MUSINA, South Africa: It’s 6 a.m. and Tholakele Nkwanyana is one of the first people to arrive at the Diepsloot public health clinic in Johannesburg, not to seek medical attention but to stop foreigners from getting care.
She and fellow members of South Africa’s anti-immigrant group Operation Dudula — which means “to get rid of by force” — are dressed in military-style fatigues as they block the entrance and demand to see patients’ identity documents. Mothers carrying children and others who are sick are turned away and told to go to private hospitals, which unlike public ones aren’t free.
Similar scenes have played out at government-run clinics across South Africa’s most populous province, Gauteng, as health care becomes the new battleground in the country’s long and painful debate over immigration.
The Johannesburg High Court has ordered Operation Dudula to stop harassing migrants. The group says it will appeal.
“In our operations we are saying, ‘Put South Africans first,’” Nkwanyana told The Associated Press. “The problem we have is that the influx of foreigners is too much and the medication is not enough.”
Anti-immigrant sentiment can be deadly
Africa’s most developed economy, which hosts world leaders this week for the Group of 20 summit, attracts migrants from neighboring Zimbabwe, Mozambique and Lesotho and as far away as Nigeria and Ethiopia.
In the year ending March 31, the Department of Home Affairs deported 46,898 migrants who had entered South Africa without documentation, an 18 percent increase from the previous year.
Operation Dudula emerged a few years ago, and its visibility has grown as mostly young Black South Africans take part. It’s not clear how many members the group has. Its actions have included closing down foreign-owned shops and blocking the children of foreigners from entering public schools.
Operation Dudula members assert that migrants entering without documents are taking jobs from South Africans, who face one of the world’s highest unemployment rates at over 31 percent.
South Africa has seen sometimes deadly waves of such sentiment. In 2008, 68 people were killed in attacks on foreigners across the country.
But the focus on denying them health care is new, along with Operation Dudula’s organized structure. The group has regional leaders and participates in news conferences and debates, and it has hinted at forming a political group.
South Africa’s government has condemned Operation Dudula’s actions and insists that the law guarantees health care for everyone, including foreigners in the country illegally.
“We are health care professionals. We don’t turn patients away because they don’t have documentation,” Health Minister Aaron Motsoaledi has said.
He and others have met multiple times with Operation Dudula and the government has posted security at public clinics, but police are overstretched in a country where the crime rate is high.
“They cannot wait at a clinic just in case something happens. They have a lot of other work to do,” national police commissioner Fanie Masemola has said.
In August, three Operation Dudula members were arrested after going into a maternity ward in Soweto and demanding that patients produce identity documents. Nurses called police. They have since been released on bail.
The South African Human Rights Commission, which has sharply criticized Operation Dudula’s actions, has said South Africa is following a global rise in anti-immigrant sentiment.
“You have seen them in the United States of America and Europe. It is a trend everywhere,” SAHRC commissioner Tshepo Madlingozi said.
Scapegoats of a broken system
South Africa spends 8.5 percent of its gross domestic product, or about $15 billion, on health care, higher than everything but education. And yet it has overcrowded hospitals, shortages of medication and poor management.
But many people in other African countries see South Africa as a relatively attractive destination.
South Africa had an estimated 2.4 million foreign nationals in 2022, about 3.9 percent of the population, according to official statistics, with no breakdown of those there legally or illegally. That was up from the estimate of over 958,000 in the census of 1996.
“We acknowledge that there are a lot of problems in the health care sector, the shortage of nurses, the shortage of doctors,” Madlingozi said. “There is crumbling infrastructure, so there’s a lot of issues. But as a commission, we are quite clear that nonnationals should not be scapegoated.”
A matter of life and death
In May, Zimbabwean national Blessing Tizirai moved from South Africa’s capital of Pretoria, where she had looked for work, to the town of Musina near the border. Four months pregnant, she had been turned away from public clinics several times by Operation Dudula or similar, smaller groups. She chose Musina because Operation Dudula does not operate there.
“Since I arrived, I have never been turned away from the clinic,” she said.
Nonhlanhla Moyo, who also had come from Zimbabwe in search of work, was among those turned away from the Diepsloot clinic by Operation Dudula.
“If I’m unable to get my asthma pump, how am I supposed to live? It is very difficult,” said Moyo, who remained in Gauteng.
Both dread the possibility of going to a clinic in Zimbabwe, where the public health system has collapsed under chronic underfunding and neglect. Patients visiting public hospitals there often must bring their own medicines, syringes, bandages and even water.
Operation Dudula’s actions have drawn attention in Zimbabwe, where a lawmaker during one recent Parliament debate brought up the group and suggested that the government do something about the rising tensions — like pay for its citizens’ treatment in South Africa.
Justice Minister Ziyambi Ziyambi replied that the government would not. Meanwhile, Zimbabwe’s political elite largely seek treatment abroad, including in South Africa.