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Coming home to South Africa

- Delia du Toit

Migration myths, human rights and the ongoing struggle to make a house a home.

When does a house become home? Foreigners, no matter how long they have stayed in a country, are often not afforded the same rights as those born locally. How do we address this global human rights issue?

Migration study by GCRO. ©Paul Weinburg | 

Shortly before Human Rights Day this year, the Gauteng Department of Health released a circular in which it sought to limit foreign nationals’ access to healthcare services by requiring them to pay for all services. The circular, decried as an outrageous human rights violation – particularly in light of South Africa’s progressive Constitution – has since been rescinded, but experts aren’t convinced that this is the end of the matter. For some people, their house will never quite be home, if policy doesn’t change for the better. 

Fear and loathing 

The UCL-Lancet Commission on Migration & Health, published in December 2018, revealed that harmful and unfounded myths about migrants prevail that are used to justify policies of exclusion. 

The Commission is the result of a two-year project led by 20 experts from 13 countries and includes insights from the Medical Research Council (MRC)/Wits Agincourt Unit in the Wits School of Public Health

One of the most prevalent and harmful myths about migrants is that they bring disease into a host country and burden its healthcare systems. However, the Commission shows there is no systematic association between migration and the importation of infectious diseases. International migrants in high-income countries also have lower rates of mortality compared to general populations across the majority of disease categories. In addition, rather than being a burden, migrants are more likely to bolster services by providing medical care, teaching children, caring for older people, and supporting understaffed services – in the UK, 37% of doctors received their medical qualification in another country. 

The myth that migrants are an economic and job-drain on a country is also unfounded. In fact, the Commission showed migration contributes to global wealth distribution. Migrants sent an estimated $613b to their families of origin in 2017, three quarters of which were to low- and middle-income countries. This is an amount three times larger than official development assistance. In advanced economies, each 1% increase in migrants in the adult population increases the gross domestic product per person by up to 2%. 

The state of internal migration 

Sadly, these facts remain largely ignored when they don’t fit political rhetoric, says Associate Professor Jo Vearey, Director of the African Centre for Migration and Society (ACMS) at Wits and Vice-Chair of the global Migration, Health, and Development Research Initiative (MHADRI). 

“Migrants are often used as scapegoats for the poor functioning of public systems such as healthcare systems and in the national elections we’re seeing more use of this negative language linked to campaigning. This is not only a South African phenomenon. Moral panic surrounding the movement of people across borders is a global problem. Yet there is no evidence that foreign nationals bring disease, nor that they displace people from labour markets – in fact, they’re likely to create jobs,” says Vearey. 

Instead, unfounded or inflated statistics are often quoted. 

Migration myths 

The number of undocumented migrants in South Africa, for example, was estimated as high as 11 million by national Police Commissioner Khehla Sitole in 2018. But Vearey and most other experts put this number at between three to four million documented and undocumented migrants. 

Even if the politically quoted figures included internal migrants, the numbers don’t make sense. Dr Carren Ginsburg, Researcher in the MRC/Wits Agincourt Unit in the School of Public Health, says that based on data from the latest population census in 2011, 5.3% of the South African population (just under 2.7 million people) had migrated within the country’s borders in the preceding five-year period, while only 1,5% had migrated into South Africa from destinations outside the country (just over 740 000 people). 

The University College London-Lancet Commission shows that, worldwide, only a quarter of all migrants (an estimated 258 million people) are international migrants. In the past three decades, the number of international migrants as a percentage of the world’s population has changed very little – from 2.9% in 1990 to 3.4% in 2017. Approximately 65% of international migrants are labour migrants and a much smaller proportion are refugees and asylum seekers. 

The South African Constitution does not afford rights only to citizens – South Africa belongs to all who live in it. The Constitution provides for the right to access healthcare services and that no one may be denied emergency medical treatment. 

Furthermore, the National Health Act specifically provides that, regardless of nationality, all persons are entitled to free primary healthcare services as long as they do not belong to medical schemes. Pregnant or lactating women and children below the age of six are entitled to free healthcare services. 

Yet even internal migrants are currently disadvantaged by the lack of planning and systems surrounding migration, says Vearey. 

“Though non-nationals face additional challenges, the majority of South African migrants struggle to access healthcare services. There is no mandate or support for migration, whether international or internal. As an example, orders of antiretroviral drugs are currently based on head counts for the previous month. But when internal labour migrants return home over Christmas and Easter, say from Gauteng to Limpopo, no provision is made for them. South Africa will struggle to meet its targets in treating HIV, malaria and TB if these treatment gaps aren’t addressed.” 

Ginsburg agrees. “Migration is an important means of creating wealth in rural areas. Our research in Bushbuckridge, Mpumalanga, shows that young adults will work for a number of years in Gauteng, while periodically going home to their original households. They send money to these households and there remains a strong interconnectedness between family members. Yet they may encounter difficulty accessing healthcare services in Gauteng, compromising their health. Better monitoring and planning are essential.” 

Future perfect 

Professor Loren Landau, South African Research Chair in Human Mobility and the Politics of Difference at the ACMS and formerly a member of the South African Immigration Advisory Board, says mobility should  be seen as a move towards empowerment – the opposite of the current way of thinking. 

“People who move do so in the hopes of improving life for themselves and others. Where communities have embraced migration as a form of development and diversification, the responses can be positive on aggregate. However, we have increasingly seen – in South Africa and elsewhere – that outsiders are used as a scapegoat to further personal economic and political ends. It is fear and those who play on it that accounts for the continuation of unfounded myths.” 

By focusing on migrants as the source of South Africa’s very real economic and health challenges, we are distracting ourselves from solutions that could benefit everyone, he adds. “Migrants represent a very small percentage of the population. If they stopped coming, there would be little change in health, joblessness or crime. Stopping migration is not beneficial, nor practical. Instead, policy makers must respond to people’s desire and mobility. Policy should be pragmatic, informed by humanity and an elaborated understanding of our collective self-interest.” 

Attitudes on the ground 

The Gauteng City-Region Observatory (GCRO), an institutional collaboration between Wits, the University of Johannesburg and the Gauteng Provincial Government, asked over 30 000 respondents about their attitudes towards various societal aspects, including migration. The results were released in a research report entitled Social cohesion in Gauteng in February 2019. 

Respondents from households with a monthly income of more than R38 400 were the least likely to feel that foreigners must be sent home (17%), while those with a monthly income of less than R1 600 were the most likely to feel that foreigners must be sent home (26%). This suggests that reducing socioeconomic inequality could promote greater social cohesion, says the report.

  • Delia du Toit is a freelance journalist.
  • This article first appeared in Curiosity, a research magazine produced by Wits Communications and the Research Office
  • Read more in the seventh issue, themed: #Ekhaya (isiZulu for ‘home’) about our homegrown research that crosses borders and explore the physical spaces we inhabit, where we feel we belong, where we’re from and what we identify with, including the physical/psychological space we may return to – or reject.