Health minister Aaron Motsoaledi has admitted the government does not know how many foreigners are using public health facilities because the data is not being measured.
Foreigners seeking care at crowded public hospitals and clinics are facing mounting threats and intimidation from Operation Dudula, which is campaigning for the government to prioritise services for SA citizens. Operation Dudula has recently prevented foreigners from entering health facilities in Gauteng and KwaZulu-Natal, and is threatening to apply similar tactics to government schools.
In written responses to questions posed separately by MPs from the EFF, Action SA and the IFP, the minister told parliament that neither public health facilities nor provincial health departments recorded information about patients’ citizenship or immigration status.
Action SA MP Kgosi Letlape said the minister’s admission validated his party’s long-standing concern that the public healthcare system was burdened by “an unquantified and unmanaged demand”.
“In the absence of tracking, verification or appropriate data collection, the department is unable to account for the full scope of its service delivery liabilities,” Letlape said in a statement.
“This is particularly concerning given that millions of foreign nationals, many of whom are undocumented or lack any form of medical insurance, reasonably make use of taxpayer-funded public healthcare services. In a public health system already buckling under pressure, with overcrowded hospitals, long queues, understaffing and medicine shortages, this lack of oversight is reckless and unsustainable,” said Letlape.
There were about 2.4-million international migrants living in SA in 2022, equivalent to 3.9% of the population, according to Stats SA’s last census.
The lack of patient data compromised the government’s ability to plan and budget effectively, said Letlape.
Under SA law, foreign nationals are largely entitled to the same health benefits as citizens. Foreign nationals do not have to pay for HIV or tuberculosis treatment, and face the same means-tested fees as citizens for services obtained at clinics, community health centres and public hospitals. This applies to people with an asylum permit, refugee status or a temporary resident permit, and to undocumented migrants from the Sadc region. Undocumented migrants from outside the Sadc region may be charged the highest fees, but this is not always enforced.
ActionSA said it wanted to amend the constitution “to address the untenable reality in which SA is expected to provide unlimited public healthcare to undocumented immigrants”.
“This situation is not mirrored in any other country, where foreign nationals are typically required to possess medical insurance as a condition of their visa applications. Yet South Africans are being gaslit into accepting this unsustainable burden as normal,” said Letlape.
Responding to IFP MP Nompumelelo Mhlongo’s questions, Motsoaledi said there was no mechanism in place for provincial health departments to recover costs from immigrants’ countries of origin if they failed to pay their accounts.
It was not the health department’s duty to check the immigration status of patients, he told EFF MP Chumani Matiwane. Neither the department nor public health facilities had ever stopped anyone from entering public health facilities and accessing healthcare services, he said.
It was up to law enforcement agencies to deal with people who prevented patients from obtaining the care sought, he said.
The health department’s spokesperson Foster Mohale said tens of thousands, and potentially hundreds of thousands, of South Africans did not have ID numbers or other documentation. It was not possible for clinical staff to know if patients were legally in the country, he said.
"The health departments and the staff that work in them are obliged by law to care for every person who seeks care. It is not their responsibility to act as immigration officers," he said.
Update: August 6 2025
This story was updated to include additional comment from the health department.
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