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George Washington University

Publication Date

Fall 2011

Program Name

South Africa: Community Health and Social Policy


In 1998, South Africa passed historic legislation that bridged international conventions on refugees and asylum seekers with the protections and rights defined in the South African Constitution and Bill of Rights. The 1998 refugees act defined specific rights that refugees and asylum seekers are entitled in South Africa, the most important of which include the provision of legal and immigration documentation, employment, adequate housing, and health and social services. When asylum seekers arrive in Durban, many are in the need of immediate health services as a result of long journeys, pre-existing conditions, pregnancy, or illnesses contracted in refugee camps throughout Southern Africa. However, despite domestic and international protocols outlining the need to provide health services to refugees and asylum seekers, many migrants under this specific immigration status have experienced barriers in access of quality of primary health care. Through in-depth interviews of refugees and asylum, as well as a volunteer position with Lawyers for Human Rights, a learnership project was completed to explore ways in which the public sector can better provide acceptable health services for refugees and asylum seekers specifically in Durban. The learnership specifically attempts to understand refugee and asylum seekers experience accessing health services in South Africa under this migration status in the public sector, knowledge of refugee rights and methods of advocacy to uphold those rights, and structural determinants of access and quality of health services.

Methodologies employed in the development of this paper include formal interviews with refugees and asylum seekers, a volunteer position with Lawyers for Human Rights, and informal discussions with experts and attorneys. Formal interviews conducted employed both standardized open and dialogic interviews, where informants discussed biographical information and access to health and social services as an asylum seeker in Durban. In addition the learner volunteered with LHR, specifically within its Refugee and Migrants Rights Program to observe the legal aid process, provide any necessary organizational support, and gain more insight into the services refugees and asylum seekers receive compared to those which they are legally entitled by national and international law.

The learner found that individual attitudes of service providers have the power to determine the provision and quality of services guaranteed by national and international law to refugees and asylum seekers. Barriers to health services, and even refusal of PHC altogether, are a result of health staffs’ demands to produce legal documentation, refusal to converse with foreign patients in a common language, denying the use of interpreters, verbal abuse and discriminatory remarks, prioritizing of South African nationals in the quality and wait time for care, and the lack of confidentiality and privacy protections for refugees and asylum seekers seeking HIV treatment at public PHC facilities.


Demography, Population, and Ecology | Family, Life Course, and Society | Health Services Research | International Public Health | Medicine and Health | Public Health


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