A community clinic just north of Johannesburg has become the front line of the fight in South Africa over whether foreigners can access public health facilities.
What started as a small local effort in one region in 2022 spread when activists from the anti-immigration group Operation Dudula picketed some hospitals and clinics in the provinces of Gauteng and KwaZulu-Natal. They check IDs and prevent non-South Africans from entering the country.
“Dudula” is a Zulu word that means to remove something by force.
Despite some arrests, authorities appear unable to stop the picketing.
Their latest campaign location is in Dieplsoot, a poor town of more than 200,000 people near the country’s commercial hub.
On a cool spring Thursday morning, Sicelokuhle Moyo, dressed in a blue and beige skirt, heavy windbreaker jacket and black headwrap, set off early for the hospital.
The Zimbabwean, who has been living in South Africa since 2006, was going there as he often did to collect medicine for a chronic illness.
But this time, when I arrived at the gate, things were different.
Manned at the entrance were two men wearing white T-shirts with the slogan “Operation Dudula – Mass Deportation.” They required everyone to submit documentation before being allowed inside.
“I said I had a passport. They said they wouldn’t accept my passport. They said I only needed an ID card.” Mr. Moyo said, hiding his frustration behind a polite smile.
Despite this being a potential flashpoint, there was a strange calm and resignation, as people knew that Operation Dudula activists had been violent in the past.
Anyone unable to produce a South African identity card was turned away.
Mr. Moyo, who was walking slowly from the entrance, joined a group of women on the side of the road. Young children were strapped to their backs, waiting in uncertainty as to what would happen next.
Tendai Musvava, a woman in her 40s, faced the same fate.
“I was standing in line and they said they only need people with ID. I don’t have ID. I have a passport and I’m from Mozambique. So I can’t get the medicine because I don’t have ID,” she said.
Mr Musbaba, wearing a bright orange winter jumper and white hat, looked dejected.
“I think they just do what they want because it’s their country. I don’t have the authority to do anything. For now, I have to follow what they say. I have no choice.”
According to official statistics, there are about 2.4 million migrants living in South Africa, less than 4% of the total population. Most come from neighboring countries such as Lesotho, Zimbabwe and Mozambique, which have a history of providing migrant labor to their wealthier neighbors.
Xenophobia has long been a problem in South Africa, sometimes accompanied by deadly outbursts of violence, and anti-immigrant sentiment has become a major political issue.
Operation Dudula, which began as a campaign and was criticized for using force to make its case, has now become a political party with ambitions to run in next year’s local government elections.
Party leader Zandile Dabula insists the work his organization does in public clinics in Johannesburg and elsewhere is justified.
“We want to put South Africans first. We understand that emergency care should be sought, but if it is illegal, it should be handed over to law enforcement,” she told the BBC.
When challenged about the fact that many immigrants are living in the country legally, she pivoted to arguing that South Africans should be prioritized because they have the least resources.
“Life comes first. We don’t deny that, but it can’t be free for everyone. You can’t satisfy the whole world. It’s not enough for us.”
The Constitution guarantees the right to health care to everyone in the country, regardless of nationality or immigration status.
But Mr Dabula said the public health system, which covers nearly 85% of the population, was overburdened.
She says some people have to wake up at 4 a.m. and stand in long lines to get to their local clinic. Because I know that if I don’t get there on time, there won’t be any medicine left.
South Africa is a deeply unequal society with most of the country’s wealth in the hands of a few. Unemployment and poverty levels are high, and migrants, who often live in poor communities, are blamed by some for the problems people experience.
Operation Dudula’s methods found a sympathetic response among some Diepsloot residents.
One of them, South Africa’s Sipho Mohale, described Operation Dudula’s campaign as a “positive change”.
“When I’ve been here before the lines were very long, but this time it only took a few minutes to get the items out,” he said.
Another resident, Jennifer Shingange, also welcomed the participation of activists in Diepsloot.
“As South Africans, we come to clinics and find that we cannot get the medicine we need. But since foreigners stopped using clinics, it has made a difference,” she said.
Ironically, some South Africans have not been immune to anti-immigration campaigns.
They were also expelled from public health facilities because they could not produce identification cards. It is estimated that more than 10% of South Africans do not have proper documentation proving their nationality.
But what infuriates activists on both sides of the debate is the disregard for the Constitution in Operation Dudula’s actions.
“It’s a serious problem that you have groups that don’t have state approval for who comes in and who goes out,” said Fatima Hassan, a human rights lawyer at the Health Justice Initiative.
“If the government does not deal with this situation soon, it will lose its ability to enforce law and order itself.”
Deputy Health Minister Joe Phaahla told the BBC his government opposed targeting foreigners or anyone trying to use local clinics and hospitals.
“We do not agree with that approach because health is a human right. As long as we understand that service provision must be properly organized, we do not organize services in a way that amounts to harassment,” he told the BBC.
Several major political parties, including the Economic Freedom Fighters and the Democratic Alliance, also condemned Operation Dudula.
However, a recent attempt by the South African Human Rights Commission to take the matter to court failed on technicalities, effectively allowing the group to continue its campaign.
In recent weeks, several members of Operation Dudula have been arrested for blocking entrances to public health facilities. They were later released with a warning. However, police action appears to have failed to stop these groups.
Mr Hasan believes stronger measures are needed, saying “police and military should have been on the scene from day one because (the picketing) was simply illegal.”
Dr Phaahla said the measure was being considered but police “lacked the resources to monitor and intervene in a timely manner when these incidents occur”.
As the country hesitates about what to do, Operation Dudula is boldly turning its attention to public schools, saying it is part of a campaign to eradicate illegal immigration.
But in Diepsloot, the group’s actions prevented people from getting the medical help they needed.
Having been shunned, Mr. Musbaba is now looking for an alternative. Despite her limited resources, she is considering entering the private sector.
“I think I’m going to have to go to the doctor. I’m going to pay for it. I’m going to have to make sacrifices to get it,” she said.
She had no idea how much it would cost.
“I don’t have any money, but I think I need to make a plan.”
You may also be interested in:
