There have been numerous instances lately of xenophobic groups preventing people from entering public healthcare facilities because they did not possess South African identity documents. As related cases slowly grind through the courts, Teri Brown and Thembi Mahlathi of SECTION27 – writing for Spotlight – connect the dots between what the law says and what people are experiencing.
They write:
Over the years, many migrants and undocumented people have contacted SECTION27, where we both work, for assistance. These were often pregnant women, lactating mothers and children under six, who were denied access to healthcare facilities.
Initially, it was easy to simply write a letter to hospital and clinic personnel where our clients were being turned away at the doors. But the situation got significantly worse, and more and more migrants were being barred from entering these facilities.
Writing letters and asking for meetings clearly wasn’t enough anymore.
We went to court and in April 2023 got an order in which the South Gauteng High Court held that important sections of the National Health Act apply to all pregnant women, lactating women and children under six, irrespective of their documentation status.
This affirmed that in South Africa, they have the right to free healthcare services at all public health establishments, including hospitals and clinics.
Public sector hospitals and clinics are required to assess the status of migrants and then apply a lawful means test to determine the services that can be offered to them.
However, this does not appear to be done routinely. Instead, particular focus is often placed on South African identity documents, while other forms of documentation held by migrants are disregarded.
Entry to Rahima Moosa Mother and Child Hospital in Coronationville and South Rand Hospital in Rosettenville as well as several clinics across Gauteng has been denied to patients, including South African nationals, who actually have the necessary documentation.
Furthermore, we are aware that to avoid being refused healthcare and to demonstrate the urgency of their need for treatment for themselves or their children, migrants have sometimes been forced to disclose their HIV status.
In mid-2025, we started receiving a surge of calls from clients complaining about not being able to enter public sector clinics where they had previously been assisted. They said a group of people outside these clinics requested their identity documents, and when they produced these, confirming either their refugee status or asylum seeker status, they were unlawfully prevented from entering.
These groups explicitly told them that they should go to a private clinic for treatment or go back to their home country.
Thus, two years after the April 2023 court order, the denial of access to healthcare had worsened: it was not only women and children who could not enter clinics, but anyone who could not provide South African identity documentation.
It wasn’t just healthcare staff denying access, but vigilante groups stationed outside the facilities.
Despite the crisis being widely reported, the state failed to address it effectively. We had no choice but to return to court, which again found in our favour.
In December 2025, the South Gauteng High Court ordered the state to take immediate and decisive action to end the obstruction of access to public healthcare facilities. The case was brought by the Treatment Action Campaign, Doctors Without Borders, and Kopanang Africa Against Xenophobia, all represented by SECTION27.
In this landmark judgment, Judge Stuart Wilson concluded that the state entities tasked with upholding the constitutional mandate to safeguard everyone’s right to access healthcare had failed. Consequently, this failure violated the constitutional rights of patients seeking care at the Yeoville and Rosettenville clinics.
Despite this court order, our monitoring found ongoing vigilante activity at the two clinics. The applicants then launched an urgent contempt application, heard last month, arguing that the state had failed to fully comply with Judge Wilson’s court order.
After this, a court-ordered settlement agreement was reached with the Gauteng Department of Health and other respondents. Among other things, it required the authorities to take reasonable steps to ensure safe and unhindered access to the Yeoville and Rosettenville clinics, and to report on the implementation by 18 May 2026. It also makes provision to continue legal proceedings if necessary to enforce full compliance with Judge Wilson’s order.
Laws governing healthcare for migrants in South Africa
Taking a step back, and this specific set of facts, it is worth remembering that South African law really does provide extensive protection to migrants needing healthcare services.
This is guaranteed by section 27 of our Constitution, stating that everyone has this right, and that no one may be refused emergency medical treatment. The term “everyone” is not restricted to South Africans only. It includes everyone within the borders of South Africa, regardless of their nationality.
This right extends to all children living in South Africa under section 28(1)(c) of the Constitution. This guarantees their access to basic healthcare services dependent on the availability of resources, to which they can never be completely denied.
After the Constitution, the most important piece of healthcare legislation relevant to migrants is the National Health Act (NHA), which assists in giving effect to the constitutional right to basic healthcare services by outlining who can receive fee services at public clinics. It obligates the provision of these free services to pregnant or breastfeeding women, or children under six.
Moreover, the NHA requires that free primary healthcare be provided to those without medical aid.
It also makes it clear that those working in healthcare cannot refuse any person emergency medical treatment.
Along similar lines, South Africa’s Refugees Act states that a refugee is entitled to full legal protection, including the rights set out in the Bill of Rights, except those reserved for citizens.
The Act formally acknowledges that refugees are entitled to the same basic healthcare services and primary education that South African citizens receive. While it does not expressly cover undocumented migrants, it is grounded on the principle of non-discrimination, which supports equal access to essential services.
South Africa is also party to several international and regional human rights instruments that prohibit discrimination and guarantee equal access to healthcare for all. These include the African Charter on Human and Peoples’ Rights, the Convention Relating to the Status of Refugees, the International Covenant on Economic, Social and Cultural rights, the Convention on the Rights of the Child, and the Convention on the Elimination of All Forms of Discrimination against Women.
Why all of this matters
The denial of healthcare has significant impacts on many aspects of people’s lives. Migrants often become so desperate to receive care that they feel compelled to disclose their HIV status, which infringes on their rights, particularly the constitutional rights to privacy and dignity. It also creates feelings of stigma and discrimination, further marginalising people who are often already vulnerable.
There are also direct health consequences. Denying treatment to a migrant not only negatively affects that person’s health, it can also result in the continued transmission of infectious diseases to both other migrants and South Africans.
For example, HIV and TB typically become non-infectious a while after someone starts treatment. Deciding not to treat someone ends up harming everyone. As untreated conditions worsen, it may require emergency medical attention that could have been avoided through early treatment.
All of this places extra pressure on an already fragile health system – which could be avoided by providing more migrants with healthcare service as soon as they need it.
The failure to provide these services also affects their livelihoods and well-being. For those who run their own businesses, this may prevent them from working altogether and could lead to them and other people, possibly South Africans, losing their jobs. Ultimately, this has a ripple effect on the country’s economy, job security, and perpetuates cycles of poverty and vulnerability.
At its heart then, this issue is about who we choose to be as a society. Turning people away at their most vulnerable moments erodes not only their dignity, but also their humanity and ours.
In a country built on the values of equality and dignity, we cannot allow this attack on our basic humanity and decency to succeed. We are, and must be, better than that.
*Brown is a legal researcher and Mahlathi is a paralegal with SECTION27. In the court case discussed in this article, SECTION27 represented the Treatment Action Campaign, Médecins Sans Frontiers, and Kopanang Africa Against Xenophobia.
See more from MedicalBrief archives:
Judge orders government, police to block anti-migrant vigilantes
Second legal bid to get authorities to act against Dudula vigilantism
Court orders Operation Dudula to stop targeting migrants
Interdict bid against Operation Dudula dismissed over lack of urgency