Refugee camps, once the visible manifestation of the desperate needs displaced people face, are nowadays increasingly vanishing from view. This is not because the reasons that force people to flee their home countries have ceased.
Far from it — because many have become ‘invisible” in urban areas while authorities struggle to find ways to address their situation, they have become more vulnerable. Previously when people fled manmade disasters, conflicts and economic collapse, there was no question about the construction of camps to house them.
But governments now frown on creating new camps and many are adopting restrictive asylum and migration policies to clamp down on displaced and migrant people, which force them into hiding, increase their vulnerability and make it difficult to reach them.
Today almost half of the world’s displaced people reside in urban areas but they experience the same protracted problems as those in camps. They are particularly vulnerable in terms of mental health, from stress and the continuous fear of deportation.
Physically they are at risk because of poor living conditions and a lack of access to basic services, including healthcare.
In South Africa the lack of accurate information about their rights, widespread discrimination and arrests have kept many Zimbabweans and other urban displaced people from accessing basic services necessary for their survival. This has left thousands living in abject conditions in derelict buildings in downtown Johannesburg.
Born out of the need to seek solutions and raise awareness about the medical and humanitarian needs of these groups in Southern Africa, Médecins Sans Frontières (MSF — or Doctors Without Borders), the international medical humanitarian organisation, and the University of Johannesburg’s faculty of health sciences assembled a diverse discussion panel for the launch of several public debates last month.
The panel included Bishop Paul Verryn of the Central Methodist Mission in Johannesburg and Zwelinzima Vavi, the general secretary of Cosatu, academics and other influential people.
Adam Habib, the vice-chancellor of the university, chaired the discussion, framed within the context of a South Africa rated the most economically unequal society on Earth.
Huge informal settlements perch on the periphery of metropoles and lack the most basic commodities for a dignified life — decent housing, employment and access to health services. Unemployment and poverty are higher in South Africa than in any other middle-income country in the world.
The stark contrast between the overcrowded Diepsloot West township, north of Johannesburg, and the neighbouring wealthy suburb of Dainfern is a case in point. Half the adult population in Diepsloot is unemployed, whereas Dainfern is a gated community boasting a lush golf course.
During the discussion, Vavi highlighted that just 4% of South Africans own 40% of the country’s wealth, though many desperate people still seek refuge here under the ‘mistaken notion that South Africa is a land of milk and honey”.
The plight of displaced and migrant populations, seen against the backdrop of service delivery protests and growing frustration at local government countrywide, poses many questions: How can we support people who have fled their home countries when many South Africans themselves are struggling to survive?
What protection are refugees and migrants afforded and how does this affect their ability to access basic services?
What is the role of the government, academia and civil society in ensuring that South Africa meets its obligations under national and international law, such as the South African Constitution, the 1948 Universal Declaration of Human Rights, the 1951 Refugee Convention and the 1966 International Covenant on Economic, Social and Cultural Rights?
These questions cannot be ignored as the spectre of a possible resurgence of the xenophobic violence seen in May 2008 still looms.
Both Habib and Vavi referred to the Constitution and the Bill of Rights, which affords protection and access to basic services to all people within South Africa’s borders, regardless of nationality and legal status, and suggested harnessing South Africa’s pioneering spirit of solidarity.
Vavi also called for a regional approach that ideally would work across borders to find solutions. The reality for many people seeking refuge in South Africa, described by panellists such as Verryn, is that the lack of legal status makes them vulnerable — they live in horrific conditions and suffer serious health risks.
‘I have spent more time speaking about toilets than I have about Jesus at the Central Methodist Mission,” Verryn said.
Russell McGregor, from the national department of cooperative government and traditional affairs, spoke on future response models for new arrivals, while conceding that the most pressing current needs remained unaddressed.
McGregor said that, clearly, there was a lack of capacity in responding to the number of asylum claims and the shelter crisis in Johannesburg’s inner city. But South Africa’s experience is not unique.
From the MSF’s work globally it is clear that the issue of displaced and migrant populations is not new and won’t end soon.
The MSF will continue to provide necessary health services to the invisible and excluded forever unless we — and the refugees — can make ourselves heard in the corridors of power. That is where the decisions are made that impact on the structural dynamics of the global economy and ultimately on the lives of so many.
Sharon Ekambaram and Bridget Steffen work in the programme unit of Médecins Sans Frontières in South Africa