Critically ill Ethiopian refugee fights for treatment

When the laws of the land collide with the Hippocratic Oath, which wins? A state hospital says that a ‘foreign national’ does not qualify for care despite her life-threatening condition.

Sitting on a simple chair in her room in a shared apartment in Yeoville, Johannesburg, Alem Bazabe Ereselo, 29, is wrapped tightly in a bright pink blanket. A bloodied plaster on her neck and slightly swollen ankles covered by slippers are the first signs that she’s not healthy.

The plaster has been there for two days, since her last intravenous hemodialysis session. She was scheduled for another session later in the day, an exhausting process.

She fell ill towards the end of last year, and was diagnosed with Lupus Nephiritis WHO Class VI following a kidney biopsy in February this year. She requires a kidney transplant to survive but entered tri-weekly hemodialysis treatment at Helen Joseph hospital in Johannesburg shortly after her diagnosis.

Complicating her situation is that she came to South African from Ethiopia nearly 10 years ago as an asylum seeker. The hospital halted her treatment following a circular issued earlier this year by the department of health stating that asylum seekers do not qualify for life-saving treatment such as dialysis.

But without it, she will die.

Legal intervention

Lawyers for Human Rights have approached the courts on behalf of Ereselo, fighting to get an order against the State that would allow her to receive treatment and challenging the constitutionality of the health department’s decision.

Delaying the proceedings was the recent announcement of a new cabinet. Following arguments in court last week, the respondents have been given a month to get instructions from the national and provincial departments of health, management at Helen Joseph and the Gauteng MEC for health. In the meantime, the respondents agreed to provide treatment.

With Ethiopian church music playing on a small TV screen in her room, which is decorated by religious ornaments, Ereselo said: “When they said I must go to Ethiopia, that broke my heart. I don’t have family here and I don’t have money to go to a private [hospital] … I believe in God and I pray, that is where the strength comes from.”

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Ereselo has no real support structure in South Africa except for her younger brother living in Johannesburg. Her parents are in Ethiopia, and she has not been able to be entirely open to them about her condition.

“My mother doesn’t know. My father knows that. We agreed not to tell my mother everything. If she hears this, she will not be able to take it,” Ereselo said through a translator. “When I call her, I tell her I’ve got a problem with my throat. My mother knows that I struggle to eat or drink, that’s what I explained to her. But I didn’t tell her about my kidney problems.”

“I believe God is right. I believe He will heal me in this time,” she said. “That’s all I can do.”

No way home

Ereselo has no intention of returning to Ethiopia and besides that she would be unable to do so. Were she to go back seeking treatment in her country of birth, she would immediately lose her asylum seeker status in South Africa as well as her claim to be a refugee fleeing political persecution in her own country.

“As an asylum seeker dependent on the protections accorded by law to asylum seekers and refugees by government in the Republic, I cannot legally claim medical treatment from Ethiopian authorities in my home country,” she said in her affidavit to the court.

“Depriving me medical treatment will undermine the objects of the Refugees Act. This is so because post 1 May 2019 (the date the hospital indicated she would not be able to access treatment anymore), I will be caught between on the one hand, sticking around in South Africa without medical treatment and unnecessarily prematurely succumb to death, and on the other hand, induced by this medical deprivation and desperation to obtain it and cling on to my life, I risk returning to Ethiopia to face persecution instead of medical treatment,” she said in the court papers.

Ereselo insisted her only chance of surviving would be to remain in South Africa, be granted refugee status and be allowed to access treatment. Her attempts to be recognised as a refugee have yielded very little success.

Fighting for refugee status

When Ereselo arrived in South African in 2010, she applied for asylum at the Durban Refugee Reception Office. A person first has to apply for asylum before a Refugee Determination Officer grants them refugee status. Ereselo’s has been denied, leaving her to lodge an appeal with the Refugee Appeals Board.

But while she has been waiting for the opportunity to appeal her rejected application, she has had to travel to Durban about 16 times to renew her permit, which is only renewed for three or six months at a time.

“From the time when I applied for asylum and was issued with the asylum permit, I have had the permit extended continuously for approximately 16 times until it expired on 6 March 2016. Due to my depressed state of health, which restricts my movements, I have to date not been able to travel to the Durban Refugee Reception Office to renew the permit,” she said in court papers.

“Yet, in order to meaningfully participate in my appeal before the Refugee Appeal Board and or any subsequent review proceedings that may become necessary before this Honourable Court, I need to be in a sound state of health. To achieve that, I submit, depends on my continued access to acute hemodialysis treatment by the hospital.”

Hospital reaction

Despite this situation, the management of Helen Joseph Hospital insists Ereselo is an “illegal immigrant” and does not qualify for treatment.

Malcolm Davies, the head of the department of nephrology at Helen Joseph, confirmed in his answering affidavit that Ereselo presented with “signs of life-threatening uraemia” and required emergency treatment with dialysis to “prevent her imminent demise”.

However, because of her status, she was disqualified for treatment.

“The applicant is a foreign national with lapsed temporary asylum permit and thus does not qualify for transplantation,” he said in his papers.

“The hospital has not offered long-term peritoneal dialysis to non-South African citizen or non-South African permanent resident for the following: We have limited numbers of peritoneal slots to accommodate transplant-eligible South African patients; and the treatment lasts on average for 3-5 years before the patient requires transfer to haemodialysis and it is expensive to maintain.”

Davies’ affidavit further stated: “Regrettably there is a high demand for dialysis and there is a scarcity of resources which thereby limits the Respondent’s obligations.”

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