Since 2000 MSF has been working in South Africa, primarily in response to the HIV epidemic. In Khayelitsha, the largest township in the Western Cape, MSF has worked with the provincial authorities to pioneer comprehensive HIV treatment, including antiretroviral (ARV) medicines, at a primary care level. Today, these clinics support over 6,000 people on ARV therapy.
n 2003, together with the Nelson Mandela Foundation, MSF opened a similar programme in Lusikisiki, one of the most underserved areas of rural Eastern Cape. By 2005 universal ARV coverage had been achieved and in 2006 the programme was finally handed over to the provincial health authorities.
At the same time, MSF was opening a programme in Lesotho based on the model implemented in Lusikisiki. There, MSF and the health authorities started a pilot nurse-based programme to provide HIV/AIDS and TB care. In less than two years, nearly 2,000 people had been initiated on ARV treatment.
Together, these programmes have done more than simply treat patients. They have provided vital lessons about how comprehensive treatment for HIV can practically be delivered both in rural and urban settings. At the same time, MSF has been lobbying, with many other organisations, for cheaper medicines, more global funding for the HIV crisis and changes in policy towards the epidemic.
Despite the successes, many challenges remain, such as the problems of TB and HIV co-infection, drug-resistant strains of TB and the issue of long-term adherence to ARV treatment. MSF works with patients, academics, local health authorities and international experts to find innovative and practical solutions to these problems. In response to the high levels of sexual violence in Khayelitsha, MSF supports the Simelela Centre for rape survivors – a one-stop location which combines practical medical care to protect against infection and psychological support with police and forensic assistance.
In 2007, MSF opened an office in Johannesburg. The new office supports MSF programmes in the region and elsewhere by providing medical expertise, recruiting medical and other professionals and fundraising. MSF in Johannesburg also speaks out about medical and humanitarian crises facing vulnerable communities by sharing information with the South African public, the media, government agencies, and other non-governmental organisations. We are always ready to tackle new humanitarian needs as they arise in South Africa.
In 2007, massive numbers of Zimbabweans started seeking refuge in South Africa, mostly illegally, due to the collapse of the economy and the political violence nationwide. MSF launched two projects providing humanitarian relief and medical assistance to the refugees at the end of 2007.
In Musina, the northernmost town of the Limpopo province right across the border from Zimbabwe, MSF provides medical care for the new arrivals, collaborating with the public hospital to refer patients for secondary level care, chronic patient assessment and treatment of HIV and TB.
MSF also started its medical intervention in downtown Johannesburg next to the Central Methodist Church (CMC) where migrants seek refuge every night despite the appalling living conditions. MSF in Johannesburg carries out primary health care services, support on water, sanitation, and punctual relief assistance. The team also aimed at documenting the pattern of clients that are coming from surroundings settlement in Central Business District and seeking care in the clinic.
Four years down the line, hundreds of Zimbabwean are still crossing the border every day for the same economical and political reasons. Although the global situation has changed in Zimbabwe, there are still many areas of insecurity that cause this survival migration.
MSF believes that everyone has the right to basic medical care. In countries with collapsed or chronically disrupted health care systems, MSF works with the local authorities to rehabilitate hospital and clinic services. MSF also works with marginalized groups in countries with advanced economies such as street children, prisoners and illegal migrants who do not get adequate medical support.
Armed conflicts and other tense situations often cause large population movements, as individuals flee persecution or violence. A refugee is a civilian who no longer is receiving protection from his or her own government, and crosses a national border to escape the conflict or persecution.
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