South Africa: Discrimination of foreign patients in Gauteng

October 20, 2013

In August 2013, a number of notices appeared in hospitals in Gauteng Province, South Africa.  Apparently sent by the Gauteng Department of Health, they urge hospital staff to demand full, up-front payment from patients without permits or refugee documents, or who are asylum seekers. A clear example of a dual loyalty dilemma, Marliese Richter and Jo Vearey claim.

A draft Gauteng Department of Health policy entitled ‘Non-South African citizens (foreign patients) Guidelines’ stipulated specifically that “foreign Patients without any documentation or permits shall not be refused emergency medical treatment as outlined on the National Health Act No.61 of 2004. For non-emergency treatment, documentation and payment should be provided.”

Immigration officials?

According to Richter (International Center for Reproductive Health) and Vearey (African Centre for Migration & Society), these draft guidelines appear not to be evidence-based. They also propose turning frontline health care staff into immigration officials. “In essence, the guidelines indicate that hospital staff are expected to police the healthcare system and to remove people that the health authorities may deem undesirable. This creates a powerful example of Dual Loyalty.” The International Dual Loyalty Working Group has defined dual loyalty as “simultaneous obligations, express or implied, to a patient and to a third party, often the state.”

Should a health worker assist a foreign patient without the necessary papers, thus violating the Province’s policy, or should he turn the patient away? Following current medical ethics Richter and Vearey state that “the health care worker’s duty is to assist the patient with her ailment. This should not be dependent on the patient’s race, nationality or socio-economic status. The draft Gauteng Guidelines demanding upfront payment and the provision of document violate this duty and the law.” The authors conclude their blog article by encouraging health-care providers to document such practices and report these to democracy-supporting bodies such as the South African Human Rights Commission and relevant NGOs.

Health and human rights of migrants

The International Organization for Migration (IOM) published a report recently on the health and human rights challenges that migrants face. Besides discrimination in the health sector, these include lack of attention for health problems of migrants that are not well known or understood in their new countries of residence; legal and socioeconomic barriers impeding access to health services; and lack of migrant-sensitive or culturally and linguistically appropriate health services.

The publication was written by staff of IOM, the World Health Organization and the Office of the High Commissioner for Human Rights. Its aim is to provide all stakeholders with a reference on key health and human rights issues in the context of international migration. The report is meant to provide inspiration to policymakers to devise migration policies and programmes that are guided by both public health considerations and by human rights imperatives.


Dual Loyalty and Migrant Health in South Africa, Southern African HIV Clinicians Society blog, October 2013

International Migration, Health and Human Rights, IOM, 2013, 64 p.