Document Type

Migration Policy Series

Publication Date



Balsillie School of International Affairs


Medical xenophobia refers to the negative attitudes and practices of health sector professionals and employees towards migrants and refugees on the job. There is considerable evidence that many officials (especially the police, home affairs officials, refugee determination officers and customs agents) bring xenophobic attitudes with them when they come to work. Those in the “helping professions” (such as teachers, social workers and health care professionals) also come into contact with migrants and refugees in the course of their jobs. They have the power to withhold services and they can certainly influence the way in which those services are delivered. This report asks whether and how xenophobia manifests itself within the public institutions that offer health services to citizens and non-citizens. It presents and discusses the question from the perspective and experi­ences of the foreign patients who try to access the system.

The study extends the findings of earlier research and suggests that the phenomenon of “medical xenophobia” is very real in the contemporary South African public health system. The bad treatment of foreign migrants and refugees in public health facilities cannot all be ascribed to xenophobia, however. Migrants are also caught up in the “crisis of care” that affects every patient in the public health system. The paper concen­trates on those forms of ill-treatment that can be attributed to xenopho­bia and argues that the withholding of treatment from those who need it, and any form of discrimination motivated by hostility to the patient based on their national origins, is a form of xenophobic violence.

The fieldwork for this study was conducted in Cape Town and Johannesburg in August and September 2010. Within each city, three different types of neighbourhood were selected: a middle-income suburb, an informal settlement and a township. The survey focused on Zimbabwean migrants and used two major data collection methods: 100 in-depth interviews and 10 focus group discussions, half in each city. The findings of this survey are therefore indicative rather than representative. What they do show is a troubling disregard on the part of some public health professionals and workers towards the law and their ethical responsibili­ties to patients. We do not wish to claim that all health workers display the kinds of attitudes and behaviours described in the paper. Some clearly do take their ethical and legal obligations seriously and act with concern and care towards all patients, regardless of where they are from, and despite often trying circumstances. The Southern African Clinicians Society is a major case in point as they played a leading role in promoting equal treatment for all People Living With HIV (PLHIV), both foreign and local. However, by conducting research in six different communities in two major cities, this report suggests that there is a pattern of medical xenophobia that is not just confined to one or two rogue individuals or institutions.

Medical xenophobia is a fundamental breach of South Africa’s Constitution and Bill of Rights, international human rights obligations and various professional codes of ethics governing the treatment of patients. Medical xenophobia manifests itself in several ways in the public health system. Amongst the practices uncovered in this study were the following: first, patients are required to show identity documentation, proof of residence status and evidence of a home address before treat­ment is provided. Patients who, for one reason or another, do not have such documentation on their persons can be denied treatment. Second, communication difficulties arise when health staff refuse to communi­cate with patients in a common language or allow the use of translators. Third, treatment is often accompanied by verbal abuse and xenophobic statements and insults. Fourth, non-South African patients often have to wait until all South African patients have been attended to even if they have been waiting longer for treatment. Finally, migrants and refugees have such difficulty accessing anti-retroviral therapy (ART) for HIV in public institutions that many are forced to rely on the NGO sector. All of these manifestations of medical xenophobia are examined at length, with supporting testimony, in this report. The report concludes with a set of recommendations for rooting out xenophobia in the public health system.