IT’S a little after 5am in Beitbridge, and thousands of red-billed quelea are shouting from the trees alongside the main road. The first buses exit the border post, turn into town and wind towards the Rainbow Hotel.
This modern, battleship grey complex of buildings is the Covid19 quarantine centre for Zimbabwean residents returning from South Africa.
With the support of Doctors Without Borders (MSF), the country’s Ministry of Health and Child Care is prepared to safely guide returnees into distinct channels for Covid-19 screening, isolation and treatment.
The buses are the first of many –the heralds of a flood. According to the International Organisation for Migration, approximately 200 000 Zimbabweans have returned to their home country from South Africa since the start of hard Covid-19 lockdown on March 24 last year.
This mass movement is hardly surprising. Zimbabweans migrate to South Africa to escape extreme economic hardship at home, but life in South Africa can present many challenges for foreigners, including violent and pervasive forms of xenophobia, time-consuming bureaucracy, exploitation by employers, barriers to accessing health care and cruelty at the hands of police and soldiers.
All of these challenges have been intensified by the Covid-19 pandemic, which has destroyed economies, restricted movement, disrupted services and brought soldiers out on to the streets and along the borders.
The people arriving here are visibly exhausted. Some began their journeys two days earlier, in Cape Town or Durban, travelling via Johannesburg.
At Musina, Beitbridge’s counterpart on the South African side of the Limpopo River, it took more than five hours for the passengers to be processed and allowed to proceed across the Alfred Beit Bridge to Zimbabwe.
And then, there are those who have returned to Zimbabwe without a choice – deportees finally released after months, or sometimes years, spent in detention with limited access to health care and other services.
There are busloads of harrowing stories. One 67-year-old woman said she was diagnosed with a cyst in South Africa in March last year and was admitted to hospital for nine days awaiting a procedure.
“They moved me from one hospital to another three times, until I was told to go back home and come again after the Covid-19 pandemic had finished. That’s when I decided to come back home to Zimbabwe,” she said.
After being referred to the MSF-supported clinic in Beitbridge, her case was presented to social welfare services.
A younger woman, who is pregnant, was denied access to antenatal care services in Soweto. “I visited many hospitals but they all turned me away after I could not give a passport, ID or asylum (permit),” she said.
The first democratically elected government in South Africa removed user fees for all pregnant and lactating women, yet challenges still exist for non-nationals trying to access healthcare services in the country.
Since 2019, the MSF team in Beitbridge has collected the testimonies of returning migrants who have used MSF services.
“We do this to better understand their experiences in South Africa, which helps us to continually improve the intervention package we offer to migrants that arrive in Beitbridge, either as voluntary travellers or deportees,” said Rinako Uenishi, project co-ordinator for the MSF Migration Project in Beitbridge.
MSF formalised this process by launching an ambitious survey – The Limpopo Mobility Survey – with the objective of providing reliable evidence on migrant journey pathways and how these journeys link with migrant health outcomes.
“MSF has had operations in the region on both sides of the border off and on since 2000, but a clear and comprehensive view of migrants’ medical needs was lacking, and so a study was designed with the objective of highlighting the gaps in medical care received by migrants. It was quite an eye-opener,” says Uenishi.
“Interviews conducted with returning residents in Beitbridge revealed that many are spending long periods in detention facilities – a quarter of respondents had spent more than three years locked up, with limited access to health care and basic services. This is a real problem, from both a medical and human rights perspective,” said Uenishi.
Migrants are often detained summarily due to not having valid permits or when their papers have expired.
According to the South African Human Rights Commission (SAHRC), migrants held in police cells are not allowed to be there for more than five days before being transferred to Lindela deportation facility. However, SAHRC has received reports of migrants being held in police cells for up to three months before being transferred to Lindela for deportation.
The survey found that respondents had been to more than two facilities on average, with living conditions in police stations reported as being poorer than in Lindela or most prisons.
Only 26% of the interviewees had been tested for HIV and 9.4% for tuberculosis, most in Lindela or prison. In police stations, the rates are much lower.
“We have long known about high rates of transactional and forced sex in certain facilities, yet respondents reported very poor access to condoms in detention, especially in Lindela,” said Uenishi.
Israel Chingosho, the lead counsellor for MSF in Beitbridge, recalls the particular case of a young man who was arrested by police in South Africa while taking a walk in a neighbourhood of Tshwane.
“His crime was not having his passport on him, and for this he was detained with hardcore criminals, who raped him. He exhibited great fear towards other migrants and refused to be released together with the whole group. He was referred to Beitbridge district hospital psychiatry unit for further assessment and management.
“While in hospital he started having visual hallucinations of inmates trying to sexually abuse him. He had no money with which to travel home. We administered psychological first aid, and he was given money to get home,” Chingosho says.
Across the border in Musina, a different set of insights were reported by interviewees, including the fact that displaced populations get trapped for lengthy periods, nine months on average – 16 months in the case of Zimbabwean women – in the border town.
MSF teams found that those from countries in central Africa at Musina were particularly hampered from accessing medical care, primarily due to language barriers.
The survey also found that 23.74% of all Musina-based migrants reported having suicidal thoughts or those of self-harm some days, with the percentage rising to 37.66% among Burundian respondents.
“We have definitely noted an increase in the number of women who have psychological or psychiatric problems, serious problems,” said Sister Francis Groban, a social worker in the women’s shelter in Musina.
“I think it’s because of the traumatic situations that they’re coming from in their home countries, but lengthening processes for asylum seekers are part of the problem, because this leads to overcrowding in the shelters, causing additional stress for residents who might have family they want to get to, maybe friends, but they can’t leave because they don’t have a permit,” she said.
Of all the communities interviewed in the course of the survey, those MSF teams spoke to at Magogo’s place (a very specific place – Magogo’s House, owned by Ma Gogo, a Malawian traditional healer in her eighties) reported the highest levels of sexual abuse during their journeys. Single female migrants were found to be particularly vulnerable, with 36% having gone through an episode of sexual violence very recently.
The area was known for its smuggling and human trafficking activities.
The survey highlights unmet medical needs that should be urgently addressed, but beyond this, MSF and partners have been calling for a more considered approach to migration policy, one that acknowledges the reality of migration while promoting wider public health imperatives.
– Cape Times