A/HRC/17/33/Add.4 Government of South Africa to end all arbitrary and unlawful detention and to improve the conditions at detention facilities. D. Access to health care 60. The Special Rapporteur was informed that migrants often find it difficult to have access to adequate health-care services. The difficult material conditions in which migrants are generally forced to live, including overcrowding, poor nutrition, insufficient ventilation, lack of sanitation and little access to clean water, demand that adequate access to healthcare services be ensured, especially since such services are guaranteed to all by the Constitution and national laws. As a country of internal and cross-border migration inside a region of high population mobility and a high prevalence of communicable diseases, the Special Rapporteur believes that the Government should develop, implement and monitor a national response to migration and health. 61. Although the Special Rapporteur was pleased to note that the National Health Act and the Constitution guarantee access to life-saving care to everyone, regardless of a person’s immigration status, he also noted difficulties regarding the delivery of any health care that went beyond life-saving care. In South Africa, different categories of regional migrants are granted different rights to free public health-care services. According to national legislation, refugees and asylum-seekers should be treated as South African citizens in their access to free public health care,14 whereas other non-citizens, such as those with work or study permits, usually have to pay a “foreign fee”. The Special Rapporteur appreciates the efforts made to provide a legal framework to secure the right to health of migrants; nonetheless, different laws and guidelines seem to have led to confusion with regard to which framework should apply. For this reason, the Special Rapporteur calls upon the Government to take all feasible measures to transform guidelines and protective policies into effective practices. 62. The Special Rapporteur encourages South Africa to take the lead within the South African region, for example within SADC, to finalize, ratify and implement a regional framework for communicable diseases and population mobility. The implementation of the recommendations made in World Health Assembly resolution WHA61.17, on the health of migrants, is also important. In the resolution, the Assembly called upon Member States to, inter alia, promote migrant-sensitive health policies, establish an information system in order to assess and analyse trends in migrants’ health, and promote equitable access to health promotion, disease prevention and care for migrants. The Special Rapporteur fully supports the resolution and would welcome the implementation of its recommendations by the Government of South Africa. 63. The Special Rapporteur acknowledges the many difficulties for migrants in their access to health-care services, even though the National Department of Health and its provincial counterparts have issued clear directives to ensure equal access of all to appropriate treatment. He is especially concerned about access to antiretroviral treatment for HIV-positive persons and those with AIDS. Although the national strategic plan for the period 2007-2011 on this issue specifically includes non-citizen groups, they are often met with xenophobic attitudes from health-care staff when they request access to treatment. Some have even reported being denied treatment simply because they were foreigners. In addition to xenophobic attitudes, the Special Rapporteur also noted severe practical challenges. Clinics are often distant from the areas where migrants usually reside. Those in 14 Jo Vearey, “Migration and health delivery systems in Southern Africa”, Openspace, vol. 3, No. 3 (October 2010). 15