MUSINA, South Africa. It's 6am and Tholakele Nkwanyana is one of the first people to arrive at the Diepsloot public health clinic in Johannesburg, not to seek medical help, but to stop foreigners from getting medical help.
She and her colleagues from the South African anti-immigrant group Operation Dudula (meaning “to get rid of by force”) are dressed in military fatigues, blocking the entrance and demanding identification of patients. Mothers carrying children and other sick people are not allowed to go to private hospitals, which, unlike public ones, are not free.
Similar scenes played out in public clinics in South Africa's most populous province of Gauteng, as healthcare becomes the new battleground in the country's long and bitter debate over immigration.
The Johannesburg High Court ordered Operation Dudula to stop persecuting migrants. The group says it will appeal.
“What we say in our operations is 'put South Africans first,'” Nkwanyana told The Associated Press. “The problem we have is that the influx of foreigners is too large and there are not enough medicines.”
Africa's most developed economy hosting world leaders this week for the G20 summit, attracts migrants from neighboring Zimbabwe, Mozambique and Lesotho, as well as from Nigeria and Ethiopia.
In the year ending 31 March, the Home Office deported 46,898 migrants who entered South Africa without documents, an 18% increase on the previous year.
Operation Dudula began several years ago and has grown in prominence because it mainly involves young black South Africans. It is unknown how many members are in the group. His actions included closing foreign-owned stores and banning foreign children from attending public schools.
Participants in Operation Dudula claim that migrants entering without documents taking jobs away from South Africans facing one of the world's problems highest unemployment rate at a level of more than 31%.
South Africa has sometimes seen deadly waves of such sentiment. In 2008, attacks on foreigners killed 68 people across the country.
But the emphasis on denial of medical care is new, along with the organized structure of Operation Dudula. The group has regional leaders, participates in press conferences and debates, and has hinted at forming a political group.
The South African government has condemned Operation Dudula and insists the law guarantees medical care for everyone, including foreigners in the country illegally.
“We are healthcare professionals. We don't turn away patients because they don't have documentation,” said Health Minister Aaron Motsoaledi.
He and others have met repeatedly with members of Operation Dudula, and the government has stationed guards at public clinics, but the country's police force is overstretched. where there is a high crime rate.
“They can't wait in the clinic in case something happens. They have a lot of other work to do,” National Police Commissioner Fani Masemola said.
In August, three members of Operation Dudula were arrested after entering a maternity ward in Soweto and demanding that patients show their identification documents. The nurses called the police. They have since been released on bail.
The South African Human Rights Commission, which has strongly criticized Operation Dudula, said South Africa was monitoring a global rise in anti-immigrant sentiment.
“You've seen them in the United States and Europe. It's a trend everywhere,” said SAHRC Commissioner Tshepo Madlingozi.
South Africa spends 8.5% of its gross domestic product, or about $15 billion. on healthcareabove everything except education. And yet, hospitals are overcrowded, there are shortages of medicines and poor management.
But many people in other African countries view South Africa as a relatively attractive destination.
Official statistics estimated that there were 2.4 million foreign nationals living in South Africa in 2022, about 3.9% of the population, without a breakdown of those who were there legally or illegally. This is more than was estimated in the 1996 census, when their number was more than 958,000.
“We recognize that there are many challenges in health care: a shortage of nurses, a shortage of doctors,” Madlingozi said. “The infrastructure is collapsing, so there are many problems. But as a commission we are very clear that non-citizens should not be scapegoated.”
In May, Zimbabwean national Blessing Tizirai moved from the South African capital Pretoria, where she was looking for work, to the town of Musina near the border. Four months pregnant, she was turned away from government clinics several times during Operation Dudula or similar, smaller groups. She chose Musina because Operation Dudula does not operate there.
“Since I arrived, I have never been turned away from the clinic,” she said.
Nonhlanhla Moyo, who also came from Zimbabwe in search of work, was among those turned away from the Diepsloot clinic as a result of Operation Dudula.
“If I can't get an asthma pump, how will I live? It's very difficult,” said Moyo, who remains in Gauteng.
Both are afraid of going to a clinic in Zimbabwe, where the healthcare system has collapsed in conditions of chronic underfunding and neglect. Patients visiting government hospitals often have to bring their own medications, syringes, bandages and even water.
Operation Dudula's efforts have attracted attention in Zimbabwe, where a lawmaker raised the issue of the group during a recent parliamentary debate and suggested the government should do something about rising tensions, such as paying for medical treatment for its citizens in South Africa.
Justice Minister Ziyambi Ziyambi responded that the government would not do this. Meanwhile, Zimbabwe's political elite largely seek treatment abroad, including to South Africa.
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Associated Press writer Farai Mutsaka in Harare, Zimbabwe, and video journalist Alfonso Nkunyana in Johannesburg contributed to this report.
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