The international medical humanitarian organisation Médecins Sans Frontières (MSF) is today expressing grave concern for the health and lives of thousands of survival migrants and refugees entering and living in South Africa. Sexual violence, appalling living conditions, police harassment, threats of xenophobic attacks and a lack of access to essential healthcare still define the desperate lives of thousands of these vulnerable people. (Read the MSF briefing paper - MSF briefing paper) MSF is providing health care to survival migrants and refugees at its clinics in Musina, a border town with Zimbabwe, and in Johannesburg. In Musina, MSF has witnessed an increase in the number of attacks, robberies and rapes by violent gangs active on both sides of the border since the beginning of 2010. MSF has treated 103 survivors of sexual violence in the first four months of this year, 71 since March 1 alone. While providing consultations to an average of 2,300 patients a month in Johannesburg, MSF sees its patients continue to face serious health risks related to overcrowding and unhygienic living conditions. While some still seek shelter in the Central Methodist Church, thousands more people live in abandoned buildings often without electricity, water or basic sanitation, putting their health and safety at risk. In June of 2009, MSF released a report raising the alarm about the dangerous health situation of people entering and struggling to survive on the margins in South Africa. Now almost one year later, their situation remains dire and largely ignored. “What has changed for our patients in the last year? Very little. They are still risking their lives when they cross the border, raped in shocking numbers by gangs, and then facing uncertainty about their status in the country. Many go on to a life in Johannesburg that continues to endanger their health,” says Mickael Le Paih, head of mission for MSF in South Africa. The threat of sexual violence for those crossing the border from Zimbabwe must be acknowledged. They need access to a formal status to be legally allowed in the country so they are not forced to cross the border irregularly and be exposed to this extreme violence. Access to both emergency shelter and primary health care should be ensured for survival migrants, refugees and vulnerable South Africans living in inhumane conditions. Without access to basic medical care, safety and shelter, the lives of survival migrants and refugees in South Africa remains precarious and uncertain.