The importance of a piece of paper
Jesuit Missions volunteer Beth Morgan has completed three months in South Africa working with Jesuit Refugee Service (JRS) and accompanying health care workers. She was shocked by how refugees and asylum seekers were treated within the South African health care system and has shared some of her observations from during her health visits with refugees.
Before coming to South Africa, I had no idea how important a piece of paper could be: how it could decide your health care accessibility and the way you are regarded by health care professionals. As a UK citizen, I am lucky enough to benefit from the National Health Service and I was relatively ignorant to just how important one piece of paper, which labelled you either a refugee or an asylum seeker, could be on both your life chances and human dignity. My first weeks volunteering in South Africa opened my eyes to this.
The issues stem far deeper than simply a piece of paper, but ultimately, your status as written down on a documentation paper can literally decide whether or not you gain access to life saving treatment.
South Africa has some of the most progressive legislation in Africa regarding the rights of refugees. This legislation allows refugees the same legal rights and basic health care access in public hospitals that South African citizens are entitled to. These rights are not extended to asylum seekers who are entitled to basic health care by virtue of the constitutional provision. Although there are cases where documentation leads to the denial of treatment, the most frequent cases of inequality are shown through the routine encounters with health care professionals. It is the interpretation by health care workers of the documentation that refugees and asylum seekers possess that leaves them open to discrimination, xenophobia and unfair and undignified treatment. These issues became clear to me when I encountered the treatment of a client in my second week in South Africa.
I was working with Fr Vaidas, a Jesuit Priest who is head of the pastoral care department in JRS. We received a call from a member of the health care team who was asking for our help in transferring a desperately ill patient to hospital. When we arrived, we found the client sitting in a wheel chair outside the local health clinic, which had since closed, in agony and holding a plastic bag containing his own vomit. The clinic had refused to see the patient or administer any form of treatment to him as he was already in contact with a local hospital and they stated he needed to go there for treatment. The client was suffering from kidney failure and was in need of kidney dialysis. Due to his status as an asylum seeker, he was not entitled to this treatment at a public hospital and was told he would have to pay privately. Private kidney dialysis in South Africa costs around R6000 a month (~£330). Given that most people cannot afford to even pay their rent there was no option for this client’s family to pay extortionate sums of money for kidney dialysis. His condition had rapidly deteriorated in his weeks without treatment and he was now in a huge amount of pain, his organs and body failing him.
I was already horrified that this man’s documentation meant he was denied lifesaving treatment, but the actions of those working at the local clinic and hospital had shocked me even further. The clinic had refused him basic pain care medication and left him outside to await an ambulance. The ambulance that was called for him did not arrive. When he arrived at hospital and was eventually given a bed, after hours waiting, he was told that he would have to pay for a blanket and pillow, whilst other patients were given them freely. Health care professionals showed a lack of sympathy and were openly frustrated when conversing with this client due to his lack of English. All of these injustices ensured that the final days of this gentleman’s life were unnecessarily painful and traumatic.
A major obstacle that refugees and asylum seekers face when trying to access health care in public hospitals is as a result of misunderstanding. Many speak little or no English and suffer as a result. I witnessed the treatment of one elderly woman who was suffering from tooth ache due to an infection. She had visited the local clinic on two consecutive days and waited for many hours only to be eventually told that she would not be seen due to her lack of English. On her third visit myself and two members of the JRS team accompanied her to help translate. Although the patient was seen, she still had to wait for many hours. This is very common at hospitals and clinics where refugees and asylum seekers encounter longer waits and greater difficulties accessing treatment compared to locals simply because of their language difficulties.
Refugees and asylum seekers also experience difficulties due to delayed treatment and the prevention of access to medication. Although waits for treatment are common in South Africa, refugees and asylum seekers are often viewed as low priority in comparison to locals. One patient I spoke to has been waiting over three years for an operation to treat prostate cancer, whenever he asks for explanations, he is treated with hostility by administration staff and cannot gain access to doctors or his medical files.
These issues all lead to feelings of frustration, rejection and inequality among the communities of refugees and asylum seekers living in South Africa. The climate of mass inequality and poverty in South Africa fuels feelings of prejudice towards refugees and asylum seekers. Rather than considering the persecution, violence and fear that drives people to abandon their homes in hope of finding safety within the South African border; they accuse refugees and asylum seekers of trying to steal jobs, increase crime and poverty and take advantage of the already overstretched South African health care system. Health care is just one area where I have witnessed discrimination against refugees and asylum seekers, but it is potentially one of the most important. The human rights of individuals are being violated. Members of the JRS health care team and pastoral care department fight tirelessly to protect the rights of all refugees and asylum seekers. The ability of Jesuit Missions and JRS to accompany these people and fight for the protection of their rights and dignity brings some relief and comfort. I hope to continually raise awareness about the mistreatment of refugees and asylum seekers in South Africa and to work towards a future where a piece of paper no longer defines someone’s life chances or their dignity.
Header photo: JRS client, health workers and Beth outside an illegal shelter in Pretoria