- Email: [email protected]
Health and human rights in a South African bantustan
Sot. Sci. .Med Vol. 22. No 9. pp. X37-891. 1986 Pnnted ,n Great Bntain
0277-9536 86 53 00 + 0.00 Pqamon Journals Ltd
HEALTH AND HUMAN RIGHTS IN A SOUTH AFRICAN BANTUSTAN MEREDETH TCRSHES
School
of Urban
and Regional
Policy. Lucy Stone Hall. I4mer New Brunswick. NJ 08903. L.S..i\.
Campus.
Rutgers
University.
Abstract-South Africa has stripped blacks (the majority population) of democratic rights and, ober a period of 300 years. deprived them of their land; this dispossession culminated in 3.5 million involuntary removals of black South Africans to overcrowded and underdeveloped bantustans. on which a pseudo-independence is beins conferred. Blacks are denationalized and disenfranchized in South Africa and their mobility is strictly controlled by the pass system, but their situation is even worse in the so-called ‘homelands’. where repression has replaced the rule of law. This paper presents a case study of health and human rights in the Ciskei. a bantustan that became ‘independent’ of South Africa in December 1951 It documents severe deprivation. widespread malnutrition and gross riolations of human rights. Ke.v worr(s-human
rights.
health
in bantustan
Eight million South Africans were stripped of their citizenship between 1960 and 1984. The government of South Africa unilaterally declared them aliens and summarily made them nationals of bantustans: Transkei. Bophuthatswana. Venda and Ciskei. Six more bantustans are slated for this pseudoindependence [I]. The creation of these so-called ‘independent homelands’ is the centrepiece of the government’s plan to create a white South Africa by removing the African majority (72% of the population) to ten states that occupy 13% of the land of South Africa. Since 1960 there have been more than 3.5 million forced removals, sometimes at gunpoint, in circumstances causing great suffering. One and one-half million more removals are threatened bv the government. The ‘homelands’ policy gained’importance in the 1970s as blacks demonstrated renewed resistance in the strike waves that began in 1973, the student riots that spread from Soweto in 1976, the mass boycotts, the upsurge of African National Congress (ANC) activity, the increasing momentum of unionization. and the new militancy of black trade unions. The creation of ‘independent homelands’ is a response both to the intensification of the class struggle and to changed conditions for capital expansion in South Africa [2. p. 461. The government uses the ‘homelands’ to increase control of workers and of the allocation of their labour by- gradually transforming the workforce into legal ‘foreigners’ through the manipulation of nationality, citizenship and-immigration laws. Whereas before blacks were merely disenfranchized, now they are aliens and must acquire passports. in addition to passbooks. This change is more than symbolic: it abolishes people’s legal rights. affecting their chances of survival and legitimates new, more exploitative. labour recruitment practices. Relocation has meant the loss of ‘section ten’ rights, w-hich grant Africans the status of permanent residents in white urban areas. Without this status their presence is illegal after 72 hr. unless they have
l-year migrant labourer’s contract and housing. While 4 million Africans have won rights to reside permanently in white urban areas, 75% of the African population is more tightly controlled than before. Ofhcially. the ‘homelands’ manage their own affairs while the role of the South African state in the market declines. In practice, the bantustan authorities exercise petty control over labour matters (as in the distribution ot contracts), while the South African bureaucracy, particularly administrative boards, plays a growing role in rural labour markets. (See Greenberg and Giliomee for a detailed field report [3].) However, the South African government is not ignorant of the political advantage, of bantustan authorities appearing inefficient and corrupt. (The white regime’s refusal to share power with blacks or to accelerate the pace of reform is repeatedly justified by reference to the corruption and inehiciency of independent sub-Saharan nations; similar failings in bantustan governance fulfill white prophecies.) Currently, South Africa recruits men from the bantustans for unskilled work (e.g. as labourers, night watchmen and to remove night-soil) for ‘dirty’ work (e.g. at the foundries of ISCOR, the giant South African iron and steel corporation), for ‘unpopular’ work (e.g. farmwork) or for ‘unpopular’ firms. Women are recruited for nursing and domestic work, but most find jobs only in casual and daily farm work, at sawmills, on roadworks, with very small firms or on the sugar plantations of Natal. Skilled, workers are recruited from the townships within South Africa. as part of the strategy to create a relatively- privileged and politically stable group of urban blacks uho could be won away from radical causes like one man one vote. a
THE CISKEI
The Ciskei is the newest of the so-called ‘independent homelands’. which many people outside South
MEREDETH
888
r\frica
first learned
of through
Grnre of Dimbax~‘,
or associate
the 1975 film. ‘Lasr with Steve Biko, the leader of the black consciousness movement who lived there after he was banned in 1973. The bantustan is a 8000-9000 km’ wedge of land on the coast of the Eastern Cape, which the South African government pieced together by consolidating dozens of separate parcels of land. and ‘colonized’ by removing 350,000 Xhosa-speaking blacks from South Africa and resettling them in their ‘own group area’ [4]. Its present de facto population is over 1 million, making the Ciskei. with perhaps 100 people per km’, one of the most densely populated parts of South Africa. The Ciskei was made ‘independent’ on 31 December 1981. One-third of the population is concentrated in the dormitory town of Mdantsane. The inhabitants of Mdantsane provide daily labour for the nearby port of East London (in South Africa) and contract labour for the South African mines. Nearly half of Mdantsane’s workers are under 30 years of age; it seems the better educated youth of the Ciskei seek employment there [5]. Outside of Mdantsane, unemployment is widespread in the Ciskei, as it is in other bantustans, owing to the changed conditions for capital expansion. Within South Africa one may cite revisions of the contract system for migrant labour [6], the need for skilled rather than unskilled labour in the new high-tech industries, the decision to create a stable urban black labour force which reduces opportunities for migrant labour, the expansion of capital intensive agriculture which needs fewer workers, the current recession and the 4-year drought, which reduced the demand for seasonal labour on white farms, the major source of casual employment for women and children. Few jobs are available within the bantustans. The South African government has in effect relocated the unemployed in the bantustans, where they pose less of a threat than in the white urban areas. Within the Ciskei there has been little of the promised development, despite the push of an aggressive policy of industrial decentralization and the pull of cheap labour. In 1982 Green and Hirsch estimated that fewer than 5000 jobs had been created for blacks [7]. Unemployment rates are now running at an estimated 40% in the Ciskei [8]. The political strategy of ‘independent homelands’ involves a new magnitude of economic manipulation. There are no labour laws in the Ciskei, no minimum wage, and trade unions are banned [8]. The ban applies to commuters living in Mdantsane and working in East London. Trade union officials have been arrested in their offices in East London and transferred to the Ciskeian security police for further detention [9, p. 341. (For a description of the torture of labour leaders, see Lelyveld [IO].) The Ciskei government tolerates no protest, nor is any local self-government countenanced if it challenges the ruling party (the Ciskei National Independence Party). In July 1983, the Mdantsane Town Council was disbanded because, according to Lindile Williams, Minister of Internal Affairs, it had exceeded the limits of its duties and responsibilities [ 1I]. The lack of political rights for workers who are economically exploited directly affects health status:
Ttifwm
unorganized workers cannot defend their health and safety on the job or secure a living wage. According to Hirsch and Kooy. wages in East London are generally lower than in other industrial centres such as Cape Town and Durban, and substantially lower than the national average: in I976 African monthly wages in East London factories ranged from 40 to 100 rand. East London also has the worst unemployment of any South African city [12]. Nonetheless, industrial workers are better off than farm workers, who currently earn an average of 45 rand per month when they are paid in cash; sometimes women and children are paid in kind [ 131. The minimum living level for an average household was 250 rand per month at the beginning of 1983. according to the Swart Commission [l1]. Food prices soared during the prolonged drought: maize rose 25%, imported rice 16%. poultn IO-l5%, eggs 5%, breakfast cereals IO%, biscuits 9%, tea 25%, coffee 7.5% and sugar 3% [l5]. The disparity between urban and rural living standards in the Ciskei is great. The Surplus People Project estimated that in 1980, 59% of rural households and 20% of urban households earned less than 133 rand per month, well below the 1980 household subsistence levels of I70 rand in rural and 196 rand in urban areas. Formerly, subsistence farming absorbed the worst shocks of economic recession, but this last resort is no longer available in the overcrowded Ciskei where there is land scarcity, a siruation created artificially when the South African government allocated so little territory to the new ‘state’. In addition, only 13% of the area is arable, a constraint made worse by the Ciskei government. which bars so much land from habitation, reserving it for large commercial ranching and irrigation schemes. The remaining soil is ovenvorked, overstocked and eroded because of overcrowding: this deterioration cannot be ascribed to poor farming practices. Currently, only 8% of inhabitants of the Ciskei are estimated to be subsistence farmers [16]. The impression that few Africans are farming is confirmed by reports from the labor bureaus. As recently as IO years ago, droughts and floods would bring forth more jobs seekers. But during 1982, a drought year. there was no difference in the number of workers seekings jobs, presumably because few Africans were affected as so few now farm. Most people in the Ciskei depend on pensions. the income of commuters, the remittances of migrants. and the daily earnings of those who find casual work. Only 36% of income earned by Ciskei residents is generated inside the bantustan; 64% is earned outside by commuters and migrant workers [17]. The extent of migration from the Ciskei is evident in imbalanced population ratios and age distributions: in the general population there are 86 males for every 100 females: in the rural population aged 25-64 years the ratio is 49 males for every 100 females. Children under I5 years together with adults over 65 years make up more than 50% of the population [-t]. The large proportion of young and elderly dependents places a heavy burden on wage earners and means that already inadequate pay packets must be stretched to provide for twice as many people.
Health and human rights in a South African bantustan
of women In the old pattern of migration from the labour reserves, women remained in the rural areas working the farms, bearing and rearing children. and carine for the elderly, the ill, and the disabled, while me: worked in the mines and on plantations and, later, in the factories. South Africa carried the colonial labour reserve system to an extreme, requiring first men and then women to carry passbooks in which their ‘place of origin’ (an arbitrarily assigned tribal ‘homeland’) was stamped and residence elsewhere was linked to a valid labour contract. Because they were not permitted to live at the men’s worksites, women sought employment that would legalize their presence in the cities, but the only job available was live-in domestic work, which separated them not only from their men but also from their children. This pattern has changed and with it, women’s ability to support themselves and their families. The social disorganization caused by enforced relocation cannot be underestimated: removals have not only broken up families and created new waves of migration, but also imposed new hardships on older communities, putting them in conflict with displaced persons [18]. The overcrowding and escalating poverty of the bantustans have driven women off the land. Under sexually discriminatory laws, newly arrived women have no rights to land in the bantustans and are often refused any land allocation by the government appointed chiefs. These women must either find employment in the bantustans or join the stream of workers who migrate illegally to the cities and risk imprisonment [19]. Once women could depend on remittances from migrants, but the new system of renewable annual contracts strains family relationships. In the past many men extended the break between spells away as much as 3 months to 1 year, especially if leave coincided with ploughing or harvesting. But now some men establish a second home and family where they work and others do not return at all. In these circumstances, remittances are sporadic and unpredictable, so women restricted to the bantustans must fend for themselves. Paradoxically, overcrowding has not overcome the labour constraints of subsistence agriculture, which are aggravated by the absence of migrant workers from individual families; moreover, the women, children and the elderly who have been dumped in the rural areas do not form natural farming communities with traditions of mutual assistance. The result is that rural women do not spend their days tending fields, even when they have access to land, and instead are occupied in trying to earn money to support themselves and their families by working in the informal sector or on white farms [20]. Customary law decrees that men take all the major decisions in the family. In the eyes of South African law even married African women were, until recently, minors. For many women, the demand that custom be upheld, or the unwillingness to flout convention in a situation where they are dependent and alone for I I months out of every 12, becomes highly oppressive and contradictory [20, p. 18; 211. The maintenance of male authority is entrenched in the tribal system, which is legitimated by the strategy of ‘independent The predicament
889
homelands’. Only men are members of the tribal authority. Women are thus effectively shut out from access to the structures controlling their lives. HEALTH AND HEALTH CARE
Health conditions are worse in the Ciskei than in South Africa, as comparisons of black mortality rates show. In rural areas of the Ciskei infant mortality was estimated to be as high as 50% in 1980 by the Quail Commission (which the South African govemment appointed to examine the viability of an independent Ciskei) [22]; the World Health Organization figures for the black population of South Africa range from a high of 197 per 1000 live births in rural and 1.53per 1000 in urban Kimberley (1977) to 34 per 1000 in Cape Town (1979) [23, p. 1091. Malnutrition is widespread in the Ciskei: the South African Institute of Race Relations reported that 75% of urban and 80% of rural children were malnourished, and that 10% of urban and 16% of rural children 2-3 years old had kwashiorkor or marasmus [24]. In 1980, 33% of the adult population in the Hewu district of Ciskei were found to be suffering from pellagra, a vitamin B deficiency [25, p. 281. The drought aggravated this situation: newspapers reported a 50% increase in adults and teenagers of pellagra dementia, an advanced stage of vitamin B deficiency probably induced by diets consisting solely of mealie meal [26, 271. In a recent survey of childhood malnutrition in the Ciskei, Richter et al. found that 62% of school children did not meet World Health Organization developmental standards [28, 291. In November of 1983, Operation Hunger, a project of the Institute of Race Relations, said it was feeding 150,000 starving people daily in the Ciskei [26]. Despite extensive press coverage, there are no reports of deaths attributed directly to the drought, i.e. no deaths in excess of the high mortality that prevails in bantustans like the Ciskei. In contrast, estimates of deaths from the drought in Mozambique run as high as 100,000, with 700,000 people affected and 200,000 in refugee camps [30]. South Africa publishes no national mortality statistics by race so there are no baseline data for purposes of comparison over time. In 1982 when Dr L. A. Munnik, then Minister of Health, was questioned about reports of high death rates among children and the elderly in Elukhanyweni, an area in the Ciskei to which 5000 people were removed. many at gunpoint, he replied that the Ciskei “does not fall within the jurisdiction of the Republic” [3 I]. Govemment data now routinely exclude information on the bantustans, which, as Zwi points out, makes it appear that health is improving in South Africa and that cases of infectious disease come from banrustans [32, p. 351. There is a direct link between ill health in the Ciskei and the South African government’s manipulation of labour. Lacey reports a high correlation between the level of destitution in a particular area and the type, often the absence, of labour requisitions [2, p. 511. The specific mechanisms of the way labour recruitment affects health are revealed in an unusual study of child nutrition in the Ciskei carried out by
890
MEREDETH
Gertrude Thomas [33]. In extended families that are intact and productive. whether living on the land or in employment. children are well nourished even if the family is poor. When economic necessity forces men out of their families. children remain well nourished so long as the migrants return at intervals for extended periods and send remittances regularly during their absences. But when the extended family is dissolved-through relocations and removals. through population pressure on land plots too small and exhausted to support large numbers. or through death or are underimprisonment--children nourished, their growth stunted and their weight falls relative to norms for their age group. If penury shrinks the nuclear family. as for example when the father’s migration becomes permanent, and if access to land and employment is curtailed, children will show signs of frank malnutrition. In families lacking both parents. as when the father is a permanent migrant and the mother leaves for town in search of work. the children left in the care of elderly relatives or aunts with children of their own are apt to be severely malnourished. Illegitimate children left in the care of impoverished elderly relatives may develop frank marasmus. Starving children are the remnants of fragmented families or of unproductive fragments of families discarded by the capitalist system. Tuberculosis is reported to be the greatest health problem in the Ciskei vvhich, with 2% of the adult population affected, was second only to the Traskei (4% of adults affected) in having the highest incidence of TB in South Africa [34. p. 4961. The South African National Tuberculosis Association said that overcrowding under atrocious environmental conditions, coupled with malnutrition and rising unemployment, spread the disease [34. p. 5011. Health sercices Health services in the bantustans reflect, not only the general neglect of health care for blacks, but also the urban and curative biases of medical services in South Africa, not an unusual choice in a capitalist economy. but one that limits the number of people who will receive any care. Medical aid schemes, which lessen the financial burden of treatment, cover 81% of white and only 1% of black South Africans. Curative, urban-based treatment is a wrong choice for the mainly rural bantustans. where the epidemiological picture is one of diseases that are mostly preventable. The limited state allocation to bantustan health services tends to be spent inappropriately on the capital and recurrent costs of curative services [23. p. 2211. Of 1382 million rand spent on health care in 1979. only 160 million rand were allocated to the Department of Health. which is responsible for African health services. and 68 million rand to the bantustans, almost all for curative services [23, p. 2181. Apparently not all the money allocated by the South African government is spent on health services in the bantustans. The Quail Commission reported that in 1977 the Ciskei spent three times less per person then the South African government [X, p. 321. The bantustan health services are understaffed as well as underfunded. Only 2% of all doctors in South
TLRSHEU
Africa work in the bantustans where doctor-topopulation ratios vary from I to IO per 100.000. Originally. missionaries provided health care to blacks in the bantustans: by the mid-1960s some 100 mission hospitals supplied more than 50”; of the hospital beds. In the late 1960s the state took them over. ostensibly because many mission hospitals experienced financial difficulties; the ulterior motive was to gain control of missionary and expatriate doctors who exerted a liberalizing influence [32. p. 331. The South African government has decentralized health services to the bantustans in a self-serving effort to lend legitimacy to the ‘homelands’ policy and reduce its ovvn responsibility for health conditions in these areas [23. p. E!l], to promote the regimes as being interested in the welfare of the community and reduce dissent by providing social services, and to enable the bantustan administrations to dispense patronage by providing jobs [32. pp. 33-341. Other unfortunate consequences of decentralization are the fragmentation and tribalization of professional groups like the South African Sursing Association and the withdrawal of humanitarians and missionaries from the medical services. To compensate for the acute shortage of trained biomedical (as opposed to popular or traditional) personnel in the bantustans, inexperienced white South African national servicemen are operating as doctors in civilian hospitals [23, p. ?I]. In the Ciskei. for a population of over 1 million, there were five hospitals with 1500 beds in 1980 [35. p. 241. A sixth hospital with 270 beds was opened in Keiskammahoek in 1984 [36], and 337 beds were added to Cecilia Makiwane. the regional referral hospital, in Mdantsane [37]. Forty-six per cent of the 2100 beds now available are located in hldantsane. Hewu district has no hospital, but work has started on a 250 bed facility [37]. There are 75 full-time and 28 part-time doctors, 2700 nurses and 80 paramedical personnel [34, p. 4951. Because of financial constraints all clinics and hospital posts were frozen for 1983 1984 [X3]. and nurses qualifying at Mount Coke Hospital could not find employ-ment, although only half the nursing posts at Cecilia Makiwane are filled [35. p. 321. No psychiatric hospital exists (patients are hospitalized in South Africa), and the post of psychiatrist remained vacant through 1983. There are I I3 clinics or subclinics. Because of staff shortages the clinics are overburdened; e.g. the 2 clinics in Hewu district each handle up to 10.000 cases per year [3J. p. -195. -1961. Rural clinics are supposed to be staffed by five community health sisters and three staff nurses. but usually have only two sisters with a post-basic diploma in community health nursing science and no training in primary health care [35. p. 211. Small isolated communities are without any health services. Fees for treatment in hospitals and clinics range from 2 to 4 rand per visit [35. p. 271. The onlv free health service offered to blacks in South Africa is family planning. which is seen as a cy-nical plan to control population growth. Health services in a Ciskeian rural resettlement camp like Kammaskraal, to which one thousand people were removed in IYSO. consist of a vveckly visit by a mobile clinic that charges 50 cents for treatment
Hedth
and human
rights
in a South
that is often no more than the distribution ot skimmed milk powder [39]. The hospitals nearest to Kammaskraal are in Peddie. which is 40 km away and Sumpumelelo. 50 km away. HL>IAN RIGHTS The very creation of the ‘homelands’. the denationalization and dispossession of black South Africans. their forced removal from their homes to lands manv have never seen and where they cannot survive, are \‘iolations of human rights and international law. In the Ciskei. gross and startling violations of human rights, beyond the denial of democratic rights to its ‘citizens’. have gone unchecked. These violations affect health directly when they take the form of physical assaults on civilians, illegal restraints or attacks on health personnel; they affect health indirectly when they prevent people from organizing to defend their standard of living or improve their living and working conditions. The lawyers, physicians and journalists who recorded abuses in the Ciskei in order to expose them have been detained. Freedom of the press is curtailed and censorship prevails there as elsewhere in South Africa. In 1983 the Ciskei government prohibited the distribution of seventy-three publications and detained a number of journalists [34, pp. 210 and 2121. There has been unlimited use of powers. such as detention without trial, officially conferred on the authorities by the Ciskei National Security Act of 1982. The South African Minister of Law and Order, Louis Le Grange, has said there are good relations between the South African police and the Ciskei police force, as a result of which a person detained by one might be handed over for detention by the other [34. p. 3323, a clear indication that ‘homeland independence‘ is a sham [40]. In June 1983 the Ciskei security forces carried out a combined operation with the South African Defence Force, setting up roadblocks and searching homes in Mdantsane. During the 1983:1984 bus and school boycotts that lasted 20 months, starting in Mdantsane and spreading to five other townships, Ciskei soldiers and security police beat and tortured workers commuting to East London. An unofficial army of vigilantes sponsored by the Ciskei National Independence Party (CNIP), the party headed by Life President Lennox Sebe, used physical violence to break the boycotts led by commuters and by school children protesting the treatment of their parents [9, p. 21. The Ciskei government declared a state of emergency, imposed a curfew, banned meetings of more than four people, prohibited weekend burials and placed a limit of 100 mourners on all funerals. In the first week of the emergency 750 people were arrested. and by the end of the third month 832 people had been arrested for breaking the curfew or failing to pay the Ciskei ‘development tax’ [34. p. 3361. The estimated death toll ivas 90 [34. p. 3381. Health workers were a special target of the Ciskei police and the CNIP vigilantes because of their part in documenting assaults on people and in caring for the wounded. Dr Lawrence Msauli, a popular physician \vho treated victims of vigilante beatings. was detained under the security law in 1983 [9. p. 561. The
African
bantustan
891
police raided Cecilia Makiwanr Hospital in Mdantsane and arrested workers who reported assaults and beatings. Hospital personnel were forbidden to release details of the injured and claimed the! were subjected to government pressure to falsify death figures so that many deaths uere not made known [34, p. 3383. Medical fileswere marked ‘police’ files and disappeared from the hospital [9, p. 671. These human rights violations could occur because the power structure of the ‘independent homelands’ created by the South African government made them possible. In the bantustans. tribal structuresbolstered and refashioned by the South African government when it granted legislative and executive powers to the bantustans-have replaced democratic institutions. These tribal structures have no traditional antecedents: they are creations of the South African state. The chiefs have emerged from this process with extensive executive authority, financial rewards, and control over the distribution of land, labour contracts, and social welfare grants, which are the primary sources of income for the majority [41]. The bantustan regimes are puppet regimes, but their power is based on chiefs and on headmen who are appointed by the government [18. p.I 171. In 1983, seven out of eight Ciskei cabinet ministers and more than half the members of the Ciskei National Assembly were chiefs [42]. As Haysom remarks, “this elite dare not fall out of favour with the government for fear of joining the landless pariahs” [9, p. 61. Aziza Seedat points out that “Health in South Africa is inseparable from the economic, political and social structure of the apartheid state” [25, p. IOl]. Likewise, the provision of good health services does not depend so much on the skill of health workers as on prevailing economic, social and political conditions. For example, South African paediatricians may have developed an expertise in the understanding and treatment of malnutrition and its complications. but medical expertise does not change the system that gives rise to malnutrition nor the environment to which treated children return, an environment in which half of the children die before their fifth birthday. Malnutrition, in this context, is a direct result of the government’s policies, which perpetuate the apartheid system and promote the poor health conditions and human rights violations described in this
paper.
Acknorr(edgemenrs-The research for this paper was made possible by a grant from the Rutgers University Research Council. The work was facilitated by the Insitute for Commonwealth Studies, the International Defence and Aid Fund, the American Committee on Africa and the Catholic Institute for International Relations; all of these organizations generously allowed me to use their libraries.
REFEREXCES Surplus Peoples Project-Western Cape. Khu~e[ifslla: ,Veu Home-Old Sror,~. p. 7. Cape Town. 198-l. Lacey M. Locating employment. relocating unemplbyment. In ~H&eland‘ ~Trraged~: Funcrion and Farce, DD. Universit, Devel. . 4655. Witwatersrand opment Studies Group, South Africa Research Service Information Publication No. 6. Johannesburg. 1982.
892
MEREDETH
S. and Giliomee H. Labour bureaucracies 3. Greenburg and the Afrtcan rural areas: a field research report. In cp Against rhe Fences (Edited by Gihomee H. and Schlemmer L.). David Philip, Cape Town. 1985. 4. Surplus People Project. Forced Remorals in South Afi&. Vol. 5 The E&ern Cape. Cape Town. 1983. All these fieures are subiect to oolitical dispute. The Ciskei’s boundiries are no; yet fixed. the de jure population (Ciskei ‘nationals’) is twice the de facto population (Ciskei residents) and non-registration is a means of protest. Extrapolating from the government’s 1980 data. the current population is 850,000. but this is widelv acknowledged to be too low and an estimate of I million is used in this paper. All data calculated on a population base, for example population density, are necessarily estimates. Health planners are severely handicapped by the lack of vital data. 5. Swilling M. The buses smell of blood: the East London boycott. S. Afr. Labour Bull. 9, 45, 1984. 6. Migrant labourers are restricted to employment on l-year contracts. Whereas men used to remain at home between contracts, under the new system they renew before going on leave and must return in three weeks or lose their place. The employment of first-time mineworkers has dropped from 70 to 25% in recent years. suggesting that mineowners have succeeded in creating a stable workforce. 7. Green P. and Hirsch A. Manufacturing Industry in the Ciskei. In Homeland Tragedy: Funclion and Farce, y;p.,41-46. University of Witwatersrand, Johannesburg, 8. Sunday Tribune 23 July, 1983. N. Ruling with rhe Whip: A Reporl on Ihe 9 Haysom Violarion of Human Rights in the Ciskei. University of Witwatersrand, Braamfontein. 1983. 10. Lelyveld J. Misery in a South African ‘homeland’. In The New York Timex-Magazine p. 62, 25 September, 1983. II Daily Dispafch 26 June. 1984. No elections have been held since then, and this city (the size of Geneva or Washington) is run by a manager seconded by the South African government with a budget of 10.5 million rand [Daily Dispatch 19 October, 19841. in 12 Hirsch A. and Kooy A. Industry and employment East London. S. Afr. Labour Bull. 7, 5&64. 1982. 13. Rand Daily Mail 5 March, 1984. 1984. 14. Daily Dispatch 10 January, IS. Star I2 March, 1984. 16. Financial Mail 2 March, 1984. 1984. 17. Cape Times IO January, in 18. Green P. and Hirsch A. The impact of resettlement the Ciskei: three case studies. Southern Africa Labour and Development Research Unit, Working Paper No. 49. Universitv of Cape Town, 1983. Few resettlement camps comprise whole villages moved together to a new locaiion: Ehtkhanyweni is one such instance resulting from a ‘black suet’ removal in 1977. Commonly, single families working under the labour tenant system br squatting on white farms are relocated. Green and Hirsch review the ‘reasons’ for removal in chapter one. Defence and Aid Fund. Women Under 19. International Apartheid. London, 198 I. 20. Yawitch J. Apartheid and family life. Work Prog. 27, 40-42, 1983. 21. Gordon E. An analysis of the impact of labour migration on the lives of women in Lesotho. In African Women in the Decelopment Process (Edited by Nelson N.), pp. 59-76. Frank Cass, London, 1981.
TL.RS~EN Reporr of Ihe Cixker Commission. 22. Quail Commission. Conference .Associates. Pretoria. 1950. Aparrhrid and Healrh. 23. World Health Organization. WHO. Geneva 1983. 24. Rand Dail? .Wail 6 December. 1980. 25. Seedat A. Crippling A .varion: Hralrh ti .-!parrheid Sourh .Ijrica. International Defence and Aid Fund. London. 198-t. 1983. 26. Srar 7 November, 1983. 27. W’ahshingron Posr 9 October, value of diets of 28. Richter M. J. C. er al. Nutritional blacks in Ciskei. S. A/?. med. J. 65, 338-345, 1984. 29. Star I5 March. 1984. 30. Srar I6 January 1984. 31. Guardian I4 May, 1983. 32. Zwi A. Fragmenting health in the homelands. In ‘Homeland’ Tragedy: Function and Fsrce. pp. 31-36. Development Studies Witwatersrand University GroupcSouth Africa Research Service Information Publication No. 6. Johannesburg, 1981. of childhood nutri33. Thomas G. The social background tion in the Ciskei. Sot. Sci. Med. IS.-\. 551-555, 1981. Surrey of 34 South African Institute of Race Relations. Race Relarions 1983. Johannesburg. 138-1. ’ -’ 35. Mvrdal S. and Thomson L. Health and health services in the Ciskei. Southern Africa Labour and Development Research Unit. Working Paper No. _q!. University of Cape Town, 1953. 1984. 36. Daily Dispatch I December, 31. DaiLy Dirparch 6 June. 1985. tax 38. In spite of the economic recession and corporate cuts, the Ciskei contrived a budget surp!us in 1983 198-l by cutting such administrative expenditures as health and welfare services [Daily Disparch 1-t November, 19841. 39. Cock J. Survival in a Ciskeian resettlement camp. Crii. Hlrh 6, p. 4. 1981. 40 Because the Ciskei lacks adequate jails. prisoners are kept in South Africa. a privilege for which the Ciskei paid 777.173.59 rand to South Africa in 1983. 1984 [DaiLy Disparch I I July. 19841. 41 The system of control in the Ciskei depends heavily on chiefs. Sebe uses tribal discipline to control the population and has complained that many relocated people are lawless and rootless because they did not grow up under chiefs. He blamed the bus boycotts on such people [Rand Dai1.v Mail 24 July, 19841. 42. That the Ciskei government is a puppet regime and that South Africa holds the reins of power in this bantustan are clear from the makeup of the government of this ‘independent homeland’. Although most members of the Ciskei cabinet are black, twelve of sixteen ‘key men’ (and they are all men) are white: Theo de Vries. Chancellor to the Presidency, D. G. Boushier. DirectorGeneral and Deputy Chancellor of the Presidency. J. W. Glieb, Director-General of Internal AfTairs, I. Melville, Director-General of Finance, I. M. hlullins, AuditorGeneral, Gary Godden. Director of P!anning. Bobbv Michau. Dire&or-General of Manpower. Cal. Herbert Webster. Commissioner of Prisons. J. F. Ventjr ...-.. Director-General of Post, P. J. Welttan. DirectorGeneral of Transport, C. L. Atwell. Dirstor-General of Public Works and Reg Beavitt. Chief Traffic Officer. Key posts held by blacks are foreign affairs. agriculture. education and health. Despite considerable turnover. whites retain approximately the same number of posts.
0277-9536 86 53 00 + 0.00 Pqamon Journals Ltd
HEALTH AND HUMAN RIGHTS IN A SOUTH AFRICAN BANTUSTAN MEREDETH TCRSHES
School
of Urban
and Regional
Policy. Lucy Stone Hall. I4mer New Brunswick. NJ 08903. L.S..i\.
Campus.
Rutgers
University.
Abstract-South Africa has stripped blacks (the majority population) of democratic rights and, ober a period of 300 years. deprived them of their land; this dispossession culminated in 3.5 million involuntary removals of black South Africans to overcrowded and underdeveloped bantustans. on which a pseudo-independence is beins conferred. Blacks are denationalized and disenfranchized in South Africa and their mobility is strictly controlled by the pass system, but their situation is even worse in the so-called ‘homelands’. where repression has replaced the rule of law. This paper presents a case study of health and human rights in the Ciskei. a bantustan that became ‘independent’ of South Africa in December 1951 It documents severe deprivation. widespread malnutrition and gross riolations of human rights. Ke.v worr(s-human
rights.
health
in bantustan
Eight million South Africans were stripped of their citizenship between 1960 and 1984. The government of South Africa unilaterally declared them aliens and summarily made them nationals of bantustans: Transkei. Bophuthatswana. Venda and Ciskei. Six more bantustans are slated for this pseudoindependence [I]. The creation of these so-called ‘independent homelands’ is the centrepiece of the government’s plan to create a white South Africa by removing the African majority (72% of the population) to ten states that occupy 13% of the land of South Africa. Since 1960 there have been more than 3.5 million forced removals, sometimes at gunpoint, in circumstances causing great suffering. One and one-half million more removals are threatened bv the government. The ‘homelands’ policy gained’importance in the 1970s as blacks demonstrated renewed resistance in the strike waves that began in 1973, the student riots that spread from Soweto in 1976, the mass boycotts, the upsurge of African National Congress (ANC) activity, the increasing momentum of unionization. and the new militancy of black trade unions. The creation of ‘independent homelands’ is a response both to the intensification of the class struggle and to changed conditions for capital expansion in South Africa [2. p. 461. The government uses the ‘homelands’ to increase control of workers and of the allocation of their labour by- gradually transforming the workforce into legal ‘foreigners’ through the manipulation of nationality, citizenship and-immigration laws. Whereas before blacks were merely disenfranchized, now they are aliens and must acquire passports. in addition to passbooks. This change is more than symbolic: it abolishes people’s legal rights. affecting their chances of survival and legitimates new, more exploitative. labour recruitment practices. Relocation has meant the loss of ‘section ten’ rights, w-hich grant Africans the status of permanent residents in white urban areas. Without this status their presence is illegal after 72 hr. unless they have
l-year migrant labourer’s contract and housing. While 4 million Africans have won rights to reside permanently in white urban areas, 75% of the African population is more tightly controlled than before. Ofhcially. the ‘homelands’ manage their own affairs while the role of the South African state in the market declines. In practice, the bantustan authorities exercise petty control over labour matters (as in the distribution ot contracts), while the South African bureaucracy, particularly administrative boards, plays a growing role in rural labour markets. (See Greenberg and Giliomee for a detailed field report [3].) However, the South African government is not ignorant of the political advantage, of bantustan authorities appearing inefficient and corrupt. (The white regime’s refusal to share power with blacks or to accelerate the pace of reform is repeatedly justified by reference to the corruption and inehiciency of independent sub-Saharan nations; similar failings in bantustan governance fulfill white prophecies.) Currently, South Africa recruits men from the bantustans for unskilled work (e.g. as labourers, night watchmen and to remove night-soil) for ‘dirty’ work (e.g. at the foundries of ISCOR, the giant South African iron and steel corporation), for ‘unpopular’ work (e.g. farmwork) or for ‘unpopular’ firms. Women are recruited for nursing and domestic work, but most find jobs only in casual and daily farm work, at sawmills, on roadworks, with very small firms or on the sugar plantations of Natal. Skilled, workers are recruited from the townships within South Africa. as part of the strategy to create a relatively- privileged and politically stable group of urban blacks uho could be won away from radical causes like one man one vote. a
THE CISKEI
The Ciskei is the newest of the so-called ‘independent homelands’. which many people outside South
MEREDETH
888
r\frica
first learned
of through
Grnre of Dimbax~‘,
or associate
the 1975 film. ‘Lasr with Steve Biko, the leader of the black consciousness movement who lived there after he was banned in 1973. The bantustan is a 8000-9000 km’ wedge of land on the coast of the Eastern Cape, which the South African government pieced together by consolidating dozens of separate parcels of land. and ‘colonized’ by removing 350,000 Xhosa-speaking blacks from South Africa and resettling them in their ‘own group area’ [4]. Its present de facto population is over 1 million, making the Ciskei. with perhaps 100 people per km’, one of the most densely populated parts of South Africa. The Ciskei was made ‘independent’ on 31 December 1981. One-third of the population is concentrated in the dormitory town of Mdantsane. The inhabitants of Mdantsane provide daily labour for the nearby port of East London (in South Africa) and contract labour for the South African mines. Nearly half of Mdantsane’s workers are under 30 years of age; it seems the better educated youth of the Ciskei seek employment there [5]. Outside of Mdantsane, unemployment is widespread in the Ciskei, as it is in other bantustans, owing to the changed conditions for capital expansion. Within South Africa one may cite revisions of the contract system for migrant labour [6], the need for skilled rather than unskilled labour in the new high-tech industries, the decision to create a stable urban black labour force which reduces opportunities for migrant labour, the expansion of capital intensive agriculture which needs fewer workers, the current recession and the 4-year drought, which reduced the demand for seasonal labour on white farms, the major source of casual employment for women and children. Few jobs are available within the bantustans. The South African government has in effect relocated the unemployed in the bantustans, where they pose less of a threat than in the white urban areas. Within the Ciskei there has been little of the promised development, despite the push of an aggressive policy of industrial decentralization and the pull of cheap labour. In 1982 Green and Hirsch estimated that fewer than 5000 jobs had been created for blacks [7]. Unemployment rates are now running at an estimated 40% in the Ciskei [8]. The political strategy of ‘independent homelands’ involves a new magnitude of economic manipulation. There are no labour laws in the Ciskei, no minimum wage, and trade unions are banned [8]. The ban applies to commuters living in Mdantsane and working in East London. Trade union officials have been arrested in their offices in East London and transferred to the Ciskeian security police for further detention [9, p. 341. (For a description of the torture of labour leaders, see Lelyveld [IO].) The Ciskei government tolerates no protest, nor is any local self-government countenanced if it challenges the ruling party (the Ciskei National Independence Party). In July 1983, the Mdantsane Town Council was disbanded because, according to Lindile Williams, Minister of Internal Affairs, it had exceeded the limits of its duties and responsibilities [ 1I]. The lack of political rights for workers who are economically exploited directly affects health status:
Ttifwm
unorganized workers cannot defend their health and safety on the job or secure a living wage. According to Hirsch and Kooy. wages in East London are generally lower than in other industrial centres such as Cape Town and Durban, and substantially lower than the national average: in I976 African monthly wages in East London factories ranged from 40 to 100 rand. East London also has the worst unemployment of any South African city [12]. Nonetheless, industrial workers are better off than farm workers, who currently earn an average of 45 rand per month when they are paid in cash; sometimes women and children are paid in kind [ 131. The minimum living level for an average household was 250 rand per month at the beginning of 1983. according to the Swart Commission [l1]. Food prices soared during the prolonged drought: maize rose 25%, imported rice 16%. poultn IO-l5%, eggs 5%, breakfast cereals IO%, biscuits 9%, tea 25%, coffee 7.5% and sugar 3% [l5]. The disparity between urban and rural living standards in the Ciskei is great. The Surplus People Project estimated that in 1980, 59% of rural households and 20% of urban households earned less than 133 rand per month, well below the 1980 household subsistence levels of I70 rand in rural and 196 rand in urban areas. Formerly, subsistence farming absorbed the worst shocks of economic recession, but this last resort is no longer available in the overcrowded Ciskei where there is land scarcity, a siruation created artificially when the South African government allocated so little territory to the new ‘state’. In addition, only 13% of the area is arable, a constraint made worse by the Ciskei government. which bars so much land from habitation, reserving it for large commercial ranching and irrigation schemes. The remaining soil is ovenvorked, overstocked and eroded because of overcrowding: this deterioration cannot be ascribed to poor farming practices. Currently, only 8% of inhabitants of the Ciskei are estimated to be subsistence farmers [16]. The impression that few Africans are farming is confirmed by reports from the labor bureaus. As recently as IO years ago, droughts and floods would bring forth more jobs seekers. But during 1982, a drought year. there was no difference in the number of workers seekings jobs, presumably because few Africans were affected as so few now farm. Most people in the Ciskei depend on pensions. the income of commuters, the remittances of migrants. and the daily earnings of those who find casual work. Only 36% of income earned by Ciskei residents is generated inside the bantustan; 64% is earned outside by commuters and migrant workers [17]. The extent of migration from the Ciskei is evident in imbalanced population ratios and age distributions: in the general population there are 86 males for every 100 females: in the rural population aged 25-64 years the ratio is 49 males for every 100 females. Children under I5 years together with adults over 65 years make up more than 50% of the population [-t]. The large proportion of young and elderly dependents places a heavy burden on wage earners and means that already inadequate pay packets must be stretched to provide for twice as many people.
Health and human rights in a South African bantustan
of women In the old pattern of migration from the labour reserves, women remained in the rural areas working the farms, bearing and rearing children. and carine for the elderly, the ill, and the disabled, while me: worked in the mines and on plantations and, later, in the factories. South Africa carried the colonial labour reserve system to an extreme, requiring first men and then women to carry passbooks in which their ‘place of origin’ (an arbitrarily assigned tribal ‘homeland’) was stamped and residence elsewhere was linked to a valid labour contract. Because they were not permitted to live at the men’s worksites, women sought employment that would legalize their presence in the cities, but the only job available was live-in domestic work, which separated them not only from their men but also from their children. This pattern has changed and with it, women’s ability to support themselves and their families. The social disorganization caused by enforced relocation cannot be underestimated: removals have not only broken up families and created new waves of migration, but also imposed new hardships on older communities, putting them in conflict with displaced persons [18]. The overcrowding and escalating poverty of the bantustans have driven women off the land. Under sexually discriminatory laws, newly arrived women have no rights to land in the bantustans and are often refused any land allocation by the government appointed chiefs. These women must either find employment in the bantustans or join the stream of workers who migrate illegally to the cities and risk imprisonment [19]. Once women could depend on remittances from migrants, but the new system of renewable annual contracts strains family relationships. In the past many men extended the break between spells away as much as 3 months to 1 year, especially if leave coincided with ploughing or harvesting. But now some men establish a second home and family where they work and others do not return at all. In these circumstances, remittances are sporadic and unpredictable, so women restricted to the bantustans must fend for themselves. Paradoxically, overcrowding has not overcome the labour constraints of subsistence agriculture, which are aggravated by the absence of migrant workers from individual families; moreover, the women, children and the elderly who have been dumped in the rural areas do not form natural farming communities with traditions of mutual assistance. The result is that rural women do not spend their days tending fields, even when they have access to land, and instead are occupied in trying to earn money to support themselves and their families by working in the informal sector or on white farms [20]. Customary law decrees that men take all the major decisions in the family. In the eyes of South African law even married African women were, until recently, minors. For many women, the demand that custom be upheld, or the unwillingness to flout convention in a situation where they are dependent and alone for I I months out of every 12, becomes highly oppressive and contradictory [20, p. 18; 211. The maintenance of male authority is entrenched in the tribal system, which is legitimated by the strategy of ‘independent The predicament
889
homelands’. Only men are members of the tribal authority. Women are thus effectively shut out from access to the structures controlling their lives. HEALTH AND HEALTH CARE
Health conditions are worse in the Ciskei than in South Africa, as comparisons of black mortality rates show. In rural areas of the Ciskei infant mortality was estimated to be as high as 50% in 1980 by the Quail Commission (which the South African govemment appointed to examine the viability of an independent Ciskei) [22]; the World Health Organization figures for the black population of South Africa range from a high of 197 per 1000 live births in rural and 1.53per 1000 in urban Kimberley (1977) to 34 per 1000 in Cape Town (1979) [23, p. 1091. Malnutrition is widespread in the Ciskei: the South African Institute of Race Relations reported that 75% of urban and 80% of rural children were malnourished, and that 10% of urban and 16% of rural children 2-3 years old had kwashiorkor or marasmus [24]. In 1980, 33% of the adult population in the Hewu district of Ciskei were found to be suffering from pellagra, a vitamin B deficiency [25, p. 281. The drought aggravated this situation: newspapers reported a 50% increase in adults and teenagers of pellagra dementia, an advanced stage of vitamin B deficiency probably induced by diets consisting solely of mealie meal [26, 271. In a recent survey of childhood malnutrition in the Ciskei, Richter et al. found that 62% of school children did not meet World Health Organization developmental standards [28, 291. In November of 1983, Operation Hunger, a project of the Institute of Race Relations, said it was feeding 150,000 starving people daily in the Ciskei [26]. Despite extensive press coverage, there are no reports of deaths attributed directly to the drought, i.e. no deaths in excess of the high mortality that prevails in bantustans like the Ciskei. In contrast, estimates of deaths from the drought in Mozambique run as high as 100,000, with 700,000 people affected and 200,000 in refugee camps [30]. South Africa publishes no national mortality statistics by race so there are no baseline data for purposes of comparison over time. In 1982 when Dr L. A. Munnik, then Minister of Health, was questioned about reports of high death rates among children and the elderly in Elukhanyweni, an area in the Ciskei to which 5000 people were removed. many at gunpoint, he replied that the Ciskei “does not fall within the jurisdiction of the Republic” [3 I]. Govemment data now routinely exclude information on the bantustans, which, as Zwi points out, makes it appear that health is improving in South Africa and that cases of infectious disease come from banrustans [32, p. 351. There is a direct link between ill health in the Ciskei and the South African government’s manipulation of labour. Lacey reports a high correlation between the level of destitution in a particular area and the type, often the absence, of labour requisitions [2, p. 511. The specific mechanisms of the way labour recruitment affects health are revealed in an unusual study of child nutrition in the Ciskei carried out by
890
MEREDETH
Gertrude Thomas [33]. In extended families that are intact and productive. whether living on the land or in employment. children are well nourished even if the family is poor. When economic necessity forces men out of their families. children remain well nourished so long as the migrants return at intervals for extended periods and send remittances regularly during their absences. But when the extended family is dissolved-through relocations and removals. through population pressure on land plots too small and exhausted to support large numbers. or through death or are underimprisonment--children nourished, their growth stunted and their weight falls relative to norms for their age group. If penury shrinks the nuclear family. as for example when the father’s migration becomes permanent, and if access to land and employment is curtailed, children will show signs of frank malnutrition. In families lacking both parents. as when the father is a permanent migrant and the mother leaves for town in search of work. the children left in the care of elderly relatives or aunts with children of their own are apt to be severely malnourished. Illegitimate children left in the care of impoverished elderly relatives may develop frank marasmus. Starving children are the remnants of fragmented families or of unproductive fragments of families discarded by the capitalist system. Tuberculosis is reported to be the greatest health problem in the Ciskei vvhich, with 2% of the adult population affected, was second only to the Traskei (4% of adults affected) in having the highest incidence of TB in South Africa [34. p. 4961. The South African National Tuberculosis Association said that overcrowding under atrocious environmental conditions, coupled with malnutrition and rising unemployment, spread the disease [34. p. 5011. Health sercices Health services in the bantustans reflect, not only the general neglect of health care for blacks, but also the urban and curative biases of medical services in South Africa, not an unusual choice in a capitalist economy. but one that limits the number of people who will receive any care. Medical aid schemes, which lessen the financial burden of treatment, cover 81% of white and only 1% of black South Africans. Curative, urban-based treatment is a wrong choice for the mainly rural bantustans. where the epidemiological picture is one of diseases that are mostly preventable. The limited state allocation to bantustan health services tends to be spent inappropriately on the capital and recurrent costs of curative services [23. p. 2211. Of 1382 million rand spent on health care in 1979. only 160 million rand were allocated to the Department of Health. which is responsible for African health services. and 68 million rand to the bantustans, almost all for curative services [23, p. 2181. Apparently not all the money allocated by the South African government is spent on health services in the bantustans. The Quail Commission reported that in 1977 the Ciskei spent three times less per person then the South African government [X, p. 321. The bantustan health services are understaffed as well as underfunded. Only 2% of all doctors in South
TLRSHEU
Africa work in the bantustans where doctor-topopulation ratios vary from I to IO per 100.000. Originally. missionaries provided health care to blacks in the bantustans: by the mid-1960s some 100 mission hospitals supplied more than 50”; of the hospital beds. In the late 1960s the state took them over. ostensibly because many mission hospitals experienced financial difficulties; the ulterior motive was to gain control of missionary and expatriate doctors who exerted a liberalizing influence [32. p. 331. The South African government has decentralized health services to the bantustans in a self-serving effort to lend legitimacy to the ‘homelands’ policy and reduce its ovvn responsibility for health conditions in these areas [23. p. E!l], to promote the regimes as being interested in the welfare of the community and reduce dissent by providing social services, and to enable the bantustan administrations to dispense patronage by providing jobs [32. pp. 33-341. Other unfortunate consequences of decentralization are the fragmentation and tribalization of professional groups like the South African Sursing Association and the withdrawal of humanitarians and missionaries from the medical services. To compensate for the acute shortage of trained biomedical (as opposed to popular or traditional) personnel in the bantustans, inexperienced white South African national servicemen are operating as doctors in civilian hospitals [23, p. ?I]. In the Ciskei. for a population of over 1 million, there were five hospitals with 1500 beds in 1980 [35. p. 241. A sixth hospital with 270 beds was opened in Keiskammahoek in 1984 [36], and 337 beds were added to Cecilia Makiwane. the regional referral hospital, in Mdantsane [37]. Forty-six per cent of the 2100 beds now available are located in hldantsane. Hewu district has no hospital, but work has started on a 250 bed facility [37]. There are 75 full-time and 28 part-time doctors, 2700 nurses and 80 paramedical personnel [34, p. 4951. Because of financial constraints all clinics and hospital posts were frozen for 1983 1984 [X3]. and nurses qualifying at Mount Coke Hospital could not find employ-ment, although only half the nursing posts at Cecilia Makiwane are filled [35. p. 321. No psychiatric hospital exists (patients are hospitalized in South Africa), and the post of psychiatrist remained vacant through 1983. There are I I3 clinics or subclinics. Because of staff shortages the clinics are overburdened; e.g. the 2 clinics in Hewu district each handle up to 10.000 cases per year [3J. p. -195. -1961. Rural clinics are supposed to be staffed by five community health sisters and three staff nurses. but usually have only two sisters with a post-basic diploma in community health nursing science and no training in primary health care [35. p. 211. Small isolated communities are without any health services. Fees for treatment in hospitals and clinics range from 2 to 4 rand per visit [35. p. 271. The onlv free health service offered to blacks in South Africa is family planning. which is seen as a cy-nical plan to control population growth. Health services in a Ciskeian rural resettlement camp like Kammaskraal, to which one thousand people were removed in IYSO. consist of a vveckly visit by a mobile clinic that charges 50 cents for treatment
Hedth
and human
rights
in a South
that is often no more than the distribution ot skimmed milk powder [39]. The hospitals nearest to Kammaskraal are in Peddie. which is 40 km away and Sumpumelelo. 50 km away. HL>IAN RIGHTS The very creation of the ‘homelands’. the denationalization and dispossession of black South Africans. their forced removal from their homes to lands manv have never seen and where they cannot survive, are \‘iolations of human rights and international law. In the Ciskei. gross and startling violations of human rights, beyond the denial of democratic rights to its ‘citizens’. have gone unchecked. These violations affect health directly when they take the form of physical assaults on civilians, illegal restraints or attacks on health personnel; they affect health indirectly when they prevent people from organizing to defend their standard of living or improve their living and working conditions. The lawyers, physicians and journalists who recorded abuses in the Ciskei in order to expose them have been detained. Freedom of the press is curtailed and censorship prevails there as elsewhere in South Africa. In 1983 the Ciskei government prohibited the distribution of seventy-three publications and detained a number of journalists [34, pp. 210 and 2121. There has been unlimited use of powers. such as detention without trial, officially conferred on the authorities by the Ciskei National Security Act of 1982. The South African Minister of Law and Order, Louis Le Grange, has said there are good relations between the South African police and the Ciskei police force, as a result of which a person detained by one might be handed over for detention by the other [34. p. 3323, a clear indication that ‘homeland independence‘ is a sham [40]. In June 1983 the Ciskei security forces carried out a combined operation with the South African Defence Force, setting up roadblocks and searching homes in Mdantsane. During the 1983:1984 bus and school boycotts that lasted 20 months, starting in Mdantsane and spreading to five other townships, Ciskei soldiers and security police beat and tortured workers commuting to East London. An unofficial army of vigilantes sponsored by the Ciskei National Independence Party (CNIP), the party headed by Life President Lennox Sebe, used physical violence to break the boycotts led by commuters and by school children protesting the treatment of their parents [9, p. 21. The Ciskei government declared a state of emergency, imposed a curfew, banned meetings of more than four people, prohibited weekend burials and placed a limit of 100 mourners on all funerals. In the first week of the emergency 750 people were arrested. and by the end of the third month 832 people had been arrested for breaking the curfew or failing to pay the Ciskei ‘development tax’ [34. p. 3361. The estimated death toll ivas 90 [34. p. 3381. Health workers were a special target of the Ciskei police and the CNIP vigilantes because of their part in documenting assaults on people and in caring for the wounded. Dr Lawrence Msauli, a popular physician \vho treated victims of vigilante beatings. was detained under the security law in 1983 [9. p. 561. The
African
bantustan
891
police raided Cecilia Makiwanr Hospital in Mdantsane and arrested workers who reported assaults and beatings. Hospital personnel were forbidden to release details of the injured and claimed the! were subjected to government pressure to falsify death figures so that many deaths uere not made known [34, p. 3383. Medical fileswere marked ‘police’ files and disappeared from the hospital [9, p. 671. These human rights violations could occur because the power structure of the ‘independent homelands’ created by the South African government made them possible. In the bantustans. tribal structuresbolstered and refashioned by the South African government when it granted legislative and executive powers to the bantustans-have replaced democratic institutions. These tribal structures have no traditional antecedents: they are creations of the South African state. The chiefs have emerged from this process with extensive executive authority, financial rewards, and control over the distribution of land, labour contracts, and social welfare grants, which are the primary sources of income for the majority [41]. The bantustan regimes are puppet regimes, but their power is based on chiefs and on headmen who are appointed by the government [18. p.I 171. In 1983, seven out of eight Ciskei cabinet ministers and more than half the members of the Ciskei National Assembly were chiefs [42]. As Haysom remarks, “this elite dare not fall out of favour with the government for fear of joining the landless pariahs” [9, p. 61. Aziza Seedat points out that “Health in South Africa is inseparable from the economic, political and social structure of the apartheid state” [25, p. IOl]. Likewise, the provision of good health services does not depend so much on the skill of health workers as on prevailing economic, social and political conditions. For example, South African paediatricians may have developed an expertise in the understanding and treatment of malnutrition and its complications. but medical expertise does not change the system that gives rise to malnutrition nor the environment to which treated children return, an environment in which half of the children die before their fifth birthday. Malnutrition, in this context, is a direct result of the government’s policies, which perpetuate the apartheid system and promote the poor health conditions and human rights violations described in this
paper.
Acknorr(edgemenrs-The research for this paper was made possible by a grant from the Rutgers University Research Council. The work was facilitated by the Insitute for Commonwealth Studies, the International Defence and Aid Fund, the American Committee on Africa and the Catholic Institute for International Relations; all of these organizations generously allowed me to use their libraries.
REFEREXCES Surplus Peoples Project-Western Cape. Khu~e[ifslla: ,Veu Home-Old Sror,~. p. 7. Cape Town. 198-l. Lacey M. Locating employment. relocating unemplbyment. In ~H&eland‘ ~Trraged~: Funcrion and Farce, DD. Universit, Devel. . 4655. Witwatersrand opment Studies Group, South Africa Research Service Information Publication No. 6. Johannesburg. 1982.
892
MEREDETH
S. and Giliomee H. Labour bureaucracies 3. Greenburg and the Afrtcan rural areas: a field research report. In cp Against rhe Fences (Edited by Gihomee H. and Schlemmer L.). David Philip, Cape Town. 1985. 4. Surplus People Project. Forced Remorals in South Afi&. Vol. 5 The E&ern Cape. Cape Town. 1983. All these fieures are subiect to oolitical dispute. The Ciskei’s boundiries are no; yet fixed. the de jure population (Ciskei ‘nationals’) is twice the de facto population (Ciskei residents) and non-registration is a means of protest. Extrapolating from the government’s 1980 data. the current population is 850,000. but this is widelv acknowledged to be too low and an estimate of I million is used in this paper. All data calculated on a population base, for example population density, are necessarily estimates. Health planners are severely handicapped by the lack of vital data. 5. Swilling M. The buses smell of blood: the East London boycott. S. Afr. Labour Bull. 9, 45, 1984. 6. Migrant labourers are restricted to employment on l-year contracts. Whereas men used to remain at home between contracts, under the new system they renew before going on leave and must return in three weeks or lose their place. The employment of first-time mineworkers has dropped from 70 to 25% in recent years. suggesting that mineowners have succeeded in creating a stable workforce. 7. Green P. and Hirsch A. Manufacturing Industry in the Ciskei. In Homeland Tragedy: Funclion and Farce, y;p.,41-46. University of Witwatersrand, Johannesburg, 8. Sunday Tribune 23 July, 1983. N. Ruling with rhe Whip: A Reporl on Ihe 9 Haysom Violarion of Human Rights in the Ciskei. University of Witwatersrand, Braamfontein. 1983. 10. Lelyveld J. Misery in a South African ‘homeland’. In The New York Timex-Magazine p. 62, 25 September, 1983. II Daily Dispafch 26 June. 1984. No elections have been held since then, and this city (the size of Geneva or Washington) is run by a manager seconded by the South African government with a budget of 10.5 million rand [Daily Dispatch 19 October, 19841. in 12 Hirsch A. and Kooy A. Industry and employment East London. S. Afr. Labour Bull. 7, 5&64. 1982. 13. Rand Daily Mail 5 March, 1984. 1984. 14. Daily Dispatch 10 January, IS. Star I2 March, 1984. 16. Financial Mail 2 March, 1984. 1984. 17. Cape Times IO January, in 18. Green P. and Hirsch A. The impact of resettlement the Ciskei: three case studies. Southern Africa Labour and Development Research Unit, Working Paper No. 49. Universitv of Cape Town, 1983. Few resettlement camps comprise whole villages moved together to a new locaiion: Ehtkhanyweni is one such instance resulting from a ‘black suet’ removal in 1977. Commonly, single families working under the labour tenant system br squatting on white farms are relocated. Green and Hirsch review the ‘reasons’ for removal in chapter one. Defence and Aid Fund. Women Under 19. International Apartheid. London, 198 I. 20. Yawitch J. Apartheid and family life. Work Prog. 27, 40-42, 1983. 21. Gordon E. An analysis of the impact of labour migration on the lives of women in Lesotho. In African Women in the Decelopment Process (Edited by Nelson N.), pp. 59-76. Frank Cass, London, 1981.
TL.RS~EN Reporr of Ihe Cixker Commission. 22. Quail Commission. Conference .Associates. Pretoria. 1950. Aparrhrid and Healrh. 23. World Health Organization. WHO. Geneva 1983. 24. Rand Dail? .Wail 6 December. 1980. 25. Seedat A. Crippling A .varion: Hralrh ti .-!parrheid Sourh .Ijrica. International Defence and Aid Fund. London. 198-t. 1983. 26. Srar 7 November, 1983. 27. W’ahshingron Posr 9 October, value of diets of 28. Richter M. J. C. er al. Nutritional blacks in Ciskei. S. A/?. med. J. 65, 338-345, 1984. 29. Star I5 March. 1984. 30. Srar I6 January 1984. 31. Guardian I4 May, 1983. 32. Zwi A. Fragmenting health in the homelands. In ‘Homeland’ Tragedy: Function and Fsrce. pp. 31-36. Development Studies Witwatersrand University GroupcSouth Africa Research Service Information Publication No. 6. Johannesburg, 1981. of childhood nutri33. Thomas G. The social background tion in the Ciskei. Sot. Sci. Med. IS.-\. 551-555, 1981. Surrey of 34 South African Institute of Race Relations. Race Relarions 1983. Johannesburg. 138-1. ’ -’ 35. Mvrdal S. and Thomson L. Health and health services in the Ciskei. Southern Africa Labour and Development Research Unit. Working Paper No. _q!. University of Cape Town, 1953. 1984. 36. Daily Dispatch I December, 31. DaiLy Dirparch 6 June. 1985. tax 38. In spite of the economic recession and corporate cuts, the Ciskei contrived a budget surp!us in 1983 198-l by cutting such administrative expenditures as health and welfare services [Daily Disparch 1-t November, 19841. 39. Cock J. Survival in a Ciskeian resettlement camp. Crii. Hlrh 6, p. 4. 1981. 40 Because the Ciskei lacks adequate jails. prisoners are kept in South Africa. a privilege for which the Ciskei paid 777.173.59 rand to South Africa in 1983. 1984 [DaiLy Disparch I I July. 19841. 41 The system of control in the Ciskei depends heavily on chiefs. Sebe uses tribal discipline to control the population and has complained that many relocated people are lawless and rootless because they did not grow up under chiefs. He blamed the bus boycotts on such people [Rand Dai1.v Mail 24 July, 19841. 42. That the Ciskei government is a puppet regime and that South Africa holds the reins of power in this bantustan are clear from the makeup of the government of this ‘independent homeland’. Although most members of the Ciskei cabinet are black, twelve of sixteen ‘key men’ (and they are all men) are white: Theo de Vries. Chancellor to the Presidency, D. G. Boushier. DirectorGeneral and Deputy Chancellor of the Presidency. J. W. Glieb, Director-General of Internal AfTairs, I. Melville, Director-General of Finance, I. M. hlullins, AuditorGeneral, Gary Godden. Director of P!anning. Bobbv Michau. Dire&or-General of Manpower. Cal. Herbert Webster. Commissioner of Prisons. J. F. Ventjr ...-.. Director-General of Post, P. J. Welttan. DirectorGeneral of Transport, C. L. Atwell. Dirstor-General of Public Works and Reg Beavitt. Chief Traffic Officer. Key posts held by blacks are foreign affairs. agriculture. education and health. Despite considerable turnover. whites retain approximately the same number of posts.