Musina, formerly a relatively prosperous mining town, lies on Africa’s busiest commercial border, the main road from Makhado to Beitbridge, located midway between Johannesburg, South Africa and Harare, Zimbabwe.

Zimbabwean migrants in Musina township generally work as farmworkers or informal labourers to earn money for their basic needs and to provide for their families still in Zimbabwe. Often fear of deportation and abuse prevents Zimbabwean migrants from using public health services. As a result, chronic infectious diseases like tuberculosis (TB) and HIV go unchecked and medical needs, such as urgent deliveries, leave women vulnerable. Zimbabweans are presently the largest migrant group in South Africa.

“Zimbabwean migrants face major risks, including sexual violence, physical and verbal abuse, and police harassment, both when crossing the border and in South Africa, where many are unable to find sustainable employment,” says Sylvie Kaczmarczyk, MSF field coordinator in Musina. These factors, together with their unclear legal status, lead to a very precarious situation and to general insecurity, which affects both physical and mental health.

The South African constitution guarantees access to healthcare to all those who live in the country, including migrants. However, with unemployment ranging from 25 to 40 percent in South Africa, they are increasingly viewed as intruders, creating more obstacles, such as access to services, for migrants in need of healthcare and medical treatment and exacerbating trauma endured.

MSF provides healthcare on commercial farms on the eastern border of Limpopo and has fixed consultation points in Musina township in Happer, Campel and Matswale. In the first quarter of 2008, there were more than 800 consultations each month. Headache, cough, skin diseases, pain, and sexually transmitted infections are among the main complaints.

MSF healthcare in central Johannesburg

In the MSF waiting room, a mother of a seven-month-old baby speaks of the conditions she has faced and her reasons for coming to MSF: “I came to South Africa with only the clothes I was wearing; the women at the church gave me clothes for my baby. My baby has not been immunized and I have been to three clinics in Johannesburg since December 2007 and no-one wants to immunize my baby. I came here to MSF because my baby needs his vaccinations and I’m worried that he may not be able to walk one day.”

The MSF health facility in Johannesburg is next to the Central Methodist Church, a shelter for 1,200 to 1,500 migrants, mostly Zimbabwean nationals. The migrants coming to MSF are traumatized by crossing the border and the situation faced in South Africa. It is difficult to find work and there is a real fear of deportation. Concentrated in and around the church, the migrants have limited sleeping space, poor ventilation and unhygienic conditions as a consequence of overcrowding. The church is considered by most living in it as their only safe haven, but recently this sense of safety was threatened. On January 30, South African Police raided the church, physically assaulting and arresting most of the residents.

A previously existing healthcare facility was operated once a week by volunteer health workers. However, the need for structured medical care for migrants and for medical referrals to help access the public health service, led to MSF establishing a staffed facility. The team provides basic health services and refers patients to the public health system for specialised medical treatment. Primary health care provided at the facility also includes individual and group counselling, an added medical value since the raid. There are presently three weekly counselling support groups: a raid aftermath group; an HIV group, and a men’s group. Groups for teenagers/adolescents and for mothers will commence in April 2008. In January 2008, the MSF team made 98 clinical referrals for HIV, TB and other chronic diseases, and conducted a total of 861 consultations. In February there were 1,144 consultations and 198 individual counselling sessions, and 125 referrals were made. During March, the team saw 890 patients, referred 71, and had 171 individual counselling sessions.

Bianca Tollboom is a nurse in the MSF team that assists Zimbabwean migrants in Johannesburg. Bianca tells us: “From January to March most of the patients we saw came for upper respiratory tract infections and pain, and with the diagnosis of sexually transmitted infections we notice a steady increase. The majority of patients seen by our MSF team in Johannesburg are Zimbabwean male adults who live in the church.”

MSF has witnessed the trauma Zimbabwean migrants endure living in perpetual fear and constant pain. The MSF project is an important response to the needs of Zimbabwean migrants living in South Africa.

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