People fleeing violence, intimidation and harassment sparked by anti-migrant protests in South Africa on 30 June need ongoing medical care, protection and humanitarian support as tens of thousands move through the country on their return journey to neighbouring countries. Médecins Sans Frontières (MSF) teams at the South Africa-Zimbabwe border towns of Musina and Beitbridge have been providing treatment to people who are traumatised and those who are displaced who have had their access to lifesaving HIV and other chronic medication disrupted. 

Run by the South African government, the remote temporary repatriation centre about 20 minutes’ drive from the small town of Musina is dusty and dotted with large white tents, where, despite it being winter, the mercury hovers around 30 degrees Celsius. Thousands of people gathering there are fearful and desperate; the mood is overwhelmingly desolate. The medical tent where MSF is running a clinic is quite far away from where people queue daily for buses back to their home countries, making it harder to reach some patients.

While working in a Zimbabwean gold mine six years ago, Munyaradzi* was exposed to a toxic chemical and still struggles with debilitating pain. Now travelling to Musina from where he has been living in Dennilton, a rural town straddling the Limpopo-Mpumalanga provincial border in South Africa, he has not had access to his chronic pain medication for seven weeks.

“That chemical affected me 2020 and I started drinking tablets from that year until now... I know they don’t like us here in South Africa, so I get my mind to go back home, but the police catch me before I go ... they take me to police station,” says Munyaradzi. “I told them about my situation that I am drinking tablets. [The police] didn't take me to clinic until now.” 

“That is why I have come here because I am trying to get my medicine,” he says.  “My body has got so much pain. The chemical enters in my skin and starts to damage my muscles and bones.”

Across the border in Beitbridge, MSF counsellors are concerned about the trauma their patients are experiencing. Nobuhle*, who has been living in Soweto, Johannesburg, and working as a chef at a local restaurant, was devastated to return home from work on 17 July to find her house had been burnt down. Luckily, her three children were away at the time.

“I found my house burnt. I lost my passport and permit, all my clothes and furniture, my children’s birth records and birth certificates,” says Nobuhle. “I have nothing with me. All I have is this small handbag. I do not even have a change of clothes.” 

“I thought having a passport and permit would save me, but no, I was wrong. I wanted to kill myself. I have lost hope, and I do not know what I will do”.

The narrative that the so-called ’self-repatriation’ process is always voluntary is questionable, as many fearful Malawians, Mozambicans, and Zimbabweans insist that they are documented but have little choice other than to flee for their safety. 

Passing through Musina, Joseph*, a Malawian from Pietermaritzburg who has been working as a tailor in South Africa since 1995, started ARVs in 2008. 

“They come to my house and say, ‘you are a foreigner, hamba (go)’. So, I run away and go to hide with my friends,” says Joseph. “Then I go to Durban. I am staying there at the bus station; it was raining, but we are outside.” 

“I leave my [HIV] medication there in the house. I don’t worry about that or the clothes; if I am still alive, I can get it,” he says. “I haven’t taken the medication in a few weeks. It is relief; I got my medication today [from MSF].”

Freedom, a Zimbabwean, moved to South Africa in 2009, where he has been working as an electrician and plumber. Treated in Beitbridge, he was forced to leave South Africa after his health deteriorated because he had been unable to access his antiretroviral (ARV) medication. 

Despite having a valid passport and a work permit, Freedom tells us the documents could not protect him when anti-migrant groups went door-to-door threatening non-South Africans in their homes.

“I defaulted on my medication for three months because of the xenophobic attacks in South Africa. I could no longer access the clinic as I used to, and my condition worsened,” Freedom says. “Before all this, the nurses in South Africa would not take it lightly if we missed the day for collection of our ARVs. Now everything has changed; they no longer want us.” 

“When I arrived on the Zimbabwean side, I was admitted for four days... because I had lost a lot of weight, my leg was swollen, and I was feeling very weak,” he says. “I am happy because I received a one-month supply of ARVs and was referred to a local clinic in Gweru for continued treatment.”

MSF teams are also treating many patients who do not have access to their chronic hypertension medication. Left untreated, high blood pressure can lead to serious complications, including strokes, heart failure, blood clots and even death. 

“We are concerned about access to healthcare disruptions and continuity of care for people living with chronic diseases such as HIV, TB, diabetes, hypertension and mental health conditions,” says Caroline Masunda, MSF emergency medical team lead in Musina. “We are seeing a trend in Musina of patients who have been unable to access lifesaving HIV and TB treatment for months after being turned away from South African healthcare facilities because they are migrants, increasing their risk of treatment failure and, in some cases, developing drug resistance.”

While South African authorities have reported processing over 53,000 migrants for repatriation, many people continue travelling through informal routes. Media reports indicate that 34,000 people have returned to Malawi and 100,000 to Zimbabwe, illustrating the regional scale of displacement. 

“More than 100,000 people fleeing or being displaced are the kind of numbers MSF see in hot conflict areas, not relatively stable democracies like South Africa,” says Masunda. “With so many displaced people, we call on governments in the region to step up collaborative efforts to ensure continuity of care for patients.”

Thousands of people are processed daily in Musina and stay there for an average of 24 hours. While the system appears efficient, MSF warns that vulnerable people may be missed because they are reluctant to leave queues to seek medical care or because they move on before receiving assistance.