Migration is a critical social determinant of health, yet South Africa’s governance frameworks remain poorly equipped to address the structural violence faced by international migrants and the resulting, intersecting health inequities. Despite constitutional guarantees of Universal Health Coverage, migrants routinely face administrative exclusion, from discretionary gatekeeping by frontline healthcare workers to rising xenophobia within facilities, challenges sharpened by austerity, political insecurity, and weak public health governance. The abrupt 2025 suspension of PEPFAR and USAID-funded programmes has further destabilised an already strained system, while anti-migrant vigilante mobilisation at healthcare facilities intensifies exclusionary rhetoric.

This paper examines how structural violence (including its gendered dimensions, which shape whose suffering registers as a policy concern), bureaucratic discretion, and what Torres et al. (2022) call “bordering through care” shape everyday access to public healthcare for migrants in South Africa. It analyses how the health system reproduces exclusion under the guise of legal frameworks and through scapegoating foreign nationals for a poorly performing system. The authors argue that the development of South Africa’s National Health Insurance should be a strategic opportunity to achieve UHC, yet it currently revokes healthcare access for asylum seekers and undocumented migrants. They propose a rights-based, migration-aware, and gender-responsive governance framework that responds to structural violence, calling for renewed political commitment to dignity, accountability, and UHC for all who live in South Africa.

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