COVID-19 Migration in South Africa

Introduction: Borders as Barriers to Health

On 15 March 2020, President Cyril Ramaphosa declared a national state of disaster. Overnight, borders closed to all but goods and citizen repatriation, reshaping migration across Southern Africa.

Maria*, a Mozambican domestic worker in Johannesburg, suddenly faced losing her job if she returned home, or remaining undocumented if she stayed. Her dilemma mirrored that of thousands stranded in legal limbo, with severe health and social consequences.

Surveys showed 16% of South Africans changed households in the first lockdown months, reflecting major population movement. For migrants, the disruption was harsher: rural out-migration fell sharply, while many temporary migrants returned home, destabilizing families and economies.

This article reviews the pandemic’s impact on migration, health access, and policy, while proposing reforms for a health-centered migration framework.

Border Controls and Policy Shifts

South Africa imposed some of the world’s strictest controls, closing all 53 ports of entry. Reopening was selective: 18 land borders reopened with costly requirements—PCR tests, health certificates, quarantine—that excluded many migrants.

The pandemic also advanced long-planned immigration reforms. The 2020 Border Management Act created a centralized Border Management Authority. While framed as efficiency, critics warned of increased militarization and reduced rights protections, especially as public consultation was limited.

Health System Impacts

Access barriers: Undocumented migrants, already vulnerable, avoided care as hospitals prioritized COVID-19. In Gauteng, 43% avoided care due to deportation fears (vs. 18% pre-pandemic). Chronic conditions increasingly presented at late stages.

Mental health: Wits University research found depression among Zimbabwean migrants in Johannesburg rose from 23% in 2019 to 58% in 2021. Stress, separation, and insecurity drove domestic violence, substance abuse, and suicidality, with little formal support.

City-Specific Impacts

Johannesburg: Informal sector employment shrank by ~40%. Migrants avoided clinics, relying on traditional healers. Mobile health units offered some relief but reached only ~15% of undocumented migrants.
Cape Town: Agricultural sectors faced labor shortages as seasonal migration halted, driving up workplace injuries (30% rise). Clinics reported declining migrant attendance.
Durban: While goods moved freely, people could not. Migrant truck drivers faced extended stays and rising work injuries, but vaccination coverage lagged due to documentation hurdles.

Human Stories

Dr. Patricia Mthembu*, a Mozambican nurse, risked deportation when visa renewals stalled—even as she worked on COVID-19’s frontlines.
Joseph Banda*, a Zambian trader, lost his business and remittance network; deportation separated him from his South African-born children.
Blessing Muzenda*, a 16-year-old asylum seeker, was left undocumented when refugee reception centers closed. She delayed TB treatment due to fear of arrest.

Innovations and Lessons

Community health workers (CHWs): Limpopo trained bilingual migrant CHWs, reaching 45,000 migrants and linking 78% of TB suspects to care.
Digital health tools: A WhatsApp health service in the Western Cape reached 50,000 users, 34% of them migrants.
Cross-border cooperation: Joint screening at Beit Bridge prevented ~150 transmissions and was later adopted at other posts.

Policy Recommendations

Short-term (6–12 months):

Regularize migrants stranded by COVID-19 border closures.
Guarantee access to emergency care regardless of documentation.
Establish migrant-focused mental health programs.

Medium-term (1–3 years):

Develop health infrastructure at major border posts.
Scale up CHW programs nationally.
Advance regional health agreements for data and care portability.

Long-term (3–5 years):

Create a dedicated migration health unit in the Department of Health.
Lead SADC toward regional frameworks that integrate migration and health.

Addressing Vulnerabilities

Women migrants faced heightened maternal mortality and gender-based violence. Elderly migrants were left without caregivers when families split across borders. Children missed immunizations and education. Policies must address these intersecting risks with targeted reproductive, geriatric, and child health programs.

Conclusion: Building a Health-Centered Framework

COVID-19 exposed the fragility of South Africa’s migration and health systems. Border closures deepened exclusion, worsened health inequalities, and disrupted regional economies. Yet, innovations—CHWs, digital health, and cross-border cooperation—show that inclusive approaches are possible.

The path forward requires moving beyond securitized migration control toward evidence-based, rights-respecting health policies that reflect mobility as integral to regional development. Failure to act risks repeating the mistakes of the pandemic; success would make health systems stronger and more resilient for all.

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