In the South African provinces of Gauteng and KwaZulu-Natal (KZN), social unrest, including widespread looting, has led to the disruption of crucial healthcare services and access to food and other essentials. To date, 72 people are reported killed in the violence with hundreds more sustaining injuries, including lacerations, gunshot and burn wounds.

 

How did it all start?

What began as protests against the incarceration of former president Jacob Zuma over the weekend of 9 - 11 July, quickly escalated into unprecedented scale of arson and looting of trucks, shops and shopping malls, as well as 90 pharmacies and some medical centres. Stampedes have left many dead, while other people have died in the ensuing chaos and violence.

Long-standing inequality, high levels of poverty, an unemployment rate of over 30 per cent and the devastating economic fallout from successive COVID-19 lockdowns since March 2020, have left millions of South African residents desperate and angry. The wake of devastation from riots and looting is already impacting access to food as massive supply warehouses in the port city of Durban, KZN, are now empty. Due to the violence, regular fuel distributions were cut and a petro-chemical refinery producing 35% of the country’s fuel supply has suspended operations.

Combined, these factors result in a serious supply chain set-back, especially for the KZN population of 11 million people of whom nearly 1.7 million rely on antiretroviral (ARV) drugs to manage their HIV condition. In major centres in KZN and Gauteng, community-based drug refill collection points for chronic conditions have been shuttered, causing patients much distress while health authorities seek alternative solutions.

While the police and South African National Defence Force are deployed to regain control and mop-up operations continue, there are growing concerns about food insecurity and an inevitable spike in COVID-19 cases. Prior to the unrest, several major South African cities were firmly in the grip of a third wave COVID-19 infections since late June.

 

Healthcare disrupted

Throughout the week of 12 -16 July, unrest has prevented the provision of essential healthcare delivery by blocking patients, medical staff and critical supplies from reaching facilities. There have been disruptions in every district of KZN, 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 COVID-19 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.

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

  • In Empangeni, KZN, 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. 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, KZN, 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 COVID-19 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, Gauteng, 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 province, 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.

 

MSF’s response

Despite the disruptions, MSF teams in KZN and Gauteng have assessed the needs of some overstretched and overwhelmed health facilities in hotspot areas. These mobile teams are finding ways to offer practical support as the influx of patients will grow in coming days.

Already two medical teams consisting of five MSF nurses and a medical doctor are working alongside skeleton team health staff at the emergency departments of the Alexandra Clinic in Johannesburg and the Thelle Mogoerane Hospital in Vosloorus. On Sunday the latter emergency room’s only medical doctor and limited nursing staff was overwhelmed with 25 gunshot wound patients while a stream severely ill COVID-19 patients still arrive. MSF teams are also looking into how best to support the work of restoring the supply of chronic medicines to patients in some areas in the two affected provinces.

 

Safeguard healthcare

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.

MSF is therefore calling on community leaders, political leaders, the South African government security cluster and the Presidency of South Africa to take 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.

“The urgency of ensuring that health facilities and supplies are not targeted during social unrest and violence is crucial, even more so during the height of the current wave of COVID-19 infections,” says Philip Aruna, head of MSF’s Southern Africa Support Team.

“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,” Aruna says.

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