How migration-aware was South Africa’s initial response to Covid-19?
By maHp/ACMS intern Robin Arendse, based on her MSc in Global Health Policy dissertation (UoE). Featured image Figure 1: Dimensions of a Migration-aware Response.
Executive Summary and Key Findings Report
The global outbreak of Covid-19 in February and March 2020 challenged the health systems of all affected countries. As South Africa is one of the most migrant unfriendly countries in the world and has a history of xenophobic violence and medical xenophobia, particular concerns regarding the health and wellbeing of migrants during Covid-19 were raised. Therefore, in my dissertation I aimed to answer the following question: How migration-aware was South Africa’s initial response to Covid-19?
Migration-awareness is defined as “a whole-system response whereby population movement is embedded in the design of policy and research. Such responses offer strategic opportunities to address inequity, both nationally and regionally, with resulting health and developmental benefits for all” (Vearey, Modisenyanei & Hunter-Adams, 2017, p. 90). A critical analysis of existing literature on migration and health vulnerabilities in the context of the previous HIV/AIDS pandemics was performed to distill the aspects of migration-awareness. As illustrated in figure 1, the following dimensions emerged: evidence informed, contextually appropriate, encompassing all categories and trajectories of migrants, awareness of de jure and de facto barriers, continuity of care, regional coordination and intersectoral cooperation. I drew upon examples from previous and current initiatives, programs and policies, especially regarding HIV and Covid-19, to demonstrate how these dimensions have and have not been engaged with.
The evidence-informed dimension of migration-awareness challenges the need for better migration data, what we consider to be evidence and finally, what evidence we include. The evidence regarding effective control of infectious diseases and therefore of Covid-19 is clear: leave no one behind (Orcutt et al., 2020). Therefore, when the South African Government left behind non-citizens (more specifically, those without a 13-digit RSA ID) by excluding them from the testing and tracing program, evidence was ignored (NICD, 2020). By leaving evidence behind, people were left behind, which does not only harm the individual, but hijacks an effective response. This is disappointing, since similar criticisms have earlier been made in relation to the HIV response, but not attended to by the government (Randolph, 2012).
In its response to Covid-19 the government demonstrated limited awareness of the significance of internal migration by allowing movement between provinces at later stages of the lockdown, which is believed to have contributed to the Eastern Cape becoming a hotspot. This also demonstrated a lack of understanding of the context: the lives of the poor are inherently unstable, mobile, trans-local and most South Africans do not only have one home (Bank, 2020). Not formally engaging with the national (internal) migration context and the importance of it in people’s lives and livelihood struggles, may have hindered the government’s attempt at effectively combatting Covid-19. The importance of contextual appropriateness and engaging with internal migration had been urged by academics, both previously and during Covid-19, but not heeded (Vearey, Modisenyanei & Hunter-Adams, 2017; Bank, 2020).
Awareness of de jure and de facto barriers
As the larger extent of analyzed documents were government policies, and as high-quality documents reporting barriers on the ground will only most likely be published in the latter half of 2020, the policy analysis mostly demonstrated de jure barriers for migrants during Covid-19. However, those documents that were issued by civil society do demonstrate de facto barriers in the guise of evictions and border crossings, and thereby a gap between the policies and the realities on the ground. To close this gap, accountability of those discriminating against migrants at all levels is important. The gap between policy and reality demonstrates that good policy is not sufficient for policy to be migration-aware — it must be implementable and good practice must go with it. Therefore, awareness of de jure and de facto barriers is needed. By lack thereof, the South African government’s response to Covid-19 has inadequately engaged with de jure and de facto barriers.
Continuity of care
The absence of policy documents on this topic demonstrates that continuity of care is not high on the agenda of the South African government. Similarly, in the response to Covid-19, continuity of care for other chronic diseases such as HIV was not provided in many instances (UNAIDS, 2020). The urgency thereof was illustrated by UNAIDS (2020): disruption in HIV related care and treatment due to Covid-19 in the region was predicted to result in a relapse to the 2008 HIV mortality rate. The lack of provision of continuous care during the Covid-19 pandemic may not directly hinder an effective Covid-19 response; however, it may refuel the HIV and AIDS epidemic (UNAIDS, 2020). This is especially the case as migrants find themselves in spaces of vulnerability where continuity of care for Covid-19 and chronic conditions such as HIV and TB is of the highest importance, but not being provided (IOM, 2020c).
During the response to Covid-19 there were instances where regional cooperation in the SADC region would have been beneficial and effective, but was lacking, such as with cargo and deportations. Regardless of IOM (2020a) expressing its concern regarding lack of engagement with cargo as mobile populations, the SADC reported on cargo as a business opportunity (SADC, 2020a; SADC, 2020b). Continuing detention and deportation in the affiliated poor conditions during Covid-19 demonstrates a lack of regional coordination, as South Africa has the highest prevalence of Covid-19 in the region and is surrounded by countries whose health systems may not be able to handle receiving deportees (IOM, 2020b). Furthermore, while the importance of a regional response had been urged by civil society, South Africa did the contrary by spending 37 million rand on building a 40 km fence on the Zimbabwean border in the midst of the pandemic (Parliamentary Monitoring Group, 2020c).
In the response to Covid-19 in South Africa, migration was not treated as a broad social determinant of health and well-being and the upstream structural factors affecting health were not tackled. Examples of food parcels, the social relief of distress (SRD) grant, temporary employer relief scheme (TERS), informal business operations and visa extensions demonstrate a variety of ways in which different governmental departments and civil society influence the lives and livelihood of migrants (Parliamentary Monitoring Group, 2020; Benavides, de Gruchy & Vearey, 2020; Scalabrini Centre, 2020a; ILO, 2020). The policy analysis demonstrates how many odds are stacked against migrants, while migrants were the ones who needed to be included most, as those who have been excluded from one aspect of the response are more likely to be excluded from other aspects.
Encompassing all categories and trajectories of migrants
Multiple actors have called for a shift from focusing on categories and the simplification of the migration trajectory, to acknowledging we live in a world where mobility is ever present and to engaging with migration by encompassing all categories and trajectories of migrants (Crawley & Skeplaris, 2018; Vearey, Modisenyanei and Hunter-Adams, 2017). While inclusion by the South African government did take place in the response to Covid-19, the extent of that differed per category; tourists, permanent residents, refugees and asylum seekers were included in certain aspects of the Covid-19 response, while undocumented migrants were continuously left behind. The groups that civil society has most pressed for needing inclusion — by being at intersecting points of discrimination such as LGBTQI migrants, unaccompanied separated migrant children, migrants with HIV or TB and migrants working in mining or agriculture — have not been mentioned in any of the policy documents (Arends, de Gruchy & Vearey, 2020). Semi-inclusion in the time of Covid-19 demonstrated the response to the pandemic did not sufficiently encompass all classes and trajectories of migrants.
While xenophobia had not been explicitly mentioned in most of the included documents in the scoping review, it has been a large underlying theme. This was further illustrated in the policy analysis, as xenophobia seemed to increase the difficulty of categorizing policies into a dimension of migration-awareness. While testing and tracing was categorized under the category evidence informed, leaving those without the correct ID behind in the testing and tracing program may be better explained by xenophobia. The same goes for all other dimensions of migration-awareness. Why else would, in spite of alternatives offered by civil society, detention and deportation be continuing or would R37 billion be spent on building a fence in the midst of the Covid-19 crisis? However, in lack of xenophobia, there would be no one else to blame for the government’s inadequate healthcare, health promotion, HIV prevention strategies and response to Covid-19 (Vearey, Modisenyanei & Hunter-Adams, 2017).
Key Findings and Conclusion
Civil society and scholars have repeatedly called for a migration-aware response. They have stepped in where the government was absent and have demonstrated good examples regarding migration and health that could be scaled up. High quality research has been published and actively communicated to those who are in formal positions of power. Recommendations by national migration and health forums have been made during three migration and health consultations with the government (Vearey, 2018). However, through the identification of the dimensions of migration-awareness and subsequently the analysis of 31 government documents and 15 civil society documents, this dissertation demonstrated that some aspects of South Africa’s response to Covid-19 have left migrants more vulnerable, rather than protected, while other aspects were semi-inclusive. Thus, South Africa’s response to Covid-19 was not migration-aware, nor was its response to HIV.
While this may naturally lead to the remorseful conclusion that the future of migration and health is doomed as the world is heading towards more nationalism, populism, xenophobia and the securitization agenda, small pockets of change and continuous presence of civil society offer hope (Freemantle & Walker, 2020; The Lancet Public Health, 2018). The amount of difference civil society has made for migrants during Covid-19 is inexplicable, as they occupy a vital space that would otherwise have been virtually vacuous and as they make the lives of migrants a little easier (Freemantle & Walker, 2020).
Robin Arends is a candidate in the MSc in Global Health Policy program at the University of Edinburgh, and also serves as the captain of the varsity’s women’s rugby team.
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