Zimbabweans are in South Africa as a matter of survival. The fact that about 2 500 people live in the overcrowded Central Methodist Church in Johannesburg is a reflection of their desperation and the lack of alternatives.
The church has become like an ambulance — visibly exposing a dilemma and raising the alarm of the plight of Zimbabweans in South Africa. But the ambulance is not the problem, and it cannot be dealt with as such.
The government wants to deal with the church in isolation from the broader challenges facing Zimbabweans seeking refuge in South Africa. Even more misguided is the recent approach taken by the government in blaming the church’s Bishop Paul Verryn for somehow creating this situation.
The only man-made crisis in this case is the one in Zimbabwe and the failure of the South African government from the onset to respond adequately to the cross-border humanitarian implications.
Many Zimbabweans arriving in South Africa are destitute and vulnerable and waste little time in making their way to Johannesburg, with a minority seeking refuge at the church, which has become the focus of government and media attention.
Médecins Sans Frontières/Doctors Without Borders (MSF) has medical projects in Musina and has a clinic adjacent to the church. The number of consultations in this clinic has increased from 750 patients a month in 2008 to an average of 2 350 a month in 2009.
Initially the MSF clinic was frequented primarily by church residents. Today more than 50% of the patients come from surrounding derelict buildings.
They come to MSF because of the barriers they face in accessing healthcare at public health facilities, which include the lack of implementation of a government directive to treat all people regardless of their nationality or legal status and the hostile attitude of healthcare workers.
MSF accompanies patients needing assistance to existing health facilities in Johannesburg, to ensure they get the treatment to which they are entitled under the Constitution.
The conditions in the church are in no way acceptable from a medical perspective. As in any overcrowded and unhygienic setting, people staying in the church are exposed to serious risk of communicable disease outbreaks, such as tuberculosis and measles.
This risk is mitigated by screening and vaccination initiatives. MSF has conducted these activities in coordination with the Department of Health and other partners. There is a consensus that these actions have had a major mitigating impact on epidemic risks.
The health problems MSF witnesses in the church are not unique to this building. MSF also carries out mobile medical activities in another 20 overcrowded buildings in the city centre that have poor water and sanitation conditions and we encounter similar medical problems, including HIV/Aids, respiratory tract infections, diarrhoeal conditions, as well as stress-related health problems.
These outreach activities are more daunting because they occur in places mostly deemed too dangerous by health department officials. However, these activities help to gather information for a wider picture of the health situation among migrants and refugees in the Johannesburg city centre, where it appears that living conditions in the church are no worse than in the other buildings familiar to MSF.
The appropriate response should not be to threaten the inhabitants of the church with eviction or for the police to harass them. In a recent incident a group of five women with infants on their backs were arrested by police officers because they were sitting in front of the South Gauteng High Court. They were released only after they were forced to kneel down and say sorry.
This kind of harassment and intimidation risks pushing people underground, making them invisible and even more vulnerable. To ensure continuing monitoring, containment and treatment of communicable diseases, there is a need for an environment of trust, considering the trauma endured by many Zimbabweans in coming to South Africa to try to survive in a foreign and often hostile environment.
During the past weeks discussions have taken place between government and civil society. MSF hopes that these talks will lead to a commitment from government to address the living conditions of vulnerable Zimbabweans. There is a pressing need for a coherent response from authorities to create and implement a solution for the reception, accommodation and protection of people seeking refuge in South Africa in a manner that ensures their dignity.
The people who live in the church do not continue to live in these abject conditions by choice; they do so because they do not have alternatives and no concrete remedy has been found for their predicament.
The church is not part of the problem; it offers insight into the solutions needed — most notably the need for temporary shelter.
The solution cannot be confined to the church alone and must address the needs of vulnerable Zimbabweans in South Africa as a whole.
Dr Hermann Reuter is a health activist and president of the MSF-South Africa board. MSF is an independent international medical humanitarian organisation working in more than 60 countries around the world. In South Africa MSF runs projects in Khayelitsha, Musina and Johannesburg