Accessing health and justice in a time of Covid-19

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While most scramble to find stability during these uncertain times, Fatima Hassan decided that a global pandemic was the right time to return to where she first cut her teeth as a human rights lawyer and activist. Why now? Because, now more than ever, the country needs to prepare for yet another battle of equity for its most marginalised residents — and Hassan believes that the law can be used as a tool for redress once again. 

“I was enjoying a really long sabbatical and reflecting on what my purpose is and how I will contribute to society, and then Covid-19 happened,” she explains. “During the lockdown, I began to think about the parallels to the way in which we had to initially respond to HIV. There was an awakening moment. I’d always said that I would one day return civil society into that space of movement lawyering.” 

That is how the Health Justice Initiative (HJI) was birthed, an initiative that aims to improve access to public health services through addressing how the intersection of racial and gender injustices — particularly during the Covid-19 global pandemic — exacerbate inequalities and poverty. HJI will especially focus on the access to life-saving testing, treatment and vaccines and how they can be made available during the pandemic as a vaccine is developed for the novel Coronavirus. 

Fatima Hassan says that there are many parallels between the HIV and the Covid-19 pandemic, and how they affect ordinary South Africans. (Photo: David Harrison)

Hassan, who left her position as the executive director of Open Society Foundation for South Africa in mid-2019, after 6 years, is the founder and head of HJI, and she’s not new to the social justice and human rights law sectors. She’s litigated against the South African government, private employers and pharmaceutical companies during the country’s HIV epidemic while she worked at the Aids Law Project, which represented the Treatment Action Campaign (TAC). The TAC was at the forefront of the struggle for access to medicines and treatment for people living with HIV during the “dark days of Aids denialism”. 


“It’s been seven years since I was directly involved in the civil society sector. I’m very strongly committed to the issue of transformation — particularly race and gender transformation in civil society — which I’ve written about, and I felt [it] has been very slow and needs to be expedited,” she says. 

The idea through this initiative is to encourage a new generation of young black men and women to join civil society and the type of work HJI is trying to pursue so that we actually have better health outcomes, not just for Covid-19, but on a whole range of issues where inequity is actually driving poor health outcomes and is driving poor public health in South Africa.

But as the country battles with this global pandemic, Hassan is afraid that history may repeat itself. South Africa has been here before, she says. It was a different time, with a different disease, but the same problems: an overburdened health system, a vulnerable population and a government that is not fully prepared for what comes next.

She draws from her experiences of the early 2000s when HIV was ravaging the country and when president Thabo Mbeki was unequivocally an Aids denialist. The parallels between the HIV epidemic and the Covid-19 pandemic are hard to ignore, Hassan says. The most obvious and visceral is the level of premature deaths caused by both. 

“Too many suffered needlessly and died prematurely as a result of a lack of access to testing and treatment for HIV. This is something that the ANC will have to live with on their conscience for as long as it exists,” Hassan says.  

The ANC enabled state-sponsored Aids denialism by being unable to hold a president who didn’t believe what was happening around him accountable, she adds. Hassan believes the country is yet to see the full extent of suffering and death caused by Covid-19, as South Africa waits to reach the peak of this pandemic. Already, health experts are saying that the country has under-counted the number of deaths in South Africa as a result of Covid-19. 

It’s been almost 150 days since the National Institute of Communicable Diseases confirmed the first case of Covid-19 in South Africa. Since then, the country has seen it all: from inhumane evictions happening, which are legally prohibited during the State of Disaster, to endless snaking queues of people looking for jobs, food and help in one way or the other. Hassan believes it is South African women who have borne the brunt of the consequences of Covid-19, such as unemployment and the inability to access social relief. 

She explains: “All of this points to a picture that, in particular, black poor women in South Africa are really facing the brunt of this global pandemic, as they did with HIV. Early reports are also indicating that women living with HIV and tuberculosis, women who are pregnant and those who need to have their children vaccinated are not accessing health services in the public sector since the beginning of the lockdown because of a number of factors, including fear.”

The anecdotal evidence also suggests that the burden on women in South Africa during this lockdown even cuts across class, Hassan argues, as working from home creates unpaid care work — its women who are expected to do the childcare, be involved in online school learning and also taking care of sick loved ones. 

While Covid-19 has exacerbated the stark inequalities that exist in South Africa, which also intersect through race, class and gender, ensuring a public health system that is able to serve all its users is paramount. Just as civil society was able to hold the South African government and pharmaceutical companies accountable during in the early 2000s, the same will be required as the pandemic continues and as its ramifications surface, Hassan says. HJI, through partnerships with other civil society organisations, will focus on protecting people’s rights and tackling the factors that increase inequity in health access during and after the pandemic. 

“A season of death is upon us,” she says. “What does the inability to stop premature death and suffering mean for our society and for social cohesion?”

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