Tackson Makandwa’s research while affiliated with University of the Witwatersrand and other places

The COVID-19 pandemic was an unprecedented crisis characterised by widespread disruption and significant loss of life. Governments worldwide responded with a myriad of containment measures aimed at curbing the spread of this deadly virus. In South Africa, a nation accommodating migrants from diverse backgrounds, COVID-19 mitigation protocols were authorised but met with criticism not limited to local citizens. Cross-border migrants decried these measures as manifestations of medical xenophobia and 'migrantcide', engendering reluctance among many, particularly migrants, to seek medical treatment from public healthcare facilities. This article delves into the perspectives and beliefs of Congolese and Somali asylum seekers and refugees living in South Africa, with a particular emphasis on their perceptions of COVID-19 within an immigration landscape often fraught with hostility. The central argument posits that animosity and state negligence in a time of socioeconomic difficulty exacerbated migrants' misconceptions regarding COVID-19, contributing to their hesitancy in using South African public healthcare facilities during the pandemic. The profound deficit in trust between refugees and healthcare practitioners, stemming from inadequate communication channels, further exacerbates existing tensions and mistrust. Based on extensive fieldwork conducted in 2021 among Congolese and Somali communities in Yeoville and Mayfair—two suburbs of Johannesburg, South Africa populated by migrants—this paper explores the various meanings, perceptions and beliefs surrounding the COVID-19 pandemic. It examines how these factors contributed to rising anxiety and fear, as well as the diverse responses adopted to address the deadly disease. The hesitancy of migrant groups to seek medical assistance from public healthcare facilities led them to explore alternative means of managing COVID-19 symptoms. While some of these approaches occasionally yielded positive outcomes, they often fell short of achieving the desired results, potentially resulting in an increased number of infections and fatalities that remained untested and unreported.

Given South Africa’s historical and contemporary realities of both internal mobility and migration from other countries, this paper argues that engaging with space, place, and migration is pivotal to understanding and strengthening public health-care provision in South Africa. This paper views place as emerging from and relating to space. A mutually reinforcing and reciprocal relationship between people and place over time shapes health-care delivery and health outcomes in South Africa. Therefore, this paper argues that engaging with a place-based approach is required to understand the local context in which diverse groups are situated. There is, however, a lacuna in studies situating South(ern) African public health-care challenges within such a place-based approach. This paper presents findings from a mixed-methods study that was designed to fill this gap. The research team conducted fieldwork in six health-care facilities across two provinces in South Africa – four in Gauteng and two in the Vhembe district of Limpopo province – representing urban, peri-urban, and rural settings. The study included exploratory in-depth interviews with 77 health-care providers (including nursing and administrative staff), a survey conducted with 229 health-care users, and site visits. The findings show how diverse spaces shape and are shaped by different migrant profiles, producing diverse places, which in turn present particular demands to the public-health system. It is crucial to understand the pathways, behaviors, and meanings associated with such mobility if we are to strengthen the provision of health-care services in South Africa.

This article explores the link between migration and alienation and its impact on the mental health and wellbeing of Congolese and Somali asylum seekers and refugees—two of the largest populations of displaced migrants in South Africa. Drawing on ethnographic research in Johannesburg, we highlight the various ways alienation is both imposed upon and experienced by migrants and argue that systemic dis integration, or acts of alienation, can be seen as deliberate and active policies and practices that are instrumental in excluding asylum seekers and refugees from everyday life. The experiences of marginalization and othering narrated by Congolese and Somali migrants highlight ways in which alienation and dis integration from critical social connections including family, community, and familiar contexts fundamentally impact wellbeing and mental health as well as strategies of care-seeking, and other forms of relational resilience. While conceptualizations and metrics of integration may in some ways capture the fallout of disintegration, such as access to livelihoods, housing, education, and healthcare, we suggest that this does not adequately assess the profound damage by acts of alienation on crucial relationships. The alienated psyche of innumerable migrants in South Africa results in the feeling that “when a bad thing happens…you are better only when you are home.” This pain, or feelings of alienation, we argue, are a crucial aspect to our understanding of alienation and in turn, highlight the importance of alienation as an apt analytical tool through which experiences of asylum-seeking in South Africa can be understood.