Walker, R., Vearey, J. “Closing the gap in the wrong direction” migration, health policy, and the exclusion of asylum seekers, refugees and undocumented migrants from healthcare access in South Africa. BMC Public Health 25, 3877 (2025). https://doi.org/10.1186/s12889-025-24751-4

Abstract
The right to health requires that healthcare systems be available, accessible, acceptable, and of good quality for all, regardless of legal or migration status. While South Africa’s Constitution and international commitments uphold this right, recent policy developments — such as the 2023 National Health Insurance (NHI) Act and the 2024 White Paper on Citizenship, Immigration, and Refugee Protection — mark a shift toward institutionalised exclusion. Discriminatory practices that were once informal are increasingly codified in law, aligning healthcare policy with a broader securitisation agenda and undermining progress toward Universal Health Coverage (UHC). This paper draws on a multi-method research design combining a structured policy review of South African, regional and global frameworks, with semi-structured interviews (n = 25) conducted with healthcare providers, civil society actors, and government stakeholders between 2022 and 2025. Data was analysed using thematic analysis to explore how formal policy and informal practice interact to produce exclusion. Findings reveal that legal and policy shifts are systematically narrowing healthcare access for asylum seekers, refugees, and undocumented migrants.Click here to download this paper for free: “Closing the gap in the wrong direction” migration, health policy, and the exclusion of asylum seekers, refugees and undocumented migrants from healthcare access in South Africa.