Need that bullet removed from your arm? Then show us your papers

“My arm is dead,” he says, showing his completely limp right arm, the result of the gunshot wound.

Hussein [not his real name] owns a spaza shop in Site B, Khayelitsha. His shop was robbed in October, and during the incident he was shot twice in the arm. One bullet went straight through his arm, and the other traveled from his elbow up through the arm to where it is now stuck behind his shoulder.

The bullet gives Hussein immense pain. “I can’t sleep at night when it’s cold. It’s too painful,” he says.

Hussein resorts to sleeping during the day sometimes, when it is warmer and more bearable, but that takes time away from being at the shop. Additionally, he now only has one functional arm.

Desperate to get the bullet removed, Hussein is unsure if he will be able to get medical care to do so.

After the shooting, the police and his wife helped Hussein to Tygerberg Hospital where he got initial treatment for the wound. The doctors told him the remaining bullet was lodged in a dangerous location and that he would need further surgery to remove it. They set down 30 December as the date for the operation.

Hussein is a Somali refugee. During the October incident, the perpetrators robbed him of everything he had, including his refugee permit. According to Hussein, the hospital requires a passport, asylum or refugee papers for the operation. Without documentation, Hussein will be denied treatment unless he pays the full price for the procedure, which he cannot afford. Tygerberg Hospital has confirmed this with GroundUp.

Since then, Hussein has tried and failed multiple times to get new refugee documentation. Every day, he is scared that time is running out before the operation date. “I’m worried for my life,” he says.

Hussein’s situation highlights a larger legal issue in migrant health in South Africa. The South African Constitution and National Health Act grants everyone in the country the right to access to healthcare services. This would seem to imply that Hussein has the same right to free treatment as a South African citizen..

However, according to Sasha Stevenson, an attorney at SECTION27, the legal situation is more complex. A refugee or asylum seeker in South Africa has the same rights to healthcare as a South African, but policy is more ambiguous for undocumented foreigners, according to Stevenson.

The Uniform Patient Fee Schedule, which outlines the Department of Health’s public hospital fee policy, states that if a patient is living in South Africa as an undocumented foreigner from a Southern African Development Community (SADC) country, they can pay the same fees for healthcare as a citizen. However, it does not specify this right for non-SADC countries including Somalia.

According to Stevenson’s interpretation of Hussein’s situation, “Under the current law, it is unclear if he is entitled to care. That is problematic, because we are then leaving people living in South Africa to be in a private healthcare system that is expensive and therefore inaccessible.”

Stevenson believes there needs to be more discussion on migrant access to health given uncertainty in the law and amongst hospital administrators. “There is lack of clarity around this point. People are being turned away incorrectly by hospitals, and there is confusion about what rules really are. There hasn’t been enough consideration of these issues. It doesn’t make sense to exclude these people,” she says.

For Hussein, the prime concern has become obtaining new refugee papers to show the hospital.

After the robbery, Hussein filed an affidavit with the police stating his refugee permit was stolen. Hussein also possessed a valid refugee ID, which he left with a friend to keep safe, but when he went to collect it the friend said it had gone missing. His friend filed an affidavit attesting that Hussein possessed a refugee ID.

Hussein has gone to the Cape Town Home Affairs office several times to apply for new refugee papers, bringing both affidavits signed by the police as proof that he was previously documented. Each time, he has come home empty handed.

When Hussein goes to the office and asks Home Affairs officers to apply for a permit, they demand money from him. He is told to pay a fee of R2,500, but cannot afford to pay. Hussein knows he should be able to obtain a permit for free in the first place.

Bernard Toyambi of the refugee rights organisation PASSOP says that Home Affairs should not be charging for the replacement of a lost document. He says, “When you lose a document, you can obtain an affidavit from police then contact your bank or other institutions that used the document before for a copy, or write down the refugee number on your document. Home Affairs officials are impatient when they serve clients without this number.”

Home Affairs has not responded to multiple requests for comment.

“There is too much corruption here,” Hussein says.

That sentiment is echoed by David Cote, Strategic Litigation Programme Coordinator at Lawyers for Human Rights. According to Cote, an undocumented refugee like Hussein is entitled to a free application for refugee status. However, he says Home Affairs officers often ask for bribes.

“Corruption is quite rife at refugee reception offices. Home Affairs say such cases should be reported to its counter-corruption unit, but unfortunately it’s not easy to get in contact with them if you don’t know the process. Officers asking for money can happen at any stage, when you first queue in the line outside, enter the building, or after you get in the building for something else,” says Cote.

The bullet gives Hussein immense pain. “I can’t sleep at night when it’s cold. It’s too painful,” he says. Photo by Joyce Xi.

This is not the only time Hussein has battled with Home Affairs. Hussein has two young sons, both born in Cape Town, who need to be documented because Hussein’s wife is also a Somali refugee. Hussein says he paid R2,500 for papers for his first son’s documents because he was sick and needed urgent medical care.

Recently, he has visited Home Affairs to try and obtain papers for his second son.

“I have been six times to try to get my second son a permit. The officer said, ‘You are Somali, you don’t belong here, so you must stand in the line.’ I stand in line for hours without sitting, and then get inside and they tell me I must come again two months later. They always tell me to come back later, and I don’t know why. One time it was very cold and I stood six hours with my son who was a few months old. He was very cold outside. Six hours standing outside, and I don’t get anything and have to pay for taxi transport.”

His son remains undocumented.

“My son belongs here in South Africa. He was born in a hospital here. I have a birth certificate for my son to show them. These people don’t care,” he says.

Hussein keeps a neatly organised folder of affidavits, birth certificates, hospital files, and copies of his wife’s refugee papers. He has plenty of documents for proof, but even when he follows what he believes are the right steps he cannot get Home Affairs to take on his case. Still, Hussein visits Home Affairs whenever he can, in the hope that he will succeed.

Hussein came to Cape Town with his wife from Somalia in 2006. Like many other Somalis, he left his war-torn home country to escape precarious conditions and try to find a better life.

He recalls memories from his journey from Somalia— crossing six borders in two months, hiding cramped in trucks to navigate borders illegally, paying bribes, sleeping out in the grass, and carrying his wife through the crocodile infested waters of the Limpopo River, only to reach a place where he does not feel at home and still fears his life is at risk.

“I left Somalia because there is no peace in the country. I’d like to work there, but the country is not right. I wanted to make a nice life,” he says.

“There are big problems in this country,” Hussein says of South Africa. “I don’t like this country. I’m here only to look after my family.”

Hussein notes that crime is a particular problem in Cape Town. Somalis own spaza shops in all corners of Khayelitsha, which are often targets for robberies and violence. Hussein says his brother was killed in Site C while he was working for someone else’s business.

Hussein also feels he is not welcome in Cape Town as a foreigner and is hazy on his rights as a refugee. He does not know how to seek assistance when he needs it, and while legal services exist that could help him, he has no concept of them or how to find them.

Over and over again, Hussein emphasizes that refugee papers would make all the difference. He is still struggling to cope with his wound every single day.