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Anti-immigrant sentiment is unfolding on the streets of South Africa, with the potential for violence that took 62 lives in 2008, including 27 South Africans, and has hardened since the COVID-19 pandemic. The National Health Act is explicit: anyone not on medical aid, regardless of citizenship or immigration status, is entitled to free primary healthcare services.

The National Health Insurance (NHI) Act, however, would do the opposite, banning many foreigners from getting HIV treatment. The NHI roll-out is currently “on pause” while the Constitutional Court considers if fair processes were followed for it to become law, with a judgment not expected until December or early 2027.

Hostility towards immigrants has increased since COVID-19, according to the Human Sciences Research Council, which has been tracking sentiment towards immigrants since 2003. In 2021, 30% of South Africans said they would “welcome no immigrants” to the country, climbing to 42% by 2025, mostly driven by the poor and lowest socioeconomic classes.

Foreign nationals make up a small fraction of South Africa’s population, just 5.1%, or 3.1-million people, according to the country’s own census figures. However, these numbers have been inflated and distorted, with immigrants blamed for everything from failing clinics and overcrowded schools to soaring crime and high unemployment rates.

Anti-immigration politics gives leaders a way to address what people are angry about – immigrants – while not addressing what’s actually broken. In the health sector, examples of what’s broken include the 2021 Tembisa Hospital “skinny jeans” scandal, where R2-billion was stolen, and the corruption linked to communications company Digital Vibes.

The NHI Act, as it is written, would exclude refugees, undocumented migrants, and asylum seekers from free health treatment for non-emergency and non-notifiable diseases, including HIV.

Mia Malan asked Motsoaledi if he’d be prepared to start a process to get the Act changed, should the Constitutional Court rule the Act can go ahead.

No one party can pass anything alone in Parliament now, and there would need to be an agreement with other parties to make any changes to the Act. The situation remains uncertain, with the Constitutional Court’s judgment on the NHI Act not expected until December or early 2027.

Scientists and activists will continue to fight for the clause about access to health treatment for foreigners to be adjusted, ensuring that everyone in South Africa has access to the necessary healthcare services.

It is a matter of life and death.