A mobile medical team near the border

Musina, formerly a relatively prosperous mining town, lies on the South Africa-Zimbabwe border, along the main road that runs from Makhado to Beitbridge. Musina-Beitbridge is Africa's busiest commercial border, located midway between Johannesburg, in South Africa, and Harare, Zimbabwe's capital city.

Migrants generally work as farmworkers or informal labourers, earning money for their basic needs and providing for their families still in Zimbabwe. Often, fears of deportation and abuse prevent Zimbabwean migrants from utilising the public health service and so chronic infectious diseases, such as tuberculosis (TB) and HIV, go unchecked and medical needs, such as urgent deliveries, leave women vulnerable.

The South African constitution guarantees access to health care to all those who live in the country, including migrants. Zimbabweans are, at present, the largest migrant group in South Africa and, with unemployment ranging from 25 to 40 percent in South Africa, this group is increasingly seen as intruders throughout the country, creating more obstacles, such as access to services, for migrants in need of health care and medical treatment.

"Zimbabwean migrants face major risks, including sexual violence, physical and verbal abuse, and police harassment when crossing the border as well as in South Africa, where many are unable to find sustainable employment," said Sylvie Kaczmarczyk, MSF Field Co-ordinator in Musina. These factors, together with their unclear legal status, lead to a very precarious situation and to general insecurity, which affect physical and mental health.

The MSF team provides health care on commercial farms on the eastern border of Limpopo and has fixed consultation points in Musina township in the areas of Happer, Campel and Matswale.

In the first quarter of 2008, there were more than 800 consultations each month. Headaches, coughs, skin diseases, pain and sexually transmitted infections are amongst the main complaints.

MSF health care in central Johannesburg

The MSF health facility in Johannesburg is next to the Central Methodist Church, which is a shelter for 1,200 to 1,500 migrants, mostly Zimbabwean nationals. An existing health care facility was staffed once a week by volunteer health workers. The need for structured medical care for migrants as well as medical referral, in order to access the public health service, led to MSF establishing a fully staffed facility. The team provides basic health services and refers patients to the public health system for specialised medical treatment.

In the MSF waiting room, a mother of a seven-month-old baby speaks of the conditions she has faced and the reason for coming to MSF: "I came to South Africa with only the clothes I was wearing; the women at the church gave me clothes for my baby. My baby has not been immunised and I have been to three clinics in Johannesburg since December 2007, and no-one wants to immunise my baby. I came here to MSF because my baby needs his vaccinations and I'm worried that he may not be able to walk one day."

This facility serves a migrant community concentrated in and around the church, where there is limited sleeping space, poor ventilation and unhygienic conditions as a consequence of overcrowding. The church is considered by most living in it as their only safe haven, but recently this sense of safety was threatened.

A raid on the church by the South African Police Service, on 30 January 2008, in which the police physically assaulted and arrested most of the residents demonstrated this. The migrants coming to MSF are traumatised by crossing the border and the situation faced in South Africa. It is difficult to find work, there is a real fear of deportation. Primary health care provided at the facility therefore includes individual and group counselling, an added medical value since the raid.

Currently there are three weekly counselling support groups: a raid aftermath group; an HIV group, and a men's group. Groups for teenagers/adolescents and for mothers will start in April 2008

In January this year, the MSF team made 98 clinical referrals for HIV, TB and other chronic diseases, and conducted a total of 861 consultations. In February there were 1,144 consultations and 198 individual counselling sessions, and 125 referrals were made. During March, the team saw 890 patients, referred 71, and had 171 individual counselling sessions.

Bianca Tollboom is a nurse in the MSF team that assists Zimbabwean migrants in Johannesburg. Bianca tells us: "From January to March most of the patients we saw came for upper respiratory tract infections and pain, and with the diagnosis of sexually transmitted infections we notice a steady increase. The majority of patients seen by our MSF team in Johannesburg are Zimbabwean male adults who live in the church,"

MSF has witnessed the trauma Zimbabwean migrants endure living in perpetual fear and constant pain. The MSF project is an important response to the needs of Zimbabwean migrants living in South Africa.