Meanwhile, the causes of seven suspicious deaths in 2015 remain unsolved, according to an MSF report seen by Bhekisisa. In five of the seven deaths, people had consulted the clinic multiple times – only to be given headache tablets as their conditions worsened, MSF alleges.
Private security company Bosasa has run the Lindela Repatriation Centre, including its clinic, since 2007. Services provided by Bosasa at Lindela are reportedly so poor that, not only are some detainees denied life-saving care, the centre may also be putting children behind bars alongside adults, in violation of home affairs policies.
South African laws stipulate that the department of social welfare must house undocumented children in places of safety. In rare instances, minors like these can also be detained, but it is illegal to house them alongside adults, which can put children at risk of abuse, warns Corey Johnson, advocacy officer at the Scalabrini Centre of Cape Town. The development organisation works on issues of migrant healthcare.
Home affairs spokesperson Thabo Mokgola has denied that children are detained at Lindela. But since 2016, an MSF paediatrician identified around 50 minors at the repatriation centre. The children were transferred to places of safety with the help of the department of social development, MSF medical coordinator Amir Shroufi says.
The same screening services that are failing to identify at-risk youth also do not detect detainees in need of medical attention quickly enough, says MSF. As part of its contract, Bosasa is responsible for operating a 24-hour clinic and sick bay at Lindela. It is the company’s responsibility to ensure that patients in need of surgery are transferred to nearby hospitals for care, says department of home affairs spokesperson Thabo Mokgola.
But Lindela’s clinic is dysfunctional, argues Shroufi. He says there is no entry screening for diseases such as tuberculosis (TB) and HIV for detainees.
In fact, MSF found no TB or HIV testing equipment or treatment being carried out at the facility’s clinic during a visit earlier this year. Instead, patients who need treatment for either condition are referred to a nearby public clinic, which MSF says may delay diagnoses and access to medication.
Mokgola denies the claims, saying Lindela provides full medical care and added a “pre-screening clinic” this year.
“Without HIV and TB tests, the [prescreening] clinic still misses cases,” says Garret Barnwell, who was part of the MSF team that conducted the latest assessment of Lindela.
Mokgola also says that “degrading treatment” of detainees, such as beatings, is not tolerated: “There is constant monitoring of the welfare of deportees who are free to report any incidents to home affairs officials in the centre.”
Bosasa’s contract with the department of home affairs precludes them from commenting publicly on allegations and the company referred all Bhekisisa questions to the department of home affairs.
Without treatment, TB can spread quickly in detention settings such as Lindela where living quarters have historically been overcrowded and poorly ventilated, states the MSF report.
A 2011 research review published in the journal PLoS Pathogens showed that people living with HIV are 20 times more likely to develop TB.
Starting antiretroviral treatment can reduce that risk by up to 65%, a 2012 study that appeared in the journal PLoS Medicine found.
Anyone in South Africa, regardless of nationality or immigration status, is entitled to free HIV and TB treatment, according to a 2007 national health department directive.
Currently, there are no guidelines for what kind of care Lindela staff must provide to detainees, but national health department spokesperson Popo Maja says, even without this kind of guidance, the centre should adhere to national policies.
The health department does not oversee the clinic but could intervene if asked to, Maja explains.

Many of the allegations levelled against Lindela are not new. In 2012, MSF approached the South African Human Rights Commission (SAHRC) with concerns about a lack of medical care and oversight at Lindela. Almost two years later, an investigation by the human rights body found that conditions at the Krugersdorp facility infringed detainees’ right to health care, noting a lack of HIV and TB testing and care as well as condoms, among other violations.
The commission recommended home affairs submit a plan to provide these services within three months. It also suggested the department allow civil society monitors into its deportation centre.
The South African Human Rights Commission Act allows the SAHRC to take government departments to court should they fail to implement the body’s recommendations. But in a statement, the commission says it prefers to collaborate with entities such as the police and civil society to resolve violations before it approaches the courts. It credits “political changes” within the department of home affairs with preventing it from following up on its 2014 recommendations about conditions at Lindela.
The department of home affairs has allowed LHR limited access to the detention centre but required 48-hours’ notice of these visits, eliminating any possibility of spot checks. Mokgola maintains that the department encourages independent oversight of the facility.
After witnessing the dire conditions at Lindela in 2016, MSF – through the SAHRC – offered to help to improve healthcare at the facility by, for instance, training doctors and nurses.
MSF has been unable to gain the access it needs through the commission.
The terms of the agreement with MSF – which focused more on healthcare provision than monitoring — could not be reached ahead of a deadline earlier this year, says a statement by the body. But MSF says the commission failed to communicate these challenges.
Shroufi characterised MSF’s access as “sporadic and limited”, adding that teams would have needed access three or four days a week for at least six months to improve healthcare at the facility.

Both MSF and LHR have struggled to determine what health services Bosasa is contractually bound to provide – or how much of its budget for Lindela goes to healthcare – because the security giant’s agreement with home affairs is not public. LHR requested a copy of the document in early November, but has not had any feedback, Leung says.
Exerting oversight like this on the department of home affairs could become even harder as there have been calls within the ANC for it to be repositioned and moved into the state’s security architecture, according to a discussion paper released in May.
The document suggests contracts with home affairs will be “highly secure” and more tightly regulated under new security requirements. The new rules could thwart access to facilities like Lindela in the future, says regional advocacy officer at the Consortium for Refugees and Migrants in South Africa Roshan Dadoo. “There is too much emphasis on state security and not enough on human rights.”
Legislation passed in May will put a newly created central body, the Border Management Authority, in charge of all South Africa’s ports of entry, including policing and customs.
Mokgola says that operations at Lindela will continue unchanged, because the authority will only oversee border posts and ports.
There are also plans to build massive border camps for asylum seekers on South Africa’s borders. The department of home affairs plans to outsource health services to private companies and civil society. Dadoo warns that privatising health services in high-security settings such as Lindela and the camps creates more problems than it solves.
“No organisation will have the resources to properly provide these services. Asylum seekers and migrants should be allowed to move freely in the country and use the government services that are already available to them.”
Although many governments have turned to detention as a way of controlling borders over the past two decades, there is no proof that the threat of imprisonment deters migration, 2015 research by the International Detention Coalition found.
Countries that house large numbers of migrants such as Afghanistan, Greece, Romania and Turkey have abandoned detention altogether. These nations now issue migrants with a temporary permit that allows them to live freely in communities and to access health, education and legal services while their applications to stay in the country legally are being processed.
The coalition also found countries that process migrants in community settings were less likely to detain people wrongfully, reducing legal costs to their governments. Australian research estimates the lifetime health costs related to the trauma of detention amounts to more than R 250 000 a person.
Mokgola told Bhekisisa in May that South Africa’s planned processing units will learn from countries such as Australia, that have established similar detention centres.
But detention as a solution to migration makes very little sense for South Africa, research chair on migration at the African Centre for Migration and Society Loren Landau said. He warned: “The general ethos is not about protection of human rights. It is about ensuring very few people come into South Africa."

This article was originally published by the Bhekisisa Centre for Health Journalism, bhekisisa.org. The original article can be accessed here