Law centre takes on Gauteng over health care for migrants

Public interest law centre Section27 has launched legal action in the Johannesburg high court in an effort to ensure all pregnant women and young children have access to free services, regardless of their immigration status.

At issue is the alleged refusal of Gauteng hospitals to provide free health care to pregnant and breastfeeding women, and children under the age of six, who are migrants — asylum seekers, undocumented people and people who are stateless.

In her founding affidavit, Section27 executive director Umunyana Rugege catalogues the harrowing experiences of migrant women and children denied care at Gauteng hospitals or pressured to sign acknowledgment of debt letters because they could not afford the fees.

“In one unthinkable case, the discrimination against this vulnerable group led to the death of a two-year-old boy,” she said, describing how Sibusiso Ncube died of rat poisoning after he was turned away by staff at Charlotte Maxeke Hospital because his Zimbabwean mother did not have R5,000 or his birth certificate on hand.

In another case, asylum seeker Kamba Azama was assaulted and robbed when she was six months pregnant. She was advised by the police to obtain medical treatment before opening a case but was denied care at Steve Biko Academic Hospital because she did not have R2,000. Two months later, she was told by Charlotte Maxeke Hospital she would need to pay R20,000 to have treatment or give birth there.

In an application brought with three women, Section27 has asked the court to rule that any regulations, policies and circulars issued by the Gauteng health department directing public health facilities to charge migrant pregnant women and young children for services are unlawful and contravene the National Health Act.

Section 4 of the act says the state must provide free health services to pregnant and lactating women and children under six, except those who belong to medical schemes.

“It does so for good reason,” said Section27 head of health Sasha Stevenson. Access to facilities before and after birth “has contributed to a decrease in maternal and child mortality in SA in recent years”.

Section27 has also asked the court to order the health department to issue a circular to all provinces and publish posters in health facilities to make it clear that all pregnant women and young children are entitled to free health care.

It has named the health minister, health director-general, Gauteng health MEC and Gauteng health department as respondents. The health department had not responded to Business Day’s request for comment at the time of publication.

The case centres on Gauteng because it is the province in which complaints have been brought to Section27. But if the court upholds its application, the ruling would have national implications, said Stevenson.

Jo Vearey, director of the African Centre for Migration and Society at Wits, said there was no evidence that a disproportionate number of foreigners were accessing health services in Gauteng, nor was there evidence of foreigner nationals travelling to the province solely for medical care. “Of course there are exceptions, but the work we have done in Johannesburg, Ekurhuleni and Limpopo hasn’t shown this kind of mobility or ‘medical tourism’,” she said.