South Africa has a progressive asylum policy whereby refugees and asylum seekers are encouraged to self-settle and integrate, rather than be confined to camps. A range of protective rights are afforded to international migrants – including refugees and asylum seekers – that include the right to health, and to antiretroviral therapy. However, many challenges are experienced by international migrants as protective policy is not transformed into protective practice. Key here, are the challenges with the backlog at home affairs that presents challenges in accessing documentation and the lack of awareness of the rights of international migrants amongst service providers.
A tentative schematic representation of psychosocial pathways
A range of rights, including access to basic healthcare, are provided to non-nationals through the Refugee Act (1998) and the South African Constitution. The current HIV/AIDS and STI National Strategic Plan for South Africa (NSP) specifically includes non-nationals – international migrants, refugees and asylum seekers – and outlines their right to HIV prevention, treatment and support. In September 2007, the National Department of Health (NDOH) released a Revenue Directive [i] clarifying that refugees and asylum seekers – with or without a permit – shall be exempt from paying for antiretroviral treatment (ART) in the public sector. A key guiding principle to the successful implementation of the NSP is towards “ensuring equality and non-discrimination against marginalised groups”; refugees, asylum seekers and foreign migrants are specifically mentioned as having “a right to equal access to interventions for HIV prevention, treatment and support” [ii] . [i] Ref: BI 4/29 REFUG/ASYL 8 2007 [ii] Department of Health (2007) HIV & AIDS and STI Strategic Plan for South Africa, 2007 – 2011. April 2007: Pretoria: Department of Health, p56
In September last year, the NDOH released a revenue directive clarifying that refugees and asylum seekers – with or without a permit – have to rhight to access basic health services and ART. They must be assessed according to the current means test, as applied to South African citizens, and must not be charged foreign category fees.
The 2006 NDOH memo c larifies that possession of a South African identity booklet is NOT a prerequisite for eligibility for ART. This is important for South African citizens as well as non-citizens.
In addition, Dr. Patrick Maduna of Gauteng Health released a memo in early April providing additional clarification that South African identity booklets are NOT a requirement of healthcare, including ART.
13 th June 2011 Exploring the psychosocial and health rights of forced migrants in Johannesburg
In early 2011, a United Nations delegation called on South Africa to
“ improve social cohesion and measures against discrimination, exploitation, a tendency by the police to ignore the rights of migrants, and the overall lack of a comprehensive immigration policy that incorporates human rights protection .”
“ Given the need to prioritize its efforts and allocation of resources, UNHCR will focus on the provision of services to those refugees and asylum seekers whose needs are most acute. While these priorities will vary from city to city, they will usually include:
providing care and counselling to people with specific needs, especially people with disabilities, those who are traumatized or mentally ill, victims of torture and SGBV, as well as those with complex diseases requiring specialized care;
UNHCR, 2009: 18
“ These rights include, but are not limited to, the right to life; the right not to be subjected to cruel or degrading treatment or punishment; the right not to be tortured or arbitrarily detained; the right to family unity; the right to adequate food, shelter, health and education, as well as livelihoods opportunities.”
It is important to undertake a rapid and contextually grounded assessment of locally salient daily stressors before developing mental health and psychosocial interventions.
Before providing specialised clinical services that target psychological trauma, first address those daily stressors that are particularly salient and can be affected through targeted interventions .
When specialised mental health interventions are indicated, interventions should go beyond PTSD to address the diverse forms of distress that may result from exposure to war-related violence and loss.
It is essential to take into account that not all symptoms of trauma are necessarily related to conflict exposure . Even in situations of armed conflict, there are other sources of psychological trauma.
White paper for the transformation of the health system in South Africa
National health policy guidelines for improved mental health in South Africa
Mental Health Care Act (2002); promulgated in 2004
In line with international human rights standards
Mechanisms for decentralisation and integration of mental health
Development of community-based care
Approved in 1997. Policy not published or widely circulated. No implementation guidelines developed. Unfunded mandate. Percentage of NDOH expenditure devoted to mental health is unknown. Lund et al., 2010; Burns, 2011
Burns, 2011 South Africa has 30% of the number required for national norms of 1 per 100,000
In South Africa, the general population experiences poor access to public healthcare, including mental healthcare and psychosocial services. The urban poor face a range of daily stressors that negatively affect their emotional wellbeing.
Urban forced migrants in Johannesburg face specific challenges in accessing their right to healthcare, including mental healthcare and psychosocial services (language, documentation, livelihoods, food security, housing etc).
Additionally urban forced migrants experience specific “daily stressors” that negatively affect their emotional wellbeing.
Policies designed to protect urban forced migrants are not being effectively implemented in Johannesburg.