By: Tamuka Chekero and Alois Muzenje | Date: November 7th, 2025
South Africa’s legal and constitutional frameworks formally enshrine healthcare as a universal human right. Section 27 of the Constitution guarantees everyone the right to access healthcare services, including reproductive care, sufficient food and water, and social security, while obligating the state to realize these rights within its available resources progressively. Section 27(3) ensures that emergency medical treatment cannot be denied, regardless of an individual’s financial status or citizenship. South Africa has also domesticated several international commitments related to migrant health, including the 2008 World Health Assembly (WHA) resolution on the health of migrants. Provisions within the National Health Act—such as those ensuring universal access to primary healthcare—and the Refugees Act of 1998—which guarantees refugees’ right to the same basic health services as citizens—reflect this commitment. While these do not directly codify the WHA resolution, they demonstrate South Africa’s intent to align national policy with international standards on migrant health.
Yet the lived reality for many migrants is starkly different. Despite legal protections, undocumented migrants, particularly women and children, routinely face denial of healthcare. Migrant women in South Africa, a vital destination town, frequently cannot access state reproductive healthcare due to a lack of proper documentation. Pregnant women and children under six, who are legally entitled to free services, often encounter “medical xenophobia”: discriminatory practices by healthcare providers who refuse treatment based on nationality or paperwork. As a result, many women turn to private healthcare despite high costs or rely on informal social networks for care, including through churches or community connections, where personal relationships rather than formal institutions mediate medical support. The disjuncture between what exists on paper in South Africa’s policy framework and the papers migrants possess (passports and permits) in practice reveals how bureaucratic regimes shape unequal access to healthcare. Migrants without documentation often navigate this exclusion through alternative social networks, such as churches, where medical care is reconfigured within a religious and relational register.
The Politicization of Health
Migration in South Africa is increasingly framed as a site of threat, and public health has become deeply politicized. Social movements like Operation Dudula and Put South Africans First promote narratives portraying migrants as burdens on public services. Migrants are scapegoated for structural failures in healthcare systems, including staff shortages, underfunding, and mismanagement. Yet data reveal that migrants constitute less than 4% of the population and actively avoid hospitals due to fear of arrest or discrimination. The problem lies not in migration but in chronic mismanagement, underfunding, and weak governance.
By reinforcing social and institutional barriers, the label “migrant” transforms healthcare from a right into a contested privilege. Access to care is increasingly facilitated by documentation, legal status, and social networks, meaning that survival often depends on navigating relationships rather than relying on formal or legal entitlements. This dynamic demonstrates how borders are not merely physical but also social, shaping who is considered worthy of care and protection.
Constitutional Protections vs. Everyday Exclusion
Section 27 of the Constitution is unambiguous in its guarantee of health rights. The Constitutional Court, in cases such as Soobramoney v Minister of Health, (KwaZulu-Natal), recognized the right to health while also acknowledging resource constraints. Similarly, Mazibuko v City of Johannesburg emphasized the reasonableness of state policies while upholding the right to access sufficient water. While the law establishes a framework for equitable access, its application is deeply uneven.
The National Health Act mandates non-discriminatory provision of services and explicitly requires attention to vulnerable populations, including migrant women and children. Section 27 obliges healthcare practitioners to respect these rights and ensure that no individual is denied care. Despite these obligations, multiple reports, including those by Doctors Without Borders (MSF), reveal that migrant women and children are denied essential maternal and pediatric services across South Africa.
During the broader fieldwork for the project that informed this blog, a conversation was held with Tendai’s mother, a 32-year-old Zimbabwean woman. Tendai, a four-year-old child diagnosed with gastroenteritis, was unable to access the specialist care required in Johannesburg. Although South African law, under Section 27, entitles children under six to free healthcare, hospital staff demanded payment before opening her medical file, effectively treating the exemption as applicable solely to South African nationals. Tendai’s mother recounted:
When I arrived at the hospital, I expected the nurse to treat my child’s case as an emergency since she couldn’t talk or eat, but they let me sit on the bench in the corridors for hours before one of them dismissed me, saying if I didn’t have money, my child couldn’t be attended to. I ended up leaving without treatment.
The consequences are devastating: lack of regular care results in poorly managed health conditions, increasing vulnerability and suffering. Operation Dudula and related community-based movements routinely deny pregnant women access to healthcare.
Migrant Survival Strategies: Conviviality and Social Navigation
Faced with exclusion and hostility, migrants have developed adaptive strategies rooted in social networks and informal solidarity. Horizontal community structures, often facilitated through WhatsApp groups, neighborhood networks, and religious institutions, provide access to healthcare, financial assistance, and protection from immigration enforcement. These strategies demonstrate practical applications of the Shona concepts of hushamwari (friendship) and conviviality, highlighting relational approaches to survival.
Migrant women also rely on informal or “extra-state” medical access. Healthcare providers who deny migrants access to official institutions may still be available through personal connections in churches or community networks, where care is often mediated through trust and social obligation. This blurring of boundaries between formal healthcare and informal relational care reflects a critical site of negotiation, demonstrating how social and moral networks compensate for institutional exclusion.
These adaptive practices illustrate the limitations of a purely legalistic framework for health rights. While the Constitution and international protocols provide a foundation, they cannot ensure access when bureaucratic, social, and political barriers persist. Migrants’ everyday strategies reveal the importance of relationality and social mediation in realizing health outcomes, echoing anthropological insights on interdependence, kinship, and community-based resilience.
Debunking the “Healthcare Burden” Myth
The widespread narrative that migrants “overburden” the healthcare system is factually inaccurate. Government data confirm that migrants represent a small fraction of the population, and when they do seek care, they often pay out of pocket at higher rates than locals. Systemic challenges such as staff shortages, crumbling infrastructure, and budgetary constraints — are the fundamental drivers of public healthcare crises. Xenophobic movements exploit these systemic failures to redirect public anger toward the most vulnerable, echoing global patterns of scapegoating and fear-driven politics.
Political rhetoric and misinformation exacerbate the problem. Statements suggesting that foreigners are “abusing” the healthcare system ignore the empirical reality: migrants are frequently denied care and avoid hospitals due to fear of discrimination or deportation. Such misrepresentation distracts from the structural reforms necessary to improve health systems for all residents, thereby undermining both equity and public health.
Reimagining Healthcare and Accountability for Health Provision
South Africa’s Constitution promises healthcare for all under Section 27, yet for many migrants, this promise remains elusive. Pregnant women, children, and undocumented residents face systemic barriers that turn constitutional rights into aspirational statements rather than lived realities. Legal instruments —the National Health Act, the Refugees Act, and South Africa’s international commitments—guarantee access and prohibit discrimination, but enforcement remains a challenge. Still, enforcement is inconsistent, leaving migrants vulnerable to denial of care and medical xenophobia.
Reimagining Section 27 means more than reaffirming rights on paper. It calls for concrete accountability, in which hospitals and health officials must be held to their legal obligations, and structural barriers preventing access must be dismantled. Courts and regulators have a role in interpreting Section 27 while being mindful of its public policy purpose, emphasizing the state’s duty to ensure equality and dignity in healthcare. By linking domestic law to international frameworks, such as the WHO Health of Migrants Resolution, South Africa can transform Section 27 from a symbolic guarantee into a tangible safeguard. For migrants, this is not just a legal issue; it is a matter of survival, dignity, and the fundamental human right to health. Only through legal enforcement and policy reform can healthcare truly be accessible to all, as the Constitution intends.
Tamuka Chekero holds a PhD in Anthropology from the University of Cape Town. His research explores the lived experiences of migration in Southern Africa, examining how bureaucracy, displacement, and everyday social relations shape belonging and care. Drawing on Southern African epistemologies such as hushamwari and kuhanyisana, his work contributes to broader debates on mobility, moral economies, and the politics of humanitarianism in the Global South.
Alois Muzenje is a Lecturer in Sociology and Social Anthropology at Great Zimbabwe University and a PhD Fellow at the University of KwaZulu-Natal. His scholarship focuses on how communities respond to climate change, displacement, and food insecurity through local institutional practices. By tracing the social and ecological dimensions of resilience, migration, and equitable energy transitions, his work engages contemporary global discussions on sustainability, justice, and adaptive governance.