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Anti-immigrant sentiment unfolding on the streets has the very real potential for the kind of violence which took 62 lives in 2008, including 27 South Africans, and has hardened since the COVID-19 pandemic.

On healthcare, 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 as it is written would do the opposite: it bans many foreigners from getting HIV treatment.

The NHI roll-out is “on pause”, while the Constitutional Court is considering if fair processes were followed for it to become law; a judgment is not expected until December or early 2027.

According to the report, the current version of the Act says refugees, undocumented migrants and asylum seekers will only qualify for free health treatment for emergencies and “notifiable diseases” — diseases like tuberculosis or cholera — that can lead to an outbreak with a major impact on public health.

Mia Malan asked Health Minister Aaron 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.

Anti-immigrant sentiment has already led to violence.

Five Mozambicans were killed in Mossel Bay after an outbreak of violence there, migrant shops have been looted, thousands of migrants have been displaced while others, fearing for their lives, are fleeing the country.

President Cyril Ramaphosa addressed the issue directly on 7 June, announcing a plan that included increased immigration enforcement, border security, ending the green ID book, capping foreign worker quotas, and regional diplomacy.

The Human Sciences Research Council, which has been tracking sentiment towards immigrants since 2003, had already noted a hostile upswing since COVID-19.

In 2021, 30% of South Africans said they would “welcome no immigrants” to the country.

By 2025, that climbed to 42%, mostly driven by the poor and lowest socioeconomic classes.

In KwaZulu-Natal alone, those numbers increased from a quarter of those surveyed in 2021 to 60% in 2025.

On healthcare, the National Health Act is explicit: anyone not on medical aid, regardless of citizenship or immigration status, is entitled to free primary healthcare services.

Fixing endemic corruption and maladministration is more difficult than shouting down presumed non-nationals and blocking their access to clinics and hospitals, even when the Constitution says no one — no matter their nationality — may be refused emergency medical treatment.

Not treating everyone who tests positive for HIV, or not allowing them to take medications that can stop them from contracting the virus in the first place, means the virus will spread.

Denying people access to HIV treatment is not only unjust, but it’s also counterproductive in the fight against the disease, and this is something that active participation in healthcare can help mitigate.