Rampant discrimination against the Indigenous San people in Namibia is denying them access to healthcare and leaving them vulnerable to deadly diseases such tuberculosis (TB) and its multi-drug resistant strain, which is ravaging their communities in the Omaheke and Otjozondjupa regions, Amnesty International said today in a new report.
Namibia carries one of the highest burdens of TB, and the multi-drug resistant strain of the disease in the world, and studies indicate that the burden of TB among the San people is almost 40% higher than the national average. Yet – the report – “We don’t feel well treated: Tuberculosis and the Indigenous San people of Namibia”, shows how the government has failed to take meaningful steps to ensure the San people’s right to health, despite identifying them as one of the groups most at risk of contracting TB.
“For years, Namibian authorities have ignored the healthcare needs of the San people including those battling tuberculosis, leaving them at the risk of death,” said Deprose Muchena, Amnesty International’s Director for East and Southern Africa.
For years, Namibian authorities have ignored the healthcare needs of the San people including those battling tuberculosis, leaving them at the risk of deathDeprose Muchena, Amnesty International’s Director for East and Southern Africa.
“It’s time the authorities stopped neglecting the San people, recognized their right to health and ensured access to healthcare like any other people in Namibia.”
Known for their hunter-gatherer culture and heritage, the San face unequal access to healthcare and discrimination perpetuated by negative stereotypes and prejudices including by government officials from other language groups.
As the most marginalized group in Namibia, San people often lack access to essential social services such as healthcare and education and are the only ethnic group in Namibia whose health status has declined since independence in 1990. Not only do they suffer from higher rates of childhood and maternal mortality, the San people face elevated levels of malnutrition, which can be a major risk factor for TB that can also lead to delayed recovery and higher mortality rates.
Barriers to healthcare and the deadly threat of tuberculosis
States have an obligation to ensure access to health care as a human right, including timely, acceptable and affordable health care of appropriate quality to all people.
Despite these human rights obligations, the San people battling TB face numerous barriers to healthcare in Namibia. Higher rates of poverty mean many communities struggle to buy medicine or pay for transport to distant health facilities for treatment. Living in remote rural areas, San people often face an arduous journey to get to the nearest hospital or clinic which can be up to 80kms away, with poor road networks.
“Most government healthcare facilities are located far away from San communities, yet the Namibian authorities do not have alternatives put in place, such as mobile health clinics and services. As a result, thousands of San people are falling through the cracks.” said Deprose Muchena.
“When they are available, primary healthcare facilities are under-staffed, under-equipped and lack sufficient medical supplies to adequately treat patients.”
Long hunting expeditions are still an important part of many San people’s lives. But it entails going away for long periods of time, which poses a challenge to accessing healthcare or finishing courses of medicine.
Another major obstacle preventing San people from receiving better medical care is the language barrier. Most healthcare workers are neither San nor fluent in any of the San languages, which means patients cannot make their symptoms understood or receive treatment instructions in their languages.
The report documents widespread discrimination against the San people at healthcare centres where they are often subjected to verbal and physical abuse as well as denial of treatment. San people also told Amnesty International that health workers regularly showed preferential treatment to patients from other ethnic groups.
One patient told Amnesty International: “Nurses talk to us in English and also give facial expressions that let you know that they don’t want to help.”
Another San person was accused of lying about their symptoms when they complained of TB related ailments. “I told them that my back is paining, they told me I want to get a TB grant that’s why I was complaining about [my] chest and back,” the patient told Amnesty International.
Entrenched discrimination and prejudice have deterred San patients from seeking medical services, which has contributed to their poor health status and by extension, their burden of TB. A nurse in Tsumkwe Clinic observed that San patients are “afraid to come to the clinic” and “don’t stand up for themselves” when they are mistreated.
“The government of Namibia has failed to build an accessible and inclusive healthcare system that provides quality care for all people, including the San people, violating the human right to health,” Deprose Muchena said.
Amnesty International is calling on Namibian authorities to urgently take steps, in policy and practice, to ensure the right to health of all people, including the San, without discrimination. The government must also take immediate steps to ensure accessibility of primary healthcare facilities in line with the minimum core human rights standards.
Tuberculosis has had a devastating impact on public health in Africa. In 2020, the World Health Organization said that over a quarter of new cases of TB reported globally in 2019 were from the region. Africa accounts for over 25% of the estimated 1.7 million TB related deaths annually. Additionally, TB is a leading cause of death in women of reproductive age and is a major cause of non-obstetric maternal mortality in southern Africa. Nearly 15% of maternal deaths in southern Africa are a result of TB.
Namibia currently carries one of the highest burdens of TB and multi-drug resistant TB in the world. A 2020 study has found that the country has a rate of 442 cases per 100, 000 people, and is ranked fifth among countries with highest burden of TB.
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International Secretariat, Amnesty International