Along with hope for the future, many also bring with them the Aids virus.
But while South Africa is grappling with the challenge of providing anti-retroviral drugs (ARVs) to those of its citizens who are HIV-positive, less is said about how best to treat Aids in the country's substantial population of refugees and illegal immigrants.
As a result, the few who do qualify for ARVs often miss out on the opportunity of taking these life-prolonging drugs -- while those who don't find the hardships of migrant life compounded by HIV.
Refugees are regarded with suspicion in South Africa and are as a result discriminated against and barely integrated into society, let alone HIV and AIDS initiatives, says Melita Sunjie, a researcher at the Pretoria office of the United Nations High Commissioner for Refugees.
These words are echoed by Nathan Geffen, spokesperson for the Treatment Action Campaign (TAC): There are still high levels of xenophobia in South Africa, and because illegal immigrants and refugees lack power their interests are not represented.
According to the Department of Home Affairs, about 100 000 people have refugee status in South Africa. Illegal immigrants remain undocumented, although Zonke Majodima, the non-nationals commissioner with the Human Rights Commission, says that they could run into millions.
Most refugees originate in the Democratic Republic of Congo, Burundi, Rwanda, Angola, Somalia and -- increasingly -- Zimbabwe, where political and economic turmoil has prompted many to cross the border into South Africa. The HIV prevalence rates in these countries vary from 5,1% in Rwanda to 24,6% in Zimbabwe. South Africas infection rate is put at 28%.
Once given asylum status, refugees in South Africa have the right to seek treatment from the countrys health-care system in the event of illness (illegal migrants have no such rights). Those granted asylum are also issued with identification cards to be shown at the hospitals where they go for care. In practice, however, having a card can mean little.
When refugees comes to the hospital, they have to present their documentation to prove their refugee status, but the staff at the registration point don't recognize the legitimacy of their identification cards because they haven't been properly educated, says Dr Bernard Uzabakirilo, who practises at the Ekurhuleni hospital near Pretoria.
As a result, he adds, the patient is registered as an illegal immigrant who has to pay a consultation fee upfront before receiving treatment. Fees of between R1 700 and R14 800 are charged, depending on the severity of the patients condition.
They obviously cannot afford this, therefore they are not allocated a file and are denied access to a doctor. Without a doctors reference, an HIV-positive patient cannot receive treatment from a clinic, says Uzabakirilo, who also lobbies for the Co-ordinating Body of Refugee Organisations, an umbrella grouping based in Johannesburg.
Following a 2002 ruling by the Constitutional Court ordering the government to provide ARVs to South Africans in need of the drugs, health officials launched a programme to distribute the medicines free of charge. However, refugees who find themselves shut out of clinics because of confusion about identity cards are forced to contemplate buying the drugs privately, at a cost of about R300 a month. Again, this is a price few can afford.
Language barriers sometimes cause treatment to be delayed -- if not denied.
When refugees phone or come to the hospital and can't speak English, they are made to sit down and wait for a translator. I have seen patients who are made to wait for eight hours, says
Uzabakirilo. Repeated efforts to get comment from the Department of Health about the difficulties experienced by refugees at state hospitals were unsuccessful.
Making matters still worse is the fact that the state machinery for processing asylum requests is painfully inefficient.
Staff shortages and incompetence at the Department of Home Affairs has resulted in a backlog of more than 50 000 applications for refugee status.
Because of the backlog, this process [of application] takes up to five years, says Carnita Ernest, a researcher at the Johannesburg-based Centre for the Study of Violence and Reconciliation who is studying refugees access to health care.
While the Director General of Home Affairs, Barry Gilder, claims steps are being taken to sort out the administrative glut, he also admits that unravelling the present state of affairs will take months.
A 2003 study conducted by the Community Agency for Social Enquiry (Case), the most recent analysis of refugees and asylum seekers in South Africa, noted that of the 1 500 migrants interviewed, only 11% had been issued identification cards by the Department of Home Affairs. The remaining 89% had been waiting for more than three years for asylum status.
According to Cases National Refugee Baseline Survey, about 20% who had tried to access emergency health care were refused help, mainly by hospital administrative staff. Case is an NGO based in Johannesburg.
As the Refugees Act of 1998 places restrictions on asylum seekers by prohibiting their employment while their applications are being processed, HIV-positive migrants find themselves in limbo: unable to use state health facilities -- or work to earn the money that may cover the costs of private health care.
With high unemployment taking its toll on South Africa, opening the job market to non-nationals is understandably a delicate issue. However, not doing so may make refugees and illegal migrants more vulnerable to Aids.
Uzabakirilo says his experience has shown that HIV prevalence among refugees and illegal immigrants in the country is higher than the local prevalence because the young women refugees can't work and are thus almost always forced into prostitution. The rape rate is also very high among refugees.
Adds Sunjie: While data on HIV prevalence among refugees in South Africa is scarce, refugees and illegal immigrants are at increased risk of contacting the virus during and after displacement.
Unlike other African countries, South Africa does not have any refugee camps to house non-nationals. Asylum seekers and refugees live in urban areas, and survive largely without assistance.
Perhaps efforts to improve the access to health services for refugees and illegal migrants may only gain steam when a sufficiently large number of HIV-positive South Africans are receiving
ARVs. While the government planned to have 53 000 people on the drugs by the end of last year, it had reached only 19 000 people at the close of 2004 -- this to the alarm of groups such as the TAC, which took the government to court three years ago in a bid to compel it to issue ARVs.
About 5,6-million South Africans are infected with HIV. The TAC estimates that 300 000 people need ARVs to keep them alive. -- IPS
(Source: Mail&Guardian, February 14, 2005)