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Statement by Doctors Without Borders

Doctors Without Borders (MSF) notes with deep concern the ongoing social unrest in two provinces of South Africa, including widespread looting and disruption of crucial healthcare services, and the consequences on public health and safety. To date, 72 people are reported killed in the violence with hundreds more sustaining injuries, including lacerations and burn wounds. 

The unrest also prevents the provision of essential healthcare delivery by blocking patients, medical staff and critical supplies from reaching facilities. MSF calls for immediate steps to safeguard the right to healthcare and safety of patients, healthcare workers, medical infrastructure and supplies to avert a drastic escalation of the current COVID-19 driven healthcare crisis.

There have been disruptions in every district of KwaZulu-Natal, where staff cannot work due to public transport stoppages, road closures and the suspension of private ambulance services. Certain Gauteng hospitals and their emergency departments, already stretched by a surge in COVID19 cases, are overwhelmed due to staff shortages and a huge influx of trauma cases linked to the violence, forcing doctors to choose who receives life-saving treatment, and who does not. Several COVID-19 vaccination sites have also been closed. 

Numerous reports and the experiences of MSF teams indicate the violent unrest is characterised by a blatant disregard for the basic sanctity of health facilities and medical staff.

In addition to the impact on health department facilities, MSF medical services and support operations in KwaZulu-Natal and Gauteng have also suffered direct disruptions:

– In Empangeni, an MSF team that supports the regional COVID-19 response of Ngwelezane Hospital as well as department of health doctors were forced to stay away as a result of looting and unrest in the area, hampering the overall COVID-19 response. The hospital only had 22 COVID-19 patients on 13 July. We are concerned about people staying home with severe COVID-19 and the inevitable surge that the hospital might experience once tensions ease and transport resumes.

– In Eshowe, where MSF has run HIV/TB programmes since 2011, our team was forced to suspend all medical and community-based activities. Clinic-based HIV/TB services are currently inaccessible for many, and diabetics and hypertensives at high risk of severe COVID19 are unable to access their chronic medication. Our partner organisation, SHINE, had their offices damaged and looted and our team managed to hide two of our medical transport vehicles from looting occurring on the same street as the MSF office. One of our doctors, caught in the melee of looters, was tear-gassed.

– In Tshwane, the threat of unrest prompted our medical team to temporarily shut down the inner-city MSF-supported clinic and hub serving vulnerable people, including undocumented migrants, asylum seekers and refugees living in the greater Tshwane area. These are people who are most often unable to access appropriate healthcare and/or social services, and even more so during violence and unrest.

– Work has continued as normal in Gqeberha in the Eastern Cape, where another MSF medical team supports the COVID-19 ward in Livingstone Tertiary Hospital. However, threatened protest action could prevent this team from accessing the hospital, thus rendering the COVID-19 ward non-functional and directly affecting patient care.

“Health facilities must be respected as impartial safe spaces by all – those involved in violence and looting, as well as the police and military. MSF calls upon all of these actors to take immediate action to ensure unhindered access to healthcare and essential medicines is not threatened or disrupted in this time of crisis.” 

Providing medical humanitarian assistance in more than 70 countries, MSF recognises the challenges medical staff face working in insecure settings when violence causes the disruption, suspension or closure of healthcare service driving negative consequences for people in dire need. An MSF team in Johannesburg is currently assessing needs and ways to support some clinics in near hotspots overwhelmed due to staff shortages.

MSF is calling for support from community leaders, political leaders, the South African government security cluster and the Presidency of South Africa. Community and political leaders need to call for calm and rally support for the protection of healthcare. Police should protect vital healthcare infrastructure and services while the public condemnation of targeting healthcare should be sustained.

“Failing to respect and protect health services and healthcare workers will have disastrous consequences, especially for the most vulnerable in society during the ongoing health crisis – COVID-19 patients, trauma patients, the chronically ill, the elderly, pregnant mothers and infants and migrants and asylum seekers. The violence must end,” concludes Aruna.