Zimbabweans caught between two broken health systems

When Matilda Sibanda left Bulawayo for South Africa ten years ago, her decision was driven by Zimbabwe's collapsing healthcare system. Now 34, she finds herself in a devastating limbo - unable to access treatment at home and increasingly rejected by South African public hospitals.

"I expected to struggle for work," Sibanda says. "But being denied medical help when you're sick? That's inhumane."

Her story is shared by thousands of Zimbabweans living in South Africa, many of whom are undocumented and have become the target of Operation Dudula, a controversial anti-immigrant campaign launched in 2021. Although the movement claims to defend South African interests, it has fostered a wave of xenophobic attacks, evictions, and the denial of basic services, including emergency healthcare.

Videos circulating widely on social media have shown pregnant Zimbabwean women being turned away from South African hospitals. In one infamous incident in 2022, Limpopo Health MEC Dr Phophi Ramathuba publicly scolded a Zimbabwean patient in a hospital ward, accusing her of "killing my health system."

Even Zimbabweans with legal documentation say the atmosphere has turned hostile. "You live in constant fear of being refused help," Sibanda adds.

Efforts to seek intervention from the Zimbabwean government have yielded little. Justice Minister Ziyambi Ziyambi recently told Parliament that Zimbabwe would not fund healthcare for citizens living in South Africa, instead urging them to regularise their status and contribute to that country's systems.

"We are currently unable as Parliament to budget for adequate health services for citizens in the country," Ziyambi said. "Those who moved to other countries went to look for better opportunities and should be able to take care of themselves. Our embassies, however, stand ready to assist those with life-threatening conditions."

Back home, the public health sector is in a state of disrepair. President Emmerson Mnangagwa made unannounced visits to Harare's Parirenyatwa Group of Hospitals and Sally Mugabe Central Hospital in June, discovering widespread shortages of medicine, obsolete equipment, and overwhelmed staff.

The visits spurred government pledges to rehabilitate major hospitals to international standards. Healthcare worker groups such as the Zimbabwe Association of Doctors for Human Rights (ZADHR) welcomed the move but called for a Commission of Inquiry into the deeper structural failures of the health system. However, the speed of renovations has prompted concerns over transparency and possible corruption in procurement processes.

In South Africa, tensions remain high. Ngqabutho Mabhena, chairperson of the Zimbabwe Community in South Africa, says Operation Dudula continues unchecked.

"Operation Dudula is carrying on with its activities, even though we deem them illegal. They continue to block people from accessing healthcare. Sadly, we don't have exact figures of how many Zimbabweans have been affected," he said.

"Dudula doesn't care if one is documented or not. If you're foreign, you're barred. We've seen groups like Abahlali Basemjondolo confronting them, and some South African organisations have taken the government and the Department of Home Affairs to court for allegedly colluding with Dudula."

Mabhena urged South African authorities to ensure universal access to healthcare and protect the rights of all residents, regardless of nationality. "Those who can afford it can go to private hospitals, but many cannot. We call on the government to uphold the Constitution and human dignity."

A Daily Maverick article recently argued that South Africa's strained public health system is the result of years of mismanagement, not foreign nationals. It noted that many hospitals near borders have long suffered from underinvestment, lacking the capacity to meet rising demand from all communities.

Dr Khanyile Mlotshwa, a critical studies scholar, said the perception that foreigners are draining public resources has been exaggerated and weaponised.

"They claim foreigners are abusing South Africa's health system. It's true the system is under strain, but the idea that foreign nationals don't pay taxes is simply false," he said.

Dr Mlotshwa criticised Operation Dudula for indiscriminately targeting immigrants without any legal basis or capacity to assess immigration status. "They lump all foreigners together and brand them as illegal. That's both unlawful and dangerous."

He warned that Zimbabweans appear to be the primary target of Dudula's xenophobia. "There's a unique hatred reserved for Zimbabweans. People circulate dangerous stereotypes online, and some Zimbabweans live in fear. Others return home because of the pressure, while some stay because they have no choice."

While Dudula's actions are not enshrined in law, they are yet to be effectively challenged in court. Dr Mlotshwa noted that recent incidents, particularly the blocking of patients at hospitals, could become the subject of legal battles.

"The Helen Suzman Foundation has previously mounted successful litigation against government moves to cancel special permits. The current healthcare exclusion trend is new but will likely face judicial scrutiny soon," he said.

For now, Zimbabweans like Sibanda remain stuck—caught between a crumbling healthcare system back home and a rising tide of hostility in South Africa.