Doctors Without Borders (MSF) notes with deep concern the widening 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, over 60 people are reported to have died and numerous more have sustained injuries, including lacerations and burn wounds, as a result of these events.

The unrest is also preventing the provision of healthcare, by blocking patients, medical staff, and critical supplies from reaching facilities. A drastic escalation of the current COVID-19 driven healthcare crisis is inevitable unless immediate steps are taken to safeguard the right to healthcare and safety of patients, healthcare workers, medical infrastructure, and supplies.

There have been disruptions in every district of KwaZulu-Natal, including staff unable to work due to public transport stoppage and road closures in many areas while certain hospitals and their emergency departments already stretched by a surge in COVID19 cases are overwhelmed due to staff shortages and an influx of people needing treatment for wounds, forcing doctors to choose who receives life-saving treatment, and who does not. COVID-19 vaccination sites have been closed.

MSF medical services and support operations in KwaZulu-Natal and Gauteng have also been disrupted.

- In Empangeni, an MSF team that supports the regional COVID-19 response of Ngwelezane Hospital were forced to stay away as a result of looting and unrest in the area. Several departments of health doctors working in the COVID-19 ward did not make it into work, hampering the overall COVID-19 response.

The status of healthcare services as essential services must be visibly prioritised in South Africa

- The MSF COVID-19 response team based in Richard’s Bay were confined to their accommodation due to insecurity.

- In Eshowe, where we have run HIV/TB programmes since 2011, the MSF team was forced to suspend all medical and community-based activities. Clinic-based HIV/TB services are currently inaccessible for many, and people with comorbidities that put them at high risk of severe COVID19, such as diabetes and hypertension, are unable to access their medication. Our team had to hide vehicles in different parts of the town in order to protect these medical transports 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 us 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 health care and/or social services, and even more so during violence and unrest.

- Thus far, 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, but threatened protest action could prevent this team from accessing the hospital, thus rendering the COVID-19 ward non-functional and directly affecting patient care.

Providing medical humanitarian assistance in more than 70 countries, MSF recognises the challenges medical staff face working in insecure settings and when violence causes the disruption, suspension or closure of healthcare services, as well as the negative consequences for populations in dire need.

The status of healthcare services as essential services must be visibly prioritised in South Africa. Facilities must be respected as safe spaces by all – those involved in protests and looting, as well as the police and military. MSF calls upon all of these actors to take immediate action to ensure access to healthcare and medicines is not threatened or disrupted.

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 to rally for the protection of healthcare. Security forces should protect vital healthcare infrastructure and services while the president’s 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.

Distributed by APO Group on behalf of Médecins sans frontières (MSF).