Sylvia ChebetThe sterile corridors of public hospitals in South Africa have become unexpected flashpoints in South Africa's immigration tensions.
For Ndlovu*, a 34-year-old pregnant Zimbabwean based in Gauteng province, what should have been routine hospital visits in her last trimester have become an ordeal laced with fear worse than a medical issue.
Ndlovu's pregnancy is classified as high-risk, requiring her to avoid stress at all costs. But that's one advice she is finding hard to follow. With the baby due shortly, her worries seem to be increasing as accessing healthcare becomes challenging for foreign nationals targeted by vigilantes.
During one hospital visit, Ndlovu encountered members of "Operation Dudula" — a name derived from the isiZulu word for "force out" or "uproot". This anti-immigrant group has been targeting public healthcare facilities across Gauteng and KwaZulu-Natal provinces.
"A friend at the hospital was telling me about another hospital where foreigners were being chased away, and we were hoping and praying that they wouldn't get to us. Then, suddenly, a group entered the hospital and did exactly what we were fearing," Ndlovu recounts to TRT Afrika.
Institutional response
Amid growing unease over repeated attempts to drag healthcare into the cauldron, the reported arrest of three members of the Dudula outfit and a statement by the anti-xenophobia organisation Kopanang Africa (KAAX) have fuelled hope among foreign nationals caught in the complex intersection of immigration policy and healthcare access.
KAAX views the friction observed outside numerous healthcare facilities in South Africa as part of an attempt to exploit what it calls "legitimate frustrations" among communities regarding rising unemployment and poor service delivery.
"Xenophobia is not a solution to service delivery failure. It is a violation of human rights. Spread this message. Challenge the hate," says a post from the organisation's official X handle.
"We view the violent exclusion of foreign nationals from healthcare facilities as a grave violation of South Africa’s constitutional and human rights framework."
Targeting of foreign nationals by blocking healthcare access has intensified despite the South African government's stated zero-tolerance policy towards what is being termed "medical xenophobia".
Back in 2022, soon after an instance of picketing outside Kalafong Hospital in Atteridgeville by members of Operation Dudula, President Cyril Ramaphosa articulated what officially remains the government's stance.
"Acts of lawlessness, intimidation and humiliation directed at foreign nationals, whether they are documented or undocumented, should not be tolerated," Ramaphosa told parliament in a televised address.
Experts say the renewed crisis underscores the need for comprehensive approaches that address both concerns about resource allocation and the fundamental right to healthcare, regardless of nationality.
Snowballing crisis
The global medical charity Médecins Sans Frontières (MSF), also called Doctors Without Borders, has documented the presence of Operation Dudula members in more than half of the 15 healthcare facilities across the affected provinces.
Jane Rabothata, MSF's communication specialist in South Africa, describes arriving at one facility to find it unusually quiet.
"The reason we were not seeing a lot of people – in fact, there was no one – was because they had chased all the people," she says.
MSF learnt about the organisation's strategy from a female member at one such clinic. "She told us they come as early as they can, knowing that people who aren't South African citizens generally visit these facilities early in the morning to avoid trouble," Rabothata tells TRT Afrika.
MSF personnel encountered a mother who had been turned away from a hospital before her two children could receive their scheduled vaccinations. A pregnant woman with a history of miscarriage was worried about her well-being after learning about her peers having been turned away.
In one viral video, a Congolese man is seen pleading with Dudula members to allow his visibly ill relative in a wheelchair to receive treatment, only to be told to "shut up and leave".
Question of rights
MSF warns that continued denial of treatment in the name of anti-immigrant sentiments could overwhelm the healthcare system when emergency cases or complications arise that could have been prevented with routine care.
"Our Constitution guarantees everyone the right to free public healthcare, regardless of their status or where they come from. Hence, we want to ensure that people's right to access medical care is respected," says Rabothata.
The humanitarian organisation has been calling for police protection at the affected facilities and hopes the department of health will develop lasting solutions to what it describes as a recurring problem.
Parliamentary voices have also joined the criticism. Makhi Feni, chairperson of the Select Committee on Education, has condemned Operation Dudula's actions, describing them as persecution of people who entered South Africa seeking help.
"The actions of Operation Dudula are objectionable and an unnecessary distraction to the work the government is doing around immigration challenges. People do not just come to South Africa out of free will, but for refuge and from hunger," says Feni.
The legislator is even more alarmed by the Dudula group's plan to target schools in 2026, warning that such actions could misrepresent the country's democratic values.
"South Africa is a country of law and order, and these should be strictly adhered to," he says. "We cannot all adopt vigilante tactics when dealing with a challenge everyone accepts as massive and worthy of resolution. Legislative amendments and means are being proposed to resolve this challenge."
Daily struggles
Ndlovu's experience while seeking medical care mirrors a pattern that Dudula members follow.
A member of the group typically approaches patients in the hospital's waiting area, greeting them before producing a South African identity card. "He waves it and walks around, displaying the card. He then says that if any of us doesn't have something like what he is holding, we should start getting out," recounts the Zimbabwean mother-to-be.
The timing couldn't have been worse for Ndlovu, who makes a living selling food on the streets.
She had been referred to the hospital by a local clinic for advanced care after developing pregnancy-induced high blood pressure.
"Eventually, it occurred to me that I would be risking my life if they found out I am not South African. Even though I needed a check-up, I decided to leave," she tells TRT Afrika.
But Ndlovu hasn't given up hope of reconciliation and better understanding between people of all nationalities living in South Africa.
"We are one, we are black, let's love one another. When the other person is falling, let's pick them up," she says, hoping her words and the efforts of organisations like MSF will temper Operation Dudula's approach.
*The patient's name has been changed to protect her identity.
