences of the resultant out- flow of health professionals is a core policy issue for the national gov- January ernment. This paper aims to to examine policy debates and issues concerning attack migrants and forcibly occupy their homes. the migration of skilled health professionals from the country and to furnish new insights on the recruitment patterns of skilled health per- of Somalis, some 400 residents attack and loot shops owned by migrants. sonnel. The objectives of the paper are twofold: Q +C
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F97FI=H Zimbabwean migrant neighbours to return two months after they were violently chased away. ment of skilled professionals from South Africa in the health sector. The paper draws upon a detailed analysis of recruitment bomb is hurled at their store. Somali Association of South Africa complains that xenophobic attacks are getting worse. advertising appearing in the South African Medical Journal for the period 2000-2004 and a series of interviews conducted with February private recruiting enterprises. - Q 5G98
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K=H< tinue to live in squalid conditions in makeshift refugee camp. Say they are routinely harassed key stakeholders in the South African health sector, the paper if they step outside it. offers a series of recommendations for addressing the problem of with cattle prods, telling him that South Africa is “not your land”. skilled health migration. These recommendations are grounded in both South African experience and an interrogation of inter- local residents loot and burn migrant-owned shops, forcing them to flee area for second time national debates and ‘good policy’ practice for regulating recruit- in eight months. Some victims have been affected by xenophobic violence three times since ment. 2008 and “lost everything again.” The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a wider literature that discusses the international mobility of talent. which can result in attacks on migrants. Civil society groups and South African police are said to be working on an early warning system for xenophobic violence and government is Section Three reviews research on the global circulation of health pro- supposedly planning to create National Action Plan to address xenophobia to be monitored fessionals, focusing in particular upon debates relating to the experience by Justice Department. of countries in the developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews scale xenophobic violence if service delivery issue is not resolved. Migrant-owned stores in undertaken with health sector recruiters operating in South Africa. several areas are targeted for looting and damage during protests. Section Five addresses the questions of changing policy interventions in Samora” asking them to abandon area or “face wrath of community.” South Africa towards the outflow of skilled health professionals and the recruitment of foreign health professionals to work in South Africa. The contributed to violence in May 2008. Government institutions reacted slowly to initial bout of

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EXECUTIVEattacks, lackedS UMMARYcontingency plans, and episode was “climax” of serious social issue neglected for 14 years. it fails to provide mid-2008ealth workers violence are report one of along the withcategories information of skilled about profession- early warning system. NIA says it isals not most yet affectedfully developed by globalization. and only includes Over desk the inpast office decade, of National Commissioner. Commissionthere hascautions emerged xenophobia a substantial likely to worsen.body of research that tracks patterns of international migration of health personnel, H March assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is of someattracting 50 persons latergrowing attacks interest. traders Forand lootsalmost their 15 stores. years Four South Somali Africa refugees has arebeen hurt. Migrantsthe say target they areof a regular ‘global targets raiding’ and of that skilled authorities professionals are not "meetingby several expectations” devel- despite “ongoingoped countries. efforts”. How to deal with the consequences of the resultant out- flow of health professionals is a core policy issue for the national gov- ernment. This paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to Pakistani traders and demands they leave area. Later, union members and locals vandalize and raid stores.furnish Two shopsnew insightsare completely on the destroyed recruitment by fire. patterns of skilled health per- sonnel. The objectives of the paper are twofold: Q +C
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F97FI=HApril ment of skilled professionals from South Africa in the health and bludgeoned sector.to death. The Local paper ANC draws leader uponallegedly a detailed instigated analysis attack. of recruitment advertising appearing in the South African Medical Journal for due to regular threats. Somali Community Board maintains 17 immigrants have died in xeno- phobic attacks thisthe year. period 2000-2004 and a series of interviews conducted with private recruiting enterprises. several SomaliQ traders, 5G98
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K=H< raiding their stores and destroying property. key stakeholders in the South African health sector, the paper- sons, including migrant,offers a receive series injuries.of recommendations for addressing the problem of skilled health migration. These recommendations are grounded May in both South African experience and an interrogation of inter- more than 1,000national persons raid debates migrant-owned and ‘good businesses. policy’ practiceSome 11 shopsfor regulating are looted. recruit-Affected migrants say theyment. been targets on more than three occasions and recently relocated to Sasolburg. The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a his storewider and decamp literature with thatmoney. discusses the international mobility of talent. Section Three reviews research on the global circulation of health pro- after FIFA World Cup tournament; urges “strong and preventative action by government and other institutions”.fessionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from migrantsinternational and refugees are to stealing South SouthAfrican African issues resources. and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews progressundertaken has been made with in counteracting health sector xenophobia. recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in June South Africa towards the outflow of skilled health professionals and the to deal recruitmentwith episodes ofand foreign risks of healthviolence professionals toward migrants. to work The committeein South isAfrica. expected The to work closely with civil society groups.

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EXECUTIVE SUMMARY South Africa’s image during World Cup: “We have observed a trend where foreigners commit crime – taking advantage of fact that we have an unacceptable crime level – to tarnish our ealth workers are one of the categories of skilled profession- credibility and image.” als most affected by globalization. Over the past decade, there has emerged a substantial body of research that tracks - patterns of international migration of health personnel, tion and harassment have been received from migrants. H assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is shops. attracting growing interest. For almost 15 years South Africa has been question role of IMC and its failure to respond to current wave of threats. the target of a ‘global raiding’ of skilled professionals by several devel- oped countries. How to deal with the consequences of the resultant out- Africa is eliminated from tournament. Social Justice Coalition reports that Somalians have flow of health professionals is a core policy issue for the national gov- been threatened with violence if they fail to leave after tournament ends. ernment. This paper aims to to examine policy debates and issues concerning shops after South African team exits tournament. the migration of skilled health professionals from the country and to World Cup, army and local police carry out intensive operation, searching house to house to furnish new insights on the recruitment patterns of skilled health per- discourage violence. sonnel. The objectives of the paper are twofold: Q +C
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F97FI=H will investigate rumours of violence and act on them with help of police. ment of skilled professionals from South Africa in the health sector. The paper draws upon a detailed analysis of recruitment trying to incite violence against Somali traders. More violence is directed at immigrants after advertising appearing in the South African Medical Journal for some men are arrested. the period 2000-2004 and a series of interviews conducted with Xenophobia, which plans to organize community education programmes, including a rally to private recruiting enterprises. promote peace and harmony on July 10 at Blue Wall. Q 5G98
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K=H< key stakeholders in the South African health sector, the paper July offers a series of recommendations for addressing the problem of - skilled health migration. These recommendations are grounded Development, State Security, Basic Education, Co-operative Governance and Traditional in both South African experience and an interrogation of inter- Affairs, Arts and Culture, and International Relations and Cooperation. national debates and ‘good policy’ practice for regulating recruit- ment. C. The paper is organized into five sections. Section Two positions - debates about the migration of skilled health professionals within a ment cleaning jobs results in dispute over preferential treatment. Migrants are told to “leave wider literature that discusses the international mobility of talent. South Africa or we would be killed like in 2008.” Section Three reviews research on the global circulation of health pro- shop. fessionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from looting. international to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews fears. undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in Migrants leave areas like Du Noon, Phillipi, Phillipi East, Malmesbury and Grabouw. Some Zimbabwean migrants say their neighbours have told them to leave, while others indicate their South Africa towards the outflow of skilled health professionals and the landlords have asked them to vacate premises for fear their homes may be damaged. recruitment of foreign health professionals to work in South Africa. The peace; suggestion is directed to Inter-Ministerial Committee on xenophobia.

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EXECUTIVE SUMMARY being called “makwerekwere”, telling him to go home because “we were taking jobs.” Wandi. Three are assaultedealth workersand two shot.are one of the categories of skilled profession- als most affected by globalization. Over the past decade,- vent large-scale outbreakthere of has violence. emerged a substantial body of research that tracks patterns of international migration of health personnel, xenophobicH attacks are received in areas around Ekurhuleni and Johannesburg. Local police assesses causes and consequences, and debates policy responses at global station holdsand national urgent meeting scales. with Within settlements’ this literature, leaders and the residents. case of South Africa is - bia. Nathiattracting says government growing “will interest. not tolerate For almostany threat 15 oryears act ofSouth violence Africa against has individuals been or sectorthe of society,target noof amatter ‘global what raiding’ reasons of are skilled given toprofessionals justify such threats by several or actions.” devel- oped countries. How to deal with the consequences of the resultant out- robbed offlow meager of health possessions. professionals “We all live is ina coredifferent policy areas. issue We forhave the all nationalbeen threatened. gov- It ernment. This paper aims to to examine policy debates and issues concerning with employersthe migration to insist ofthey skilled not employ health “foreigners” professionals for lowfrom wages. the countryWard Councillor and to says residents want “illegal foreigners” to be incarcerated or deported. They also want elected representativesfurnish to new explain insights why foreigners on the recruitment are being allowed patterns to take of jobs. skilled health per- sonnel. The objectives of the paper are twofold: leave immediatelyQ +C
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F97FI=H or face death. ment of skilled professionals from South Africa in the health social and politicalsector. scientists The and paper civil drawssociety uponactivists. a detailed Report demonstrates analysis of that recruitment despite state indifference, civiladvertising society mobilised appearing across inthe the country South to denounceAfrican Medicalxenophobia Journal and to forassist victims of May 2008 violence. the period 2000-2004 and a series of interviews conducted with fresh violence in privateprovince. recruiting Some migrants enterprises. say threat is worse than experienced in May 2008. Ibrahim Mursal,Q 5G98
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K=HMitchells Plain,key but stakeholders this is worse. inNow the you South even Africansee coloured health people sector, attacking. the paper Before it was only the blacks.offers Maybe a series now ofthe recommendations whites are also coming.” for addressing the problem of skilled health migration. These recommendations are grounded Langa, Cape Town and Mbekweni. Many involve looting of migrant-owned shops. in both South African experience and an interrogation of inter- national debates and ‘good policy’ practice for regulating recruit- people from therement. chased us like dogs.” The paper is organized into five sections. Section Two positions and its perpetratorsdebates about should the be migration isolated.” of skilled health professionals within a wider literature that discusses the international mobility of talent. NationalSection Police Commissioner Three reviews is giving research anti-xenophobia on the global speech. circulation Several Somali of health shopkeepers pro- close their stores and leave with belongings: “these people called us makwerekwere and said we mustfessionals, go home. They focusing said no in one particular from another upon land debates is going relating to stay here.”to the experience of countries in the developing world. Section Four moves the focus from Philippi internationalafter shops are lootedto South and Africanscorched. issuesProvincial and authorities provides saynew there empirical have been mate- “spo- radic” attacksrial drawn on shops from and the “some survey incidents of recruitment of looting” patternsin areas like and Mbekweni, key interviews Paarl East, Wellington,undertaken and Nyanga. with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in and escort them to safety elsewhere. South Africa towards the outflow of skilled health professionals and the is not xenophobia-related.recruitment of foreign Six Malawian health migrants professionals are displaced to work after in locals South chase Africa. them outThe of their homes. Fifty three migrants are reported to be taking shelter in local church.

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EXECUTIVE SUMMARY taken against perpetrators. ealth workers are one of the categories of skilled profession- als most affected by globalization. Over the past decade, there has emerged a substantial body of research that tracks patterns of international migration of health personnel, peace has been restored to areas, using police and army patrols. H assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is “should not have fears” and government has established ministerial commission to control situation. attracting growing interest. For almost 15 years South Africa has been - the target of a ‘global raiding’ of skilled professionals by several devel- phobic violence as part of rapid response mechanism. oped countries. How to deal with the consequences of the resultant out- - flow of health professionals is a core policy issue for the national gov- sibility of another large-scale attack. ernment. This paper aims to to examine policy debates and issues concerning to happen to them, or experience something again.” the migration of skilled health professionals from the country and to xenophobia and work to change biased attitudes of South Africans towards African immi- furnish new insights on the recruitment patterns of skilled health per- grants. This is because environment and conditions that led to May 2008 attacks remain sonnel. The objectives of the paper are twofold: “largely unchanged”. Q +C
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F97FI=H ment of skilled professionals from South Africa in the health than 200 phone calls from fearful Zimbabwean migrants, many of them from Western Cape. sector. The paper draws upon a detailed analysis of recruitment Dube expresses “limited faith” in South African police: “Scores of youth are reportedly looting advertising appearing in the South African Medical Journal for and threatening foreigners in full view of police officers”; urges government to set up special courts to tackle these threats. the period 2000-2004 and a series of interviews conducted with private recruiting enterprises. Q 5G98
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K=H< key stakeholders in the South African health sector, the paper past three days after they being kicked out of their homes. offers a series of recommendations for addressing the problem of - skilled health migration. These recommendations are grounded phobic violence for as long as required. in both South African experience and an interrogation of inter- episodes of “xenophobic criminal activity” involving roaming gangs of 10 to 30 persons going national debates and ‘good policy’ practice for regulating recruit- around raiding Somali-owned shops have taken place in Khayelitsha alone over past three ment. days. They urge government to acknowledge that these incidents are rooted in xenophobia in The paper is organized into five sections. Section Two positions which “persons around Cape Town and the Western Cape are being targeted on the basis of debates about the migration of skilled health professionals within a their nationality.” wider literature that discusses the international mobility of talent. Section Three reviews research on the global circulation of health pro- acts of criminality” and notes: “today it’s called xenophobia, tomorrow it could be called rac- ism or sexism.” fessionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from response in event of large-scale violence. An “Anti-Xenophobic Action” (AXA) national international to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews authorities and humanitarian organizations. undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in assistance to migrants in Gauteng and KwaZulu-Natal. Lawyers will help migrants register cases of harassment and intimidation with police and judicial system. South Africa towards the outflow of skilled health professionals and the recruitment of foreign health professionals to work in South Africa. The Nations agencies is formed, which creates extensive emergency plan “in event of large-scale human displacement.”

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EXECUTIVE SUMMARY Churches to discuss impending threat of large-scale violence. they left after witnessingealth fresh workers violence. are one of the categories of skilled profession- als most affected by globalization. Over the past decade, there has emerged a substantial body of research that tracks patterns of international migration of health personnel,- tion of flashpoints,H use of mediators, and extensive work by police, have worked: “What could assesses causes and consequences, and debates policy responses at global have beenand mass national displacement scales. is Within minimal thisdisplacement.” literature, the case of South Africa is - ment inattracting 11 incidents growing involving interest. physical assault,For almost vandalism 15 years and theft.South Six Africa victims has are beenmigrants from Zimbabwethe target and of Mozambique.a ‘global raiding’ Minister of skilled for Community professionals Safety by Mosunkutu several devel- describes events asoped “criminal countries. activities” How and to “not deal xenophobia-related”: with the consequences “It’s just of a the group resultant of people out- car- rying outflow criminal of health activities; professionals they are failing is a corebecause policy we have issue arrested for the most national of them.” gov- Army and policeernment. are deployed. This paper aims to to examine policy debates and issues concerning store. the migration of skilled health professionals from the country and to South Africa.furnish new insights on the recruitment patterns of skilled health per- sonnel. The objectives of the paper are twofold: Q +C
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K=H< are attacked with axes. Provincial police denies it is xenophobia: “We are not saying it iskey xenophobia stakeholders because in South the South Africans African were also health victims sector, there. We the are paper treating it as criminal acts.”offers a series of recommendations for addressing the problem of skilled health migration. These recommendations are grounded Kya Sands and warns: “xenophobia will continue to re-surface unless and until government finds long-term solutionsin both toSouth this veryAfrican serious experience problem which and seemsan interrogation to be the result of ofinter- some poor, desperate andnational unemployed debates taking and matters ‘good ofpolicy’ government practice into fortheir regulating own hands.” recruit- ment. will not recur.The But paper several is organizedmigrants prepare into fiveto abandon sections. area Section as they stronglyTwo positions feel that more violencedebates is likely toabout happen. the migration of skilled health professionals within a wider literature that discusses the international mobility of talent. Section Three reviews research on the global circulation of health pro- - ing information on May 2008 violence from government and their efforts to avoid repeat fessionals, focusing in particular upon debates relating to the experience with them.of countries in the developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- face chargesrial drawnof assault, from housebreaking the survey and of recruitmentinciting violence. patterns and key interviews undertaken with health sector recruiters operating in South Africa. xenophobicSection violence. Five addresses the questions of changing policy interventions in assailantsSouth shoot AfricaSomali migranttowards in the his outflowshop in different of skilled incident. health professionals and the recruitment of foreign health professionals to work in South Africa. The- lence as “nothing but exaggeration and sensationalism”, while applauding security forces for their role in containing threat. 611 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MIGRATION POLICY SERIES NO. 45 Soft targetS: Xenophobia, public Violence and changing attitudeS to MigrantS

EXECUTIVE SUMMARY 2008 necklacing victim Ernesto Nhamuave’s case at Reiger Park Police Station or National ealth workers are one of the categories of skilled profession- Prosecuting Authority (NPA) Roll. NPA says criminal cases from May 2008 violence that als most affected by globalization. Over the past decade, “were prosecutable” have been sent to court. there has emerged a substantial body of research that tracks patterns of international migration of health personnel, Mugabe is violently assaulted near Claremont and later succumbs to his injuries. Witness H states perpetrators were chanting “makwerekwere hamba (get out foreigner)”. assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is - lent altercation; local police describe event as “resembling xenophobia.” attracting growing interest. For almost 15 years South Africa has been the target of a ‘global raiding’ of skilled professionals by several devel- August oped countries. How to deal with the consequences of the resultant out- flow of health professionals is a core policy issue for the national gov- recorded between 1 May and July 30. Forty persons have been arrested and charged with ernment. arson, intimidation, vandalism, attempted murder, assault, public violence, and theft/looting. This paper aims to to examine policy debates and issues concerning Incidents have occurred in areas like Delft, Philippi, Lwandle, Kraiifontein, Paarl, Paarl East, the migration of skilled health professionals from the country and to Franschhoek, Grabouw, Wellington, Da Gammaskop, Mossel Bay, Gugulethu, Langa, Atlantis and Khayelitsha. furnish new insights on the recruitment patterns of skilled health per- - sonnel. The objectives of the paper are twofold: ously”, and “not hesitate to take action against the perpetrators of any kind of violence”. Q +C
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F97FI=H Nevertheless, it notes “incidents of violence and looting if property reported thus far points to ment of skilled professionals from South Africa in the health criminality more than xenophobia”. sector. The paper draws upon a detailed analysis of recruitment advertising appearing in the South African Medical Journal for Related Intolerance Bill will be tabled in Parliament “soon”. the period 2000-2004 and a series of interviews conducted with September private recruiting enterprises. Q 5G98
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K=H< part of life. We do not live easy here. We only survive.” key stakeholders in the South African health sector, the paper offers a series of recommendations for addressing the problem of groups sharply criticize move as “policy of mass deportation” which could result in “[South skilled health migration. These recommendations are grounded African] communities being more xenophobic and on-going witch hunt to determine who has documents”. in both South African experience and an interrogation of inter- national debates and ‘good policy’ practice for regulating recruit- refugee status documents irrespective of where application was originally submitted. Order ment. comes after Legal Resources Center petitions court, arguing it is “cumbersome burden”, forc- The paper is organized into five sections. Section Two positions ing asylum-seekers to journey to other provinces to renew permits. debates about the migration of skilled health professionals within a - wider literature that discusses the international mobility of talent. inces worst hit by 2008 violence (Gauteng, Western Cape, Eastern Cape and KwaZulu-Natal). Section Three reviews research on the global circulation of health pro- October fessionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from shot to death, while three other migrants are injured. Somalian community says 30 traders international to South African issues and provides new empirical mate- have been victims of targeted attacks since August. rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. buy beer for several South Africans at tavern. Witnesses say attackers told Etasha: “South Section Five addresses the questions of changing policy interventions in Africa is ours”. South Africa towards the outflow of skilled health professionals and the November recruitment of foreign health professionals to work in South Africa. The are “living in fear now. We’re wondering who’s going to be next. We came to South to survive

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EXECUTIVEnot die.” LocalS UMMARYSomali Association states more than 22 Somali migrants have been killed in the area over past three months. police led by Nationalealth Police workers Commissioner are one Cele of theand categoriesPolice Minister of skilled Mthethwa profession- along with als most affected by globalization. Over the past decade, Migrants without documentsthere has and emerged those with a substantial criminal records body areof research detained. that Migrant tracks rights groups censureH actionspatterns saying it of contradicts international amnesty migration for Zimbabweans. of health personnel, assesses causes and consequences, and debates policy responses at global and national scales. WithinDecember this literature, the case of South Africa is persons attractingare killed and growing stores raided. interest. For almost 15 years South Africa has been the target of a ‘global raiding’ of skilled professionals by several devel- deportations.”oped countries. How to deal with the consequences of the resultant out- flow of health professionals is a core policy issue for the national gov- managedernment. and lacks uniformity: “There are no clear guidelines on what is required and differ- ent offices haveThis different paper aims requirements. to to examine There is policy no certainty debates in the and process.” issues concerning the migration of skilled health professionals from the country and to furnish new insights on the recruitment patterns of skilled health per- 2011 sonnel. The objectives of the paper are twofold: Q +C
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F97FI=HJanuary ment of skilled professionals from South Africa in the health sector. The paper draws upon a detailed analysis of recruitment attacked by armed gang. advertising appearing in the South African Medical Journal for taskforce to examinethe tensionsperiod 2000-2004between locals and and a migrants. series of Shops interviews belonging conducted to migrants with are to remain closed duringprivate investigation. recruiting Local enterprises. ward councillor says only 12 migrant-owned stores are to be allowedQ 5G98
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K=H< to remain locally. key stakeholders in the South African health sector, the paper offers a series of recommendationsFebruary for addressing the problem of Residents say theyskilled are “not health ready migration. to go back Theseto xenophobia”, recommendations but insist migrants are grounded steal their jobs. in both South African experience and an interrogation of inter- national debates and ‘good policy’ practice for regulating recruit- which is extensivelyment. damaged. A second migrant receives injuries. The paper is organized into five sections. Section Two positions say onlydebates their shops about are lootedthe migration and police ofrefuse skilled to help, health telling professionals them to return within to their a coun- try. wider literature that discusses the international mobility of talent.- Section Three reviews research on the global circulation of health pro- fessionals, focusing in particular upon debates relating to the experience of countries in the developingMarch world. Section Four moves the focus from international to South African issues and provides new empirical mate- to its variousrial drawn provisions. from Critics the survey call Bill of “inhumane”, recruitment “ill-conceived”, patterns and and key “draconian”. interviews Pre- screeningundertaken at border of with asylum health seekers, sector they recruiters say, makes operating refugees more in South vulnerable Africa. to “being immediately deported to countries where they may be tortured or killed” and violate countries' internationalSection human Five rights addresses obligations. the questions Other aspects, of changing including reducingpolicy interventions reporting times in to seek asylumSouth and Africa access totowards airlines' the passenger outflow lists, of are skilled deemed health harsh professionalsand a violation andof privacy the rights. recruitment of foreign health professionals to work in South Africa. The

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EXECUTIVE SUMMARY April shops on behalf of Gauteng Business Forum. ealth workers are one of the categories of skilled profession- als most affected by globalization. Over the past decade, attack Ethiopian immigrants and damage their homes, shops and vehicles. Four migrants are there has emerged a substantial body of research that tracks injured and some 150 migrants flee area. patterns of international migration of health personnel, H May assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is - cies that “respects human rights of migrants and ensures their integration into South African attracting growing interest. For almost 15 years South Africa has been society”. the target of a ‘global raiding’ of skilled professionals by several devel- - oped countries. How to deal with the consequences of the resultant out- phobic aggression and ask residents to “stop attacking foreign nationals.” Campaign is to be flow of health professionals is a core policy issue for the national gov- continued in local schools and surrounding areas. ernment. - This paper aims to to examine policy debates and issues concerning ing Somali and Pakistani traders close their stores. the migration of skilled health professionals from the country and to - ers to stop complaining about foreign traders: “you guys give these foreigners places to stay furnish new insights on the recruitment patterns of skilled health per- and places to do business because you love money.” Gauteng Business Forum Chairperson sonnel. The objectives of the paper are twofold: Mhlanga criticizes Minister’s remarks. “These people [migrants] are molesting our economy”, Q +C
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F97FI=H he says. ment of skilled professionals from South Africa in the health sector. The paper draws upon a detailed analysis of recruitment houses, two offices, bus, and police vehicle while demanding that all foreign labour be advertising appearing in the South African Medical Journal for removed. Reportedly, workers block gates and demand Korean and Chinese workers leave immediately “in peace before they left in pieces.” Damage is estimated at R500, 000. the period 2000-2004 and a series of interviews conducted with private recruiting enterprises. jobs at local mine and chase several hundred out of area. They also set the local secondary Q 5G98
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K=H< school on fire for enrolling children from migrant households. key stakeholders in the South African health sector, the paper offers a series of recommendations for addressing the problem of fire. Two stores are completely destroyed in Kamvelihle and Ramaphosa. Other Somali traders skilled health migration. These recommendations are grounded abandon area. in both South African experience and an interrogation of inter- nine charged for organizing illegal gathering to campaign to shut selected migrant-owned busi- national debates and ‘good policy’ practice for regulating recruit- nesses. ment. - The paper is organized into five sections. Section Two positions ers are raided in Motherwell and KwaDwesi. Some 200 Somali migrants flee but police rule debates about the migration of skilled health professionals within a out xenophobia and attribute it to business rivalry between local and migrant traders. wider literature that discusses the international mobility of talent. Section Three reviews research on the global circulation of health pro- Station after their stores are set on fire. fessionals, focusing in particular upon debates relating to the experience June of countries in the developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- Greater Gauteng Business Forum members are confronted by local women who urge them to rial drawn from the survey of recruitment patterns and key interviews leave the migrants alone. The Forum organizes a march in defiance of a court order and some undertaken with health sector recruiters operating in South Africa. 80 members are arrested. Section Five addresses the questions of changing policy interventions in and their role in inciting xenophobic aggression. Greater Gauteng Business Forum reveals that South Africa towards the outflow of skilled health professionals and the they have been asked to set up similar structures in areas like Limpopo, Kwazulu-Natal, Port recruitment of foreign health professionals to work in South Africa. The Elizabeth and Western Cape.

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EXECUTIVE SUMMARY being accused of theft. Zimbabwean migrants’ealth homes workers are burned are one down of andthe fourcategories others areof skilled vandalized. profession- Police say there are “groups” harassingals most and affected threatening by globalization. migrants. Violence Over occursthe past after decade, locals accuse migrants of killing twothere South has Africans emerged and a substantial occupying RDP body houses. of research Police saythat there tracks is no record of these supposedpatterns crimes. of Aroundinternational 3,000 Zimbabweans migration offlee health to the localpersonnel, police station and otherH places. assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is Sibanda and other Zimbabwean migrants. Young Communist League of South Africa calls this vigilanteattracting justice “deplorable”. growing interest. For almost 15 years South Africa has been the target of a ‘global raiding’ of skilled professionals by several devel- Sibanda’soped death. countries. She denies How any roleto dealeven withas police the assert consequences that she openly of the urged resultant locals to out-“kick out” Zimbabweans.flow of health ANC professionals says councilor is“is a innocent core policy until issueproven for guilty.” the national gov- ernment. This paper aims to to examine policy debates and issues concerning are set onthe fire. migration of skilled health professionals from the country and to to handfurnish over cash. new insights on the recruitment patterns of skilled health per- sonnel. The objectives of the paper are twofold: owned store.Q +C
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F97FI=H ment of skilled professionals from South Africa in the health Communities expressessector. concern The paper about draws “ongoing upon violent a detailed victimization analysis of Africanof recruitment refugees” in South Africa, especiallyadvertising recent appearing attacks in Limpopo.in the South African Medical Journal for the period 2000-2004 and a series of interviews conducted with die in South Africa”private than recruiting“go back to enterprises.hell on earth.” Q 5G98
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K=H< key stakeholders in the South African health sector, the paper offers a series of recommendationsJuly for addressing the problem of skilled health migration. These recommendations are grounded refused entry because they pose a burden, using up resources: “Really, this intake, for how long are we going to continuein both withSouth this African as South experience Africans? Is andit not an going interrogation to affect our of resources, inter- the economy of thenational country?” debates She later and apologizes ‘good policy’ after ANC practice accepts for that regulating her comments recruit- “may be construed to bement. xenophobic.” The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a wider literature that discussesAugust the international mobility of talent. Section Three reviews research on the global circulation of health pro- fessionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews May 2008undertaken violence, is with found health strangled sector outside recruiters her house. operating in South Africa. Section Five addresses the questions of changing policy interventions in on xenophobic violence in mid-June. South Africa towards the outflow of skilled health professionals and the prevent recruitmententry of Somali of andforeign Ethiopian health refugees professionals through theirto work territories in South into Africa.South Africa, The government issues a denial.

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EXECUTIVE SUMMARY September Somali, Ethiopian and other migrant communities have been closed since June because ealth workers are one of the categories of skilled profession- municipality will not issue them licenses. Municipality denies discrimination and insists that als most affected by globalization. Over the past decade, only landowners can apply for such licenses. Middleburg Small Business Community Forum, there has emerged a substantial body of research that tracks representing South African traders, says it helped to mobilize local government for closures. patterns of international migration of health personnel, Forum says they “are a non-violent organization”, while highlighting “problems” associated H with migrants: “Why should townships become dumping sites where foreign people come to assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is promote lawlessness?” attracting growing interest. For almost 15 years South Africa has been those motivated by xenophobia, which remain invisible. the target of a ‘global raiding’ of skilled professionals by several devel- oped countries. How to deal with the consequences of the resultant out- October flow of health professionals is a core policy issue for the national gov- ernment. Somali-owned stores. This paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to be severely punished. furnish new insights on the recruitment patterns of skilled health per- sonnel. The objectives of the paper are twofold: leave RDP homes otherwise they will be “pushed like animals or aliens.” Q +C
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F97FI=H ment of skilled professionals from South Africa in the health migrants are housed temporarily at Laudium community center. sector. The paper draws upon a detailed analysis of recruitment advertising appearing in the South African Medical Journal for Bonafides group for threatening to attack migrants, though he is not arrested. the period 2000-2004 and a series of interviews conducted with and Itireleng; say that violence may spread to other areas. private recruiting enterprises. Q 5G98
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K=H< MEC says citizens have contributed to housing crisis: “The problem is not with foreigners, key stakeholders in the South African health sector, the paper the problem is with South Africans…foreigners find that they were sold houses by South offers a series of recommendations for addressing the problem of Africans.” skilled health migration. These recommendations are grounded migrants arriving in large numbers and illegally in South Africa cause xenophobic violence. in both South African experience and an interrogation of inter- “We can’t have a country run by people who jump the borders.” national debates and ‘good policy’ practice for regulating recruit- ment. November The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a memorandum urging strict action against illegal migrant-owned businesses. Organized by wider literature that discusses the international mobility of talent. Ekurhuleni Concerned Residents, Business and Enterprise Forum, participants accuse migrant Section Three reviews research on the global circulation of health pro- traders of evading municipal by-laws and some migrants of selling drugs. Forum spokesper- son says they do not want to take law into their own hands, but adds: “what do you expect fessionals, focusing in particular upon debates relating to the experience people to do if they are going hungry because foreigners are running down their businesses.” of countries in the developing world. Section Four moves the focus from This situation, he asserts, provides “fertile ground for xenophobic attacks to happen here in international to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews we will take drastic steps.” Migrant businesses remain closed during protests. undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in December South Africa towards the outflow of skilled health professionals and the recruitment of foreign health professionals to work in South Africa. The peculiar” handling of case involving 19 Ethiopian asylum seekers that could lead to “creating and heightening tensions between nationals and foreigners.”

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EXECUTIVE SUMMARY to protect migrant shopkeepers from Zwelethemba who were assaulted in March 2008 and their shops looted; but traders failed to prove police discriminated against them. ealth workers are one of the categories of skilled profession- als most affected by globalization. Over the past decade, 2012 there has emerged a substantial body of research that tracks patterns of internationalJanuary migration of health personnel, H assesses causes and consequences, and debates policy responses at global Thokoza Township. The attack happens after local residents insist that migrant traders must leave area.and Victims’ national families scales. say Withinpolice did this not literature,help them. the case of South Africa is attracting growing interest. For almost 15 years South Africa has been assaultedthe in targettheir shack of a by ‘global five men raiding’ carrying of knobkerries skilled professionals and clubs. by several devel- oped countries. How to deal with the consequences of the resultant out- flow of health professionals Februaryis a core policy issue for the national gov- ernment. year and about 1,000 persons displaced permanently or temporarily per annum” by xenopho- bic violence.This paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to attackedfurnish and looted new in insightsThabong, on Welkom the recruitment and Odendaalsrus patterns for three of skilled days. Some health migrants per- are attackedsonnel. and injured. The Attacksobjectives happen of theafter paper local youthare twofold: take to streets when discussions with local mines Qstall +C
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F97FI=Hover preferential employment for South Africans. ment of skilled professionals from South Africa in the health migrants runningsector. small businesses The paper are drawsmost prone upon to a being detailed targeted analysis by criminals of recruitment because they cannot report crime or access banking services. MPs express concern that situation is “border- ing on xenophobia”.advertising appearing in the South African Medical Journal for the period 2000-2004 and a series of interviews conducted with run shops are lootedprivate and recruitingburned down enterprises. in Freedom Park and Segwaelane Village. Some 100 migrants, mostlyQ 5G98
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EXECUTIVE SUMMARY say they are being targeted in townships because of business rivalry and that community lead- ers and local traders are inciting the violence. ealth workers are one of the categories of skilled profession- als most affected by globalization. Over the past decade, May there has emerged a substantial body of research that tracks patterns of international migration of health personnel, immigrants. Incident happens two days after two Pakistanis are implicated in death of local H woman. Many traders seek refuge in neighbouring townships. assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is Phagemeng township. Twenty juvenile participants are asked to attend rehabilitative pro- attracting growing interest. For almost 15 years South Africa has been grammes and the rest are released with a warning. the target of a ‘global raiding’ of skilled professionals by several devel- oped countries. How to deal with the consequences of the resultant out- security industry by Private Security Industry and Regulation Authority. flow of health professionals is a core policy issue for the national gov- ernment. demolish Somali-owned stores. Police watch as members go from store to store and forcibly This paper aims to to examine policy debates and issues concerning close 15 shops. Residents say they do not support association’s actions. the migration of skilled health professionals from the country and to property and shops belonging to migrants. furnish new insights on the recruitment patterns of skilled health per- sonnel. The objectives of the paper are twofold: attacks, which left several injured. Q +C
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F97FI=H ment of skilled professionals from South Africa in the health June sector. The paper draws upon a detailed analysis of recruitment advertising appearing in the South African Medical Journal for the period 2000-2004 and a series of interviews conducted with 120 days violating terms of Immigration Act. They also protest poor conditions at centre. private recruiting enterprises. Q 5G98
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K=H< - key stakeholders in the South African health sector, the paper pant corruption entrenched in migrant deportation process. offers a series of recommendations for addressing the problem of skilled health migration. These recommendations are grounded Pakistani migrants. in both South African experience and an interrogation of inter- violently assaulting a Somali migrant. national debates and ‘good policy’ practice for regulating recruit- ment. assaulted and killed in less than one week. The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a seekers. wider literature that discusses the international mobility of talent. - Section Three reviews research on the global circulation of health pro- ited because they contribute to tensions between locals and migrants and could lead to more xenophobic violence. fessionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from residents attack migrant-run shops. Police urge traders to press charges against perpetrators. international to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews Somali to be shot dead that week. undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in July South Africa towards the outflow of skilled health professionals and the Somali, Chinese, Bangladeshi, Pakistani and Ethiopian migrants are attacked, raided and recruitment of foreign health professionals to work in South Africa. The some houses are set on fire. Nearly 600 persons are displaced.

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EXECUTIVEMitchells Plain.SUMMARY Nine shops are gutted and 20 looted over several days. Somali, Pakistani and Bangladeshi migrants are affected. document, saying it unfairlyealth workers targets migrant are one businesses of the categoriesand demonizes of skilledrefugees. profession- als most affected by globalization. Over the past decade, there has emergedAugust a substantial body of research that tracks patterns of international migration of health personnel, are raidedH and closed for operating without trading licenses. Migrant rights’ groups say selec- assesses causes and consequences, and debates policy responses at global tive enforcementand national of laws scales. sets “dangerous Within thisprecedent”. literature, the case of South Africa is cases of attractingxenophobia growingestablished interest. after May For 2008 almost “is only 15 active years when South there Africa is a prominent has been case of xenophobia.the target Otherwise of a ‘global it remains raiding’ invisible.” of skilled professionals by several devel- oped countries. How to deal with the consequences of the resultant out- flow of health professionalsSeptember is a core policy issue for the national gov- ernment. AssociationThis “declaring paper war” aims on to migrants. to examine policy debates and issues concerning the migration of skilled health professionals from the country and to cost taxpayers R4.7 million. furnish new insights on the recruitment patterns of skilled health per- sonnel. The objectives of theOctober paper are twofold: Q +C
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K=H< in January 2009. Co-accused faces ten years in jail. Magistrate says it was clearly xenophobickey and stakeholders pre-planned: in “no the civilized South society African should health tolerate sector, barbaric the conduct”. paper offers a series of recommendations for addressing the problem of skilled health migration.December These recommendations are grounded “threats” by irregularin both migrants South and African economic experience competition and from an migrants. interrogation of inter- national debates and ‘good policy’ practice for regulating recruit- ment. 2013 The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a wider literature that discusses the international mobility of talent. police vanSection and violently Three assaultedreviews inresearch custody. on the global circulation of health pro- fessionals, focusing in particular upon debates relating to the experience on theirof stores. countries More thanin the 25 developingshops are looted. world. Section Four moves the focus from international to South African issues and provides new empirical mate- this statusrial to drawn very few from of them. the surveyAcceptance of recruitment rates are less patterns than half andof the key global interviews average and it ranks undertaken36th globally withfor refugee health population sector recruiters size. operating in South Africa. Compiled bySection Sujata Ramachandran Five addresses and Sachilthe questions Singh using of various changing resources: policy ANC interventions Daily News Briefs, in SAPA, CoRMSA,South HumanAfrica Rights towards Watch, the Lawyers outflow for of Human skilled Rights, health Legal professionals Briefs Online, and SAHRC, the SAMP, Scalabrinirecruitment Centre, African of foreign Centre health for Migration professionals and Society, to Xenophobia.org,work in South Mail Africa. & Guardian The Online and other online news sources.

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EXECUTIVE SUMMARY Migration policy SerieS ealth workers are one of the categories of skilled profession- 1. Covert Operations: Clandestine Migration, Temporary Work and Immigration als most affected by globalization. Over the past decade, Policy in South Africa (1997) ISBN 1-874864-51-9 there has emerged a substantial body of research that tracks 2. Riding the Tiger: Lesotho Miners and Permanent Residence in South Africa Hpatterns of international migration of health personnel, (1997) ISBN 1-874864-52-7 assesses causes and consequences, and debates policy responses at global 3. International Migration, Immigrant Entrepreneurs and South Africa’s Small and national scales. Within this literature, the case of South Africa is Enterprise Economy (1997) ISBN 1-874864-62-4 attracting growing interest. For almost 15 years South Africa has been 4. Silenced by Nation Building: African Immigrants and Language Policy in the the target of a ‘global raiding’ of skilled professionals by several devel- New South Africa (1998) ISBN 1-874864-64-0 oped countries. How to deal with the consequences of the resultant out- flow of health professionals is a core policy issue for the national gov- 5. ernment. (1998) ISBN 1-874864-68-3 This paper aims to to examine policy debates and issues concerning 6. Trading Places: Cross-Border Traders and the South African Informal Sector the migration of skilled health professionals from the country and to (1998) ISBN 1-874864-71-3 furnish new insights on the recruitment patterns of skilled health per- 7. Challenging Xenophobia: Myth and Realities about Cross-Border Migration in sonnel. The objectives of the paper are twofold: Southern Africa (1998) ISBN 1-874864-70-5 Q +C
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K=H< Immigration Policy (1998) ISBN 1-874864-84-5. key stakeholders in the South African health sector, the paper 11. Building Skills: Cross-Border Migrants and the South African Construction offers a series of recommendations for addressing the problem of Industry (1999) ISBN 1-874864-84-5 skilled health migration. These recommendations are grounded 12. in both South African experience and an interrogation of inter- and Technikons (1999) ISBN 1-874864-89-6 national debates and ‘good policy’ practice for regulating recruit- 13. The Lives and Times of African Immigrants in Post-Apartheid South Africa ment. (1999) ISBN 1-874864-91-8 The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a 14. Still Waiting for the Barbarians: South African Attitudes to Immigrants and wider literature that discusses the international mobility of talent. Immigration (1999) ISBN 1-874864-91-8 Section Three reviews research on the global circulation of health pro- 15. fessionals, focusing in particular upon debates relating to the experience Mining Industry (1999) ISBN 1-874864-91-8 of countries in the developing world. Section Four moves the focus from 16. Borderline Farming: Foreign Migrants in South African Commercial Agricul- international to South African issues and provides new empirical mate- ture (2000) ISBN 1-874864-97-7 rial drawn from the survey of recruitment patterns and key interviews 17. Writing Xenophobia: Immigration and the Press in Post-Apartheid South Africa undertaken with health sector recruiters operating in South Africa. (2000) ISBN 1-919798-01-3 Section Five addresses the questions of changing policy interventions in 18. Losing Our Minds: Skills Migration and the South African Brain Drain (2000) South Africa towards the outflow of skilled health professionals and the ISBN 1-919798-03-x recruitment of foreign health professionals to work in South Africa. The 19. Botswana: Migration Perspectives and Prospects (2000) ISBN 1-919798-04-8

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20.EXECUTIVE The BrainS Gain:UMMARY Skilled Migrants and Immigration Policy in Post-Apartheid South Africa (2000) ISBN 1-919798-14-5 21. Cross-Border Raidingealth andworkers Community are one ofConflict the categories in the Lesotho-South of skilled profession- African Border Zone (2001)als mostISBN affected 1-919798-16-1 by globalization. Over the past decade, 22. there has emerged a substantial body of research (2001)that tracks ISBN 1-919798-30-7Hpatterns of international migration of health personnel, assesses causes and consequences, and debates policy responses at global 23. Gender and the Brain Drain from South Africa (2001) ISBN 1-919798-35-8 and national scales. Within this literature, the case of South Africa is 24. attracting growing interest. For almost 15 years South Africa (2002) has been ISBN 1-919798-38-2the target of a ‘global raiding’ of skilled professionals by several devel- 25. Zimbabweansoped countries. Who Move: How toPerspectives deal with theon consequencesInternational Migrationof the resultant in Zimba out-- bwe (2002)flow of ISBN health 1-919798-40-4 professionals is a core policy issue for the national gov- 26. The Borderernment. Within: The Future of the Lesotho-South African International BoundaryThis (2002) paper ISBN aims 1-919798-41-2 to to examine policy debates and issues concerning 27. Mobilethe Namibia: migration Migration of skilled Trends health and professionals Attitudes (2002)from the ISBN country 1-919798-44-7 and to furnish new insights on the recruitment patterns of skilled health per- 28. Changing Attitudes to Immigration and Refugee Policy in Botswana (2003) sonnel. The objectives of the paper are twofold: ISBN 1-919798-47-1 Q +C
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EXECUTIVE SUMMARY 41. The Quality of Migration Services Delivery in South Africa (2005) ISBN 1-920118-03-9 ealth workers are one of the categories of skilled profession- 42. States of Vulnerability: The Future Brain Drain of Talent to South Africa (2006) als most affected by globalization. Over the past decade, ISBN 1-920118-07-1 there has emerged a substantial body of research that tracks 43. Migration and Development in Mozambique: Poverty, Inequality and Survival Hpatterns of international migration of health personnel, (2006) ISBN 1-920118-10-1 assesses causes and consequences, and debates policy responses at global 44. Migration, Remittances and Development in Southern Africa (2006) ISBN and national scales. Within this literature, the case of South Africa is 1-920118-15-2 attracting growing interest. For almost 15 years South Africa has been the target of a ‘global raiding’ of skilled professionals by several devel- 45. oped countries. How to deal with the consequences of the resultant out- (2007) ISBN 1-920118-47-0 flow of health professionals is a core policy issue for the national gov- 46. Voices From the Margins: Migrant Women’s Experiences in Southern Africa (2007) ernment. ISBN 1-920118-50-0 This paper aims to to examine policy debates and issues concerning 47. The Haemorrhage of Health Professionals From South Africa: Medical Opinions the migration of skilled health professionals from the country and to (2007) ISBN 978-1-920118-63-1 furnish new insights on the recruitment patterns of skilled health per- 48. The Quality of Immigration and Citizenship Services in Namibia (2008) ISBN 978- sonnel. The objectives of the paper are twofold: 1-920118-67-9 Q +C
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F97FI=H ment of skilled professionals from South Africa in the health 49. Gender, Migration and Remittances in Southern Africa (2008) ISBN 978-1- sector. The paper draws upon a detailed analysis of recruitment 920118-70-9 advertising appearing in the South African Medical Journal for 50. The Perfect Storm: The Realities of Xenophobia in Contemporary South Africa the period 2000-2004 and a series of interviews conducted with (2008) ISBN 978-1-920118-71-6 private recruiting enterprises. 51. Migrant Remittances and Household Survival in Zimbabwe (2009) ISBN 978-1- Q 5G98
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K=H< 920118-92-1 key stakeholders in the South African health sector, the paper 52. Migration, Remittances and ‘Development’ in Lesotho (2010) ISBN 978-1-920409- offers a series of recommendations for addressing the problem of 26-5 skilled health migration. These recommendations are grounded 53. Migration-Induced HIV and AIDS in Rural Mozambique and Swaziland (2011) in both South African experience and an interrogation of inter- ISBN 978-1-920409-49-4 national debates and ‘good policy’ practice for regulating recruit- 54. Medical Xenophobia: Zimbabwean Access to Health Services in South Africa (2011) ment. ISBN 978-1-920409-63-0 The paper is organized into five sections. Section Two positions 55. The Engagement of the Zimbabwean Medical Diaspora (2011) ISBN 978-1- debates about the migration of skilled health professionals within a 920409-64-7 wider literature that discusses the international mobility of talent. 56. Right to the Classroom: Educational Barriers for Zimbabweans in South Africa Section Three reviews research on the global circulation of health pro- (2011) ISBN 978-1-920409-68-5 fessionals, focusing in particular upon debates relating to the experience 57. Patients Without Borders: Medical Tourism and Medical Migration in Southern of countries in the developing world. Section Four moves the focus from Africa (2012) ISBN 978-1-920409-74-6 international to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews 58. The Disengagement of the South African Medical Diaspora (2012) ISBN 978-1- undertaken with health sector recruiters operating in South Africa. 920596-00-2 Section Five addresses the questions of changing policy interventions in 59. The Third Wave: Mixed Migration from Zimbabwe to South Africa (2012) ISBN South Africa towards the outflow of skilled health professionals and the 978-1-920596-01-9 recruitment of foreign health professionals to work in South Africa. The 60. Linking Migration, Food Security and Development (2012) ISBN 978-1-920596- 02-6

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61.EXECUTIVE Unfriendly S Neighbours:UMMARY Contemporary Migration from Zimbabwe to Botswana (2012) ISBN 978-1-920596-16-3 62. Heading North: ealth The Zimbabweanworkers are one Diaspora of the incategories Canada of (2012) skilled ISBNprofession- 978-1- 920596-03-3 als most affected by globalization. Over the past decade, 63. Dystopia and Disengagement:there has emerged Diaspora a substantial Attitudes body Towards of research South Africa that tracks (2012) ISBNH 978-1-920596-04-0patterns of international migration of health personnel, assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is attracting growing interest. For almost 15 years South Africa has been the target of a ‘global raiding’ of skilled professionals by several devel- oped countries. How to deal with the consequences of the resultant out- flow of health professionals is a core policy issue for the national gov- ernment. This paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to furnish new insights on the recruitment patterns of skilled health per- sonnel. The objectives of the paper are twofold: Q +C
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K=H< key stakeholders in the South African health sector, the paper offers a series of recommendations for addressing the problem of skilled health migration. These recommendations are grounded in both South African experience and an interrogation of inter- national debates and ‘good policy’ practice for regulating recruit- ment. The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a wider literature that discusses the international mobility of talent. Section Three reviews research on the global circulation of health pro- fessionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in South Africa towards the outflow of skilled health professionals and the recruitment of foreign health professionals to work in South Africa. The

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southern AfricAn MigrAtion ProgrAMMe