Each day, thousands of Zimbabweans cross the border into South Africa, many risking their lives to flee economic meltdown, political turmoil, and a critical lack of access to health care in their country.

In the past several years, the crisis in Zimbabwe has given rise to food insecurity, an unprecedented cholera epidemic, political violence, rampant unemployment, an escalating HIV crisis and the near-total collapse of the health system. This breakdown in Zimbabwe has driven nearly onequarter of the entire population into neighbouring countries, particularly South Africa.

And despite claims that Zimbabwe is ‘normalising’ following the establishment of a Government of National Unity, Zimbabweans continue to cross the border every day, legally and illegally, in massive numbers as a matter of survival.

Upon arrival, many Zimbabweans endure further suffering in South Africa, without access to proper health care, shelter or safety. During their journey to and within South Africa, they are subjected to violence, physical and verbal abuse, police harassment, inhumane living conditions and xenophobic attacks.

The South African Constitution guarantees access to health care and other essential services to all those who live in the country – including refugees, asylum-seekers, and migrants – regardless of legal status. However, in practice, the fear of arrest, deportation, and xenophobia, coupled with a lack of accurate information about their rights, has kept many Zimbabweans from accessing basic services necessary for survival. Today, Zimbabweans are still often charged exorbitant fees to access public facilities despite policies to the contrary, turned away from hospitals when they need admission, discharged prematurely, or subjected to harsh treatment by health staff in the public services.

In 2007, Médecins Sans Frontières (MSF) opened two projects to respond to the specific health needs of Zimbabweans seeking refuge in South Africa. MSF mobile clinics, operating in and around Musina town at the border with Zimbabwe, in addition to a fixed MSF clinic at the Central Methodist Church in Johannesburg, provide general primary health care, referrals to existing hospitals or specialised medical facilities, and other humanitarian assistance, including shelter, water and food.

MSF medical teams treat 4,000-5,000 Zimbabweans each month, mainly for respiratory tract infections, including a substantial proportion of tuberculosis; sexually transmitted infections; gastro-intestinal and diarrhoeal conditions; and stress-related ailments. More than 30% of HIV tests performed are positive. Yet, this is just the tip of the iceberg. There are thousands more Zimbabweans who never come forward to access MSF or other health services, choosing instead to protect themselves by becoming invisible in South African society.

Because many patients have endured multiple traumatic events and exhibit symptoms of posttraumatic stress, MSF also provides psychological support in both Musina and Johannesburg. In addition, MSF teams treat a rising number of survivors of sexual violence and see a worrying increase in the number of unaccompanied children travelling from Zimbabwe into South Africa.

The recent announcement by the South African Department of Home Affairs that a new system will be put in place to regularise the legal status of Zimbabweans in South Africa, and to stop the systematic deportation of Zimbabweans, is a welcome departure from the government’s previous policy of aggressive harassment, arrest, and deportation. Whether the fate of vulnerable Zimbabweans in South Africa will improve depends upon how and when these new policies will be put into practice.

This report highlights the plight of Zimbabweans seeking refuge in South Africa, the appalling conditions in which they live, and their ongoing lack of access to adequate protection, shelter, and basic services, particularly health care, in South Africa.