A community clinic just north of Johannesburg has become the frontline of a battle in South Africa over whether foreigners can access public health facilities.
What started as a small local action in one area in 2022 has spread, with activists from the avowedly anti-migrant group, Operation Dudula, picketing some hospitals and clinics in Gauteng and KwaZulu-Natal provinces. They check identity cards and stop anyone who is not South African from entering.

Dudula means to remove something by force in the Zulu language.

Despite some arrests, the authorities seem unable to prevent the pickets.
The site of their latest campaign is in Dieplsoot – a poor township of more than 200,000 people near the country's commercial hub.

On a cool, spring Thursday morning, Sicelokuhle Moyo, dressed in a blue-and-beige skirt, thick windbreaker, and a black headwrap, set out early for the clinic.

The Zimbabwean, who has lived in South Africa since 2006, was going there, as she often did, to collect her medication for a chronic condition. But this time, when she reached the gate, things were different.

Two men wearing white T-shirts emblazoned with the slogan Operation Dudula – Mass Deportation were stationed at the entrance. They demanded that everyone produce their documents before being allowed inside.

I said that I had a passport. They said, they don't take passports. They want IDs only, Ms Moyo said, hiding her frustration behind a polite smile.

Despite this being a potential flashpoint, there was a strange calmness and resignation as people knew that Operation Dudula activists had been violent in the past.

Anyone unable to produce a South African ID book was turned away.

Slowly walking from the entrance, Ms Moyo joined a group of women by the roadside, young children tied to their backs, waiting with uncertainty for what would happen next.

Tendai Musvava, a woman in her 40s, faced the same fate. I was standing in the queue and then they said, they [only] need some people with IDs. Me, I don't have an ID. I have a passport, I am from Mozambique. So, I can't get my medication because I don't have an ID, she said.

Ms Musvava, dressed in a bright orange winter jumper and a white hat, appeared despondent.

I just feel like they do what they want because it's their country. I don't have a say. For now I have to follow whatever they say. I don't have a choice.

Operation Dudula has transformed from an anti-migrant pressure group into a political party, with ambitions to contest next year's local government elections. Party leader Zandile Dabula insists that what her organisation is doing at public clinics is justified.

South Africa is home to about 2.4 million migrants, just less than 4% of the population. Xenophobia has long been an issue, and the anti-migrant sentiment has become a key political talking point.

Critics, including human rights activists, warn that the actions of Operation Dudula are undermining the constitutional right to healthcare for all individuals. Meanwhile, while the state hesitates over what to do, the movement continues its campaign, leaving many vulnerable individuals without access to essential medical services.

Ms Musvava is now looking for alternatives. Despite her meager resources, she is considering going to the private sector for care.