Dying in the Queue: When the System Fails, the Poor Pay the Price First
How unemployment, state failure and unmanaged immigration forces South Africa’s poor to compete for survival
South Africa is a country where the poor wait - and die!
Those belonging to the privileged few - whose parents or children will never set foot in a public hospital - will not truly understand the danger faced by the poor. Their children will never be turned away from school, just because the classes are overcrowded with children of poor migrants.
In these healthcare facilities, people risk dying prematurely because access to life-saving treatment like chemotherapy or dialysis is delayed by long queues, staff shortages, or a lack of critical medication.
When it comes to access to basic education, children spend months waiting for a seat in a classroom, while officials struggle to find places in overcrowded schools. This crisis has been building up over time, but no one is listening.
Here is my story.
A compatriot and a man of honour recently passed away in a public hospital while waiting for life-saving dialysis. There was no national outrage. Just quiet acceptance from family, friends, and colleagues that such tragedies have become normal in South Africa.
He was a father and a husband. He was also someone who had once risked his life fighting for the rights of the poor during apartheid, believing that one day basic human rights- including access to healthcare - would be available to all.
Yet, in his hour of need, he was denied a life-saving procedure. I will not mention his name out of respect for his family. But this man, who endured detention and hardship in pursuit of justice - lost his life waiting in a system that could not accommodate him.
In my view, he died twice. The first time was under apartheid, when he was detained and dehumanised for fighting for freedom. The second was in a democratic South Africa, in a hospital where the waiting list for treatment was simply too long.
Imagine being told: we know what is wrong, and we know how to treat it, but there are too many people ahead of you. Some are locals but many come from poor countries. Some could be hardened criminals or terrorists, but we cannot turn them away because they were first in the queue.
South Africa’s public healthcare system is under severe strain. It serves the majority of the population, yet struggles with limited resources, staff shortages, and growing demand from migrants, some illegal and undocumented. At the same time, the country faces a deep economic crisis.
The unemployment rate sits at more than 30% while youth unemployment exceeds 45%, and the figure is even higher among younger age groups. Yet recently we have had 1000 medical doctors marching on our streets because they couldn’t find work in public hospitals where foreign doctors have found employment quite easily.
So our taxes are spent educating our doctors for the streets or the export market while their critical skills are needed right here at home, but we tell them we cannot accommodate them while at the same time, we have room for foreign doctors.
The broader crisis where millions of poor people are scrambling for limited access to hospitals and clinics places enormous pressure on public services and health care workers.
This is the reality the poor are navigating every day. And yet, when communities raise concerns about overcrowded clinics, overburdened schools, and shrinking opportunities, they are quickly dismissed, labelled xenophobic, or ignored. Within this context, immigration - particularly undocumented migration - has become a flashpoint in public debate.
Many communities experience overcrowded clinics, schools, and housing, and attribute part of this strain to an influx of people seeking opportunities in South Africa.
Estimates suggest that immigrants make up about 5% of the population, although the number of undocumented migrants is uncertain, often debated by those who wish to paint South Africans as xenophobes who are exaggerating the fact that jobs that should be reserved for them, are taken by foreigners without special skills.
But those who have experienced a phenomenal growth in the number of communities occupied by migrants throughout South African cities and villages, speak of numbers far exceeding the official 4 million reported in mainstream media.
What is clear is that population growth, regardless of the source, adds pressure to already stretched systems. It is worse when this growth is not known and therefore, not documented by governments who should know better.
Though it is equally important to acknowledge that South Africa’s challenges did not begin with migration, the influx of poor people especially from the continent, has put an additional burden on our fiscus and Finance Minister Enoch Godongwane said so recently.
Structural issues, slow economic growth, inequality, governance failures, and a struggling public sector are widely recognised as the primary drivers of unemployment and service delivery breakdowns. In overcrowded hospitals, someone is always ahead in the queue. And for the person who does not make it in time, the reasons matter less than the outcome.
This is where the real injustice lies: the poorest South Africans are left to compete with poor immigrants for limited resources in systems that are already failing them.
And yet, the government has also failed to manage immigration systems properly. Weak enforcement, corruption, and policy paralysis have created confusion and frustration on the ground.
When systems are not managed, pressure builds and it is the poorest who feel it first. Still, for those at the frontline of these struggles, these distinctions can feel academic, especially when faced with criminality from faceless people, like the Somalians and Pakistani mafia targeting local spaza shop owners for operating what they have now declared their turf.
The 30 innocent children who died from food purchased from Somalian and Pakistani-ran spaza shops, were not children of the affluent and political elites of this country. They were children from the black (African) townships hence there was never an outcry and the pain was felt only by their families and their communities.
Strangely, nobody has ever been prosecuted for this massacre of our young. Drugs have destroyed the lives of thousands of young people and many households are disintegrating because of drug abuse that go hand-in-hand with human trafficking that goes unchecked because of our porous borders.
At the same time, many of those with the loudest voices in public debates are not directly affected. They rely on private healthcare, private education, and networks that shield them from the realities faced by the majority.
There is so much poverty and hunger in our communities and yet nobody cares. Our government seems content to dish out R375 to our youth and R2400 to the elderly, as if they are unaware of the skyrocketing cost of food and electricity post-COVID. It is easier to dismiss the frustrations of the poor when you are not the one waiting in line.
The real issue is not simply who is in the queue but why the queue is so long in the first place. No South African should die waiting for treatment that exists. No family should have to accept preventable death as normal. And that is the real tragedy of our lives, not the peaceful marchers on our streets.
When things go wrong, the poor pay first.
Seasoned journalist Zingisa Mkhuma is editor of www.ednews.africa.
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