By Tamuka Chekero, Alois Muzenje, Owen Mafongoya and Faith Sithole
In the heart of Alexandra, Johannesburg, the morning air hums with the rhythm of traffic, chatter and restless waiting. Amid the noise, a young Congolese woman stands at the entrance of the crowded Community Health Centre. In one trembling hand, she holds a crumpled Section 22 permit—its ink fading, its expiry date mocking her persistence. In the other, she cradles her 18-month-old baby, feverish and due for vaccination. The nurse glances at the paper, sighs and shakes her head—a small gesture that carries the weight of rejection. She tells the woman to return once her permit has been renewed at Home Affairs, though both know that renewal is a distant dream.
At the Desmond Tutu Refugee Reception Centre in Pretoria, queues stretch like lifelines, and months of waiting are explained away as “backlogs” and “technical issues.” Between these bureaucratic silences, the woman walks home empty-handed, her steps heavy with more than fatigue. Her body carries the weight of exclusion; her child, the quiet ache of deferred care. Together, they move through a city that both shelters and denies them—an urban borderland where survival itself becomes a daily act of endurance.
Introduction
The encounter above reveals what ethnographers and legal scholars call liminal spaces of permanent temporariness—fragile in-betweens where asylum seekers exist between hope and despair, legality and illegality, and belonging and exclusion (Livingstone & Matthews, 2017; Chekero, 2023; Maple, Vanyoro, Achiume, Vearey, and Akena, 2023). In cities like Cape Town, Johannesburg and Pretoria, this waiting becomes a way of life, where days dissolve into months and months into years as promises of documentation, healthcare and protection hang in bureaucratic suspension. The Refugees Act of 1998, once celebrated for its progressive vision, promises refugees and asylum seekers the right to healthcare, education and employment. Yet, as Chekero and Ross (2020:42) observe, what appears empowering “on paper” turns opaque for those without “papers.” Within clinics, classrooms, and marketplaces, this opacity takes the form of everyday bureaucratic violence—denials, delays, and disciplinary silences that corrode hope itself. To live here is to endure, to resist quietly within a system that both recognises and erases.
Drawing on ethnographic research in Cape Town, Pretoria and Johannesburg, this blog traces how refugees experience borders not as lines on maps but as living forces that shape access, dignity and care. As we show, through hushamwari (Zimbabwean Shona for friendship) and kuhanyisana (South African Tsonga for mutual aid) (Chekero & Morreira, 2020), refugees and asylum seekers navigate, negotiate and reimagine belonging, transforming precarious urban margins into spaces of resilience and quiet defiance.
Why, one might wonder, focus on refugees and asylum seekers, rather than simply including all migrants? The answer lies in the depth of their vulnerability and precarity. Unlike other migrants, refugees and asylum seekers often have no home to return to, having fled war, persecution, or political turmoil. This lack of choice deepens their struggles within host cities. However, within these struggles, remarkable stories of endurance and creativity emerge. This blog delves into those stories — tracing the obstacles they confront and the inventive, relational ways they carve out spaces of care, belonging, and hope. Through these everyday acts of solidarity, refugees and asylum seekers transform borders that confine them into fragile but powerful networks of possibility.
The Bureaucratic Body and Legal Contradictions
The architecture of South Africa’s asylum system—its endless queues, misplaced files, and perpetually expiring permits—reveals bureaucracy not as a neutral process but as a subtle mechanism of control. Each delay determines who moves, who waits, and who suffers unseen, turning time itself into an instrument of governance. In cities like Cape Town, Johannesburg and Pretoria, refugees and asylum seekers find their mobility and access to basic services, especially healthcare, constrained by expired documentation that the state itself struggles to renew. Within the sterile walls of clinics and hospitals, these administrative failures are translated into human suffering. Despite possessing legal rights to care, many refugees are routinely turned away, their eligibility questioned not by law, but by prejudice.
South Africa’s Constitution (Section 27) guarantees that “everyone,” including non-citizens, has the right to access healthcare services, including reproductive healthcare, and explicitly forbids the denial of emergency medical treatment. The Refugees Act of 1998 further enshrines refugees’ rights to healthcare, education, and employment, while the National Health Act of 2003 mandates that healthcare should be provided equitably and without discrimination. On paper, South Africa’s legal framework is among the most progressive globally, yet as asylum seekers’ daily experiences reveal, these promises often dissolve at the clinic door (Makandwa & Vearey, 2017). The bureaucratic insistence on “having papers” shapes access to healthcare, forcing migrants to rely on extra-state resources or informal networks to secure wellbeing that the state ostensibly guarantees.
This contradiction—between legality and lived experience—is what Crush and Tawodzera (2014)call “medical xenophobia”: the systematic denial or poor treatment of migrants in healthcare spaces based solely on their nationality or documentation status. Bureaucratic inefficiency and social hostility turn rights into privileges, transforming care into a conditional gesture rather than a constitutional guarantee. One Congolese woman in Randfontein, eight months pregnant and denied care because her asylum permit had expired, captured this contradiction poignantly: “If they will not take me as a person, perhaps they will take my pain.” In that plea, the moral wound of South Africa’s asylum system becomes unmistakably clear. By tracing these gaps between rights and practice, we explore how power, moral obligations, and social relations intersect in the creation of lived realities, without reducing the blog to a simple exposé (Fassin, 2012).
Health as a Border
In most public healthcare facilities in South Africa, healthcare has quietly transformed into a border. Clinics and hospitals, once imagined as spaces of refuge and healing, now function like checkpoints where entry depends not on symptoms but on papers. For refugees and asylum seekers, these papers are often expired, misplaced, or impossible to renew, turning each attempt to seek care into an act of risk and uncertainty. Fear of deportation, verbal humiliation, or outright rejection keeps many away until illness becomes unbearable. The result is not a sudden catastrophe, but what anthropologists call slow violence (Mayblin, Wake & Kazemi, 2020), a gradual, invisible erosion of dignity and wellbeing that unfolds quietly over time.
In this climate, seeking healthcare becomes far more than a medical act; it is a moral and political negotiation of visibility and belonging. As one woman from the Democratic Republic of Congo put it, “They told me my papers are not enough. I cannot get the treatment my baby needs. I am left standing, crying inside, while others go in.” For a woman from Sudan, the experience is equally harrowing: “The nurse looked at my asylum document and shook her head. She said, ‘We cannot treat you today.’ I felt my body disappear, as if my sickness made me invisible.” Their words capture the despair of those whose bodies cross borders even when their papers cannot.
Every clinic visit becomes a test of endurance, what Fassin (2010) alludes to as a silent contest between legality and survival. The clinic, once a beacon of universal care, has become a frontier where legality, bureaucracy, and prejudice collide. Health itself becomes entangled with politics, transforming the human body into a living document—a site where South Africa’s contradictions are written in pain, endurance, and quiet defiance. In this uneasy terrain, the pursuit of healing is inseparable from the struggle for recognition and the right to belong.
Operation Dudula and the Policing of Belonging
In South Africa, a new kind of border has emerged—not one drawn by the state, but enforced by ordinary citizens. Operation Dudula, once dismissed as a fringe vigilante movement, has evolved into a national campaign that redefines who belongs in South Africa’s fragile democracy. Its name, meaning “to push back” in Zulu, captures its mission: to drive out migrants blamed for the country’s economic and social ills. What began as scattered protests has grown into organised patrols outside hospitals and clinics—spaces that once symbolised care, now transformed into zones of exclusion.
At these gates, health has become a matter of citizenship. Members wearing “Mass Deportation” T-shirts stand guard, demanding ID documents and deciding who may enter. Those unable to produce South African IDs—often long-time residents or asylum seekers—are turned away, their illnesses rendered invisible. Behind these acts lies something more profound than xenophobia; it is the manifestation of a nation’s unspoken anxieties. South Africa’s public health system is straining under years of corruption, inequality, and neglect. Overcrowded wards and chronic medication shortages have turned frustration inward, finding a convenient scapegoat in the migrant neighbour. As one Dudula supporter explained, “We wake up at 4 a.m. to queue at the clinic, only to find foreigners already inside.”
For migrants like Tendai, a Zimbabwean woman denied prenatal care in Diepsloot because she lacked an ID, such hostility is more than symbolic—it is life-threatening. “I know I cannot go to the clinic,” she said softly, “but I also cannot afford private care.” Her body becomes the terrain upon which the politics of belonging is fought. As Fassin, Wilhelm-Solomon, and Segatti (2017) remind us, every debate over healthcare is, at its core, a debate over whose life matters.
In Operation Dudula’s South Africa, care has become conditional—granted to some, denied to others. However, amid this moral crisis, organisations like Médecins Sans Frontières and the Treatment Action Campaign continue to resist, reminding the nation that “everyone” in the Constitution must truly mean everyone. For when the clinic becomes a border post, the struggle for belonging is no longer about documents—it is about the right to be seen, treated, and recognised as human.
Scapegoating Foreign Nationals: A Monument of Misguided Efforts
Scapegoating foreign nationals has become a monument to misdirected effort in South Africa. This misdirection is visible in clinics and hospitals where activists from Operation Dudula and similar groups block migrants from accessing basic healthcare. The irony is stark: while foreigners are denied care, billions of rands meant for health services are siphoned away through corruption and maladministration. Tembisa Hospital, for instance, lost over R2 billion to syndicates exploiting weak oversight, yet public anger is redirected at the very people who are often most vulnerable. These syndicates operated with impunity, falsifying invoices and bypassing tender regulations, while ordinary citizens and migrants alike waited for care that never arrived.
The narrative that migrants “overburden” hospitals obscures the structural rot within the health system, allowing corruption to continue unchecked. Politicians and populist leaders exploit this narrative, amplifying fear and xenophobia to distract from governance failures. Meanwhile, pregnant women, HIV patients, and chronically ill individuals—both South African and non-South African—are left to navigate queues that are longer because resources have been stolen. The human cost of corruption is immediate, visible, and tragic, yet scapegoating migrants shifts attention from the real culprits.
As the SIU report makes clear, hospital CEOs failed in oversight, departments neglected accountability, and billions were lost—all while activists blamed the wrong people. When anger is misdirected at those seeking care, the state evades scrutiny and the cycle of misgovernance continues. To confront the crisis, we must rename the monument: it is not the migrant burden, but the burden of corruption and political indifference that South Africans face.
Only by dismantling false narratives and demanding accountability can healthcare begin to serve those it was meant to protect.
Collective Care and Survival beyond the Clinic
In Johannesburg and Pretoria, the struggle for healthcare and safety stretches far beyond the walls of clinics and the constraints of bureaucracy. Refugees and asylum seekers navigate exclusion, xenophobia, and structural barriers by creating their own systems of support, grounded in hushamwari and kuhanyisana, both of which embody Southern African ethics of mutual aid and interdependence. As Chekero and Morreira (2020) observe, these practices turn survival into a shared responsibility, producing networks of care when the state fails to uphold its promises.
In Pretoria East, in an informal settlement called Plastic View, migrant women, regardless of nationality, form rotating savings clubs in cramped shelters, contributing weekly to cover transport costs, medical bills, or emergencies. When one woman falls ill, others bring food, care for her children, or lend money for private healthcare visits. WhatsApp groups function as virtual clinics, counselling spaces, and hubs of information, extending hushamwari into the digital realm and enabling collective resilience in real time. In Pretoria’s Marabastad, Sudanese and Congolese migrants build networks around faith communities, sharing prayers, medication, and financial support when formal healthcare access is denied. Makandwa and Vearey (2017) highlight how such networks transform informal spaces into essential sites of care. Maple et al (2023) note that these networks are crucial in navigating gaps left by the global refugee regime, while Maple (2024) demonstrates that local policies often compound the need for grassroots support. As one participant explained, “The place of worship is our clinic when the clinic rejects us,” illustrating how kuhanyisana redefines wellbeing as a relational, rather than institutional, practice.
These strategies intersect with Nyamnjoh’s (2017) concept of nimble-footedness, reflecting migrants’ capacity to improvise and resist structural constraints while maintaining trusted relationships and community ties. Chekero and Ross (2018) and Chekero and Morreira (2020) further emphasise how these collective practices extend survival beyond mere endurance, creating ethical, social, and emotional lifelines. Conviviality—living together across difference—underpins these networks, as everyday gestures such as shared meals, childcare, and market greetings reaffirm belonging. Even informal ties with local authorities or community leaders provide early warnings about raids or roadblocks.
Together, these practices demonstrate that care and survival are inseparable from friendship, solidarity, and ethical responsibility. In a landscape where the state and society often turn away, refugees and asylum seekers collectively reimagine belonging, transform exclusion into resilience, and turn urban margins into spaces of life, hope, and quiet defiance.
Conclusion: Toward an Ethics of Shared Fragility
Asylum in South Africa reveals a landscape where vulnerability is shared, yet unevenly recognised. Hospitals that turn away asylum seekers mirror broader systemic failures, exposing gaps that affect both migrants and South African citizens alike. These patterns are not accidental but emerge from entrenched inequality, bureaucratic inertia, and the legacies of exclusion. Recognising this, ethics of care must move beyond legalistic definitions of protection, centring relationality, solidarity, and the everyday practices through which communities sustain each other. Principles such as hushamwari, the Shona ethic of friendship and mutual support, and kuhanyisana, the South African ethic of reciprocal care, illuminate how protection is enacted daily—through kitchens, WhatsApp groups, religious gatherings, and informal aid networks.
Shifting our approach requires both structural and relational interventions. Policies should ensure asylum documentation is universally recognised across services, provide language and culturally sensitive support in clinics, and protect asylum seekers and refugees from harassment, from which they are running away from their home countries. Simultaneously, community networks must be nurtured, not undermined, as they constitute essential infrastructures of care. Health, mobility, and social services must be designed to enhance access and dignity rather than reinforce precarity.
Future research should examine how digital and social networks mediate access to care and how everyday practices of solidarity can inform policy design. By acknowledging shared fragility and valuing relational forms of protection, South Africa can begin to reimagine a system that is both lawful and humane. In this society, safety, belonging, and well-being are enacted in practice, extending beyond borders and bureaucracies, and fostering inclusive care for all.
References
Chekero, T. (2023). Borders and boundaries in daily urban mobility practices of refugees in Cape Town, South Africa. Refugee Survey Quarterly, 42(3), 361–381.
Chekero, T., & Morreira, S. (2020). Mutualism despite ostensible difference: hushamwari, kuhanyisana, and conviviality between Shona Zimbabweans and Tsonga South Africans in Giyani, South Africa. Africa Spectrum, 55(1), 33–49.
Chekero, T., & Ross, F. C. (2018). “On paper” and “having papers”: Zimbabwean migrant women’s experiences in accessing healthcare in Giyani, Limpopo province, South Africa. Anthropology Southern Africa, 41(1), 41–54.
Crush, J., & Tawodzera, G. (2014). Medical xenophobia and Zimbabwean migrant access to public health services in South Africa. Journal of Ethnic and Migration Studies, 40(4), 655-670.
Fassin, D., Wilhelm-Solomon, M., & Segatti, A. (2017). Asylum as a form of life: The politics and experience of indeterminacy in South Africa. Current Anthropology, 58(2), 160–187.
Fassin, D. (2012). “Introduction: Toward a Critical Moral Anthropology.” In A Companion to Moral Anthropology, edited by D. Fassin, 1–17. Malden: Wiley-Blackwell.
Fassin, D. (2010). “Ethics of Survival: A Democratic Approach to the Politics of Life.” Humanity 1 (1): 81–95.
Livingstone, N., & Matthews, P. (2017). Liminal spaces and theorising the permanence of transience. Transience and Permanence in Urban Development, 31–45.
Makandwa, T., & Vearey, J. (2017, March). Giving birth in a foreign land: Exploring the maternal healthcare experiences of Zimbabwean migrant women living in Johannesburg, South Africa. In Urban Forum (Vol. 28, No. 1, pp. 75–90). Dordrecht: Springer Netherlands.
Maple, N., Vanyoro, K., Achiume, E. T., Vearey, J., & Akena, A. (2023). The Influence of the Global Refugee Regime in Africa: Still “Akin to a Distant Weather Pattern”?. Refugee Survey Quarterly, 42(3), 247–258.
Mayblin, L., Wake, M., & Kazemi, M. (2020). Necropolitics and the slow violence of the everyday: Asylum seeker welfare in the postcolonial present. Sociology, 54(1), 107–123.
Nyamnjoh, F. B. (2017). Incompleteness: Frontier Africa and the currency of conviviality. Journal of Asian and African studies, 52(3), 253-270.
Project Methodology and Ethics
This study employs ethnography, combining participant observation and in-depth interviews to explore the everyday experiences, social networks, and survival strategies of migrants and refugees. Fieldwork was conducted in Cape Town, and later extended to Johannesburg and Pretoria, engaging community spaces such as homes, churches, markets, and informal gatherings. In-depth interviews allowed participants to narrate their experiences and coping strategies in their own words.
Ethical approval was granted by the University of Cape Town Ethics Review Committee (Application Number: EARC2018-30) and the Centre for the Advancement of Scholarship at the University of Pretoria. All participants provided informed consent, were assured of anonymity, and could withdraw at any time. Data is securely stored and accessed only by the research team. This methodology foregrounds relationality, agency, and the ways migrants and refugees navigate social, bureaucratic, and structural challenges.
Author Bios:
Tamuka Chekero holds a PhD in Anthropology from the University of Cape Town. His research traces the everyday lives of migrants in Southern Africa, exploring how bureaucracy, displacement, and social relations intersect. Drawing on Southern African epistemologies and ontologies of care, including hushamwari, kuhanyisana, and moral economies of support, his work illuminates the relational practices through which communities sustain belonging and wellbeing amidst precarity.
Alois Muzenje, Lecturer in Sociology and Social Anthropology, Great Zimbabwe University, and PhD fellow, University of KwaZulu-Natal. His research examines how climate change, displacement, and food insecurity are navigated through local institutional practices, tracing the social worlds of migration, resilience, and equitable energy transitions.
Owen Mafongoya, PhD, University of KwaZulu-Natal. His research focuses on indigenous knowledge systems in seasonal forecasting and climate adaptation among smallholder farmers in Zimbabwe, exploring how local knowledge can be integrated with scientific methods to enhance resilience, inform policy, and support sustainable livelihoods.
Faith Sithole, Sociologist and Lecturer, Great Zimbabwe University, and PhD fellow, University of KwaZulu-Natal. Her work investigates the intersections of gender, migration, disability, and climate change, exploring how these dynamics shape lived experiences and social inequalities, and informing advocacy for social justice and inclusion.
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