No Healing Here Violence, Discrimination and Barriers to Health for Migrants in South Africa Copyright © 2009 Human Rights Watch All rights reserved. Printed in the United States of America ISBN: 1-56432-579-2 Cover design by Rafael Jimenez Human Rights Watch 350 Fifth Avenue, 34th floor New York, NY 10118-3299 USA Tel: +1 212 290 4700, Fax: +1 212 736 1300 [email protected] Poststraße 4-5 10178 Berlin, Germany Tel: +49 30 2593 06-10, Fax: +49 30 2593 0629 [email protected] Avenue des Gaulois, 7 1040 Brussels, Belgium Tel: + 32 (2) 732 2009, Fax: + 32 (2) 732 0471 [email protected] 64-66 Rue de Lausanne 1202 Geneva, Switzerland Tel: +41 22 738 0481, Fax: +41 22 738 1791 [email protected] 2-12 Pentonville Road, 2nd Floor London N1 9HF, UK Tel: +44 20 7713 1995, Fax: +44 20 7713 1800 [email protected] 27 Rue de Lisbonne 75008 Paris, France Tel: +33 (1)43 59 55 35, Fax: +33 (1) 43 59 55 22 [email protected] 1630 Connecticut Avenue, N.W., Suite 500 Washington, DC 20009 USA Tel: +1 202 612 4321, Fax: +1 202 612 4333 [email protected] Web Site Address: http://www.hrw.org December 2009 1-56432-579-2 No Healing Here Violence, Discrimination and Barriers to Health for Migrants in South Africa Map of South Africa ............................................................................................................ 1 Executive Summary ............................................................................................................ 2 Abuses Leading to Health Vulnerability .......................................................................... 6 Violence ................................................................................................................... 6 Living Conditions ...................................................................................................... 6 Barriers to Accessing Health Care .................................................................................... 7 Discrimination ........................................................................................................... 7 Inadequate and Inaccurate Information .................................................................... 8 Barriers to emergency care for rape survivors ........................................................... 9 Extra-legal User Fees ................................................................................................ 9 Key Recommendations ...................................................................................................... 11 Methodology .................................................................................................................... 12 Background .......................................................................................................................14 Migrants in South Africa ................................................................................................ 14 Zimbabweans .......................................................................................................... 15 Rights of asylum seekers and refugees .......................................................................... 16 Internally Displaced Non-Citizens .................................................................................. 21 Health Rights of Migrants in South Africa ...................................................................... 23 Health Vulnerabilities of Migrants to South Africa ............................................................ 26 Communicable Diseases ............................................................................................... 27 HIV .......................................................................................................................... 27 Tuberculosis ........................................................................................................... 29 Cholera ................................................................................................................... 30 Violence ........................................................................................................................ 31 Sexual and Gender Based Violence ......................................................................... 35 Shelter/Living Conditions ............................................................................................. 39 Urban refugees, asylum seekers and undocumented migrants ............................... 40 Formal and Informal Camps .................................................................................... 43 Food insecurity ............................................................................................................. 48 Barriers to Obtaining Health care ..................................................................................... 54 Discrimination ............................................................................................................... 54 Inadequate and Inaccurate Information ........................................................................ 60 Barriers to care for rape survivors ................................................................................. 63 User Fees ...................................................................................................................... 66 Legal Rights ..................................................................................................................... 73 Domestic Law ................................................................................................................ 73 International Law .......................................................................................................... 76 The Right to Health ................................................................................................. 76 Non-discrimination ................................................................................................. 78 Recommendations ............................................................................................................ 81 To the South African Human Rights Commission............................................................ 81 To the South African Department of Health .................................................................... 81 To the South African Department of Home Affairs ......................................................... 83 To the South African Department of Social Development .............................................. 84 To the South African Government ................................................................................. 84 To the South African Police Service ............................................................................... 84 Acknowledgments ............................................................................................................ 86 Annex 1: Email Correspondence with the Department of Health, Republic of South Africa .. 87 Map of South Africa ©2007 United Nations Department of Peacekeeping Operations. 1 Human Rights Watch | December 2009 Executive Summary “There is no healing here in South Africa. Since I arrived here there is no rest, no recovery.” — Ndona, Congolese refugee, Johannesburg Ndona speaks for the many thousands of migrants in South Africa who were made homeless by xenophobic attacks in 2008, forced to take shelter in unsafe and unsanitary camps, abandoned buildings, churches, and on open ground, where they are vulnerable to disease and further violence. Refugees like Ndona fleeing war in places like the Democratic Republic of the Congo (DRC) and Somalia and economic and political crises in places like Zimbabwe, have found themselves without the most basic human rights fundamental to life: food, shelter, physical security, and access to basic health care. As shocking as the severity of the xenophobic violence is the fact that such widespread abuses are tolerated in South Africa, a country with some of the most expansive rights in the world for refugees and other migrants. The widespread violence and displacement leading to homelessness and unsafe living conditions, along with systemic government failures to protect migrants from arrest and deportation, has created a massive health crisis for migrants—and their hosts—in South Africa. Xenophobia, violence, and discrimination create both environments that promote risks to migrants’ health as well as barriers to obtaining basic health care. South Africa's Constitution provides for the right to health for “everyone” within the country. In recent years, this provision has been tested as regional crises created unprecedented numbers of asylum seekers and undocumented migrants entering there. Since 2007 the Department of Health (DOH) has repeatedly affirmed the rights of asylum seekers and refugees to access the same public health care to which citizens have access. However during this same period, documented and undocumented migrants alike have been denied access to health care. Even when seeking emergency care after xenophobic attacks or rapes, migrants are often turned away by medical personnel who may discharge them prematurely, harass them, charge them excessive user fees, and call the police to deport them. But the risks to health and barriers to care that migrants experience in South Africa are not the responsibility of the DOH alone. The South African asylum system has failed for years to provide protection to asylum seekers and recognized refugees due to systematic problems. Restrictive immigration provisions leave many labor migrants, long