This August, only weeks after South Africa hosted the World Cup to show off itself and its remarkable post-apartheid progress, the country was brought to a state of national emergency by a three-week long strike by 1.3 million public sector workers. Though the labor dispute behind the strikes amounted to a relatively minor 1.1 percent pay increase and R200 ($18) monthly housing allowance, it brought much of the country to a halt, including the all-important health sector. With everything from research hospitals to rural clinics crippled or closed entirely, and with South Africa still struggling against one of the world's worst HIV epidemics, the human cost of the strike could have been far worse.
Thankfully, the South African military stepped in, providing health services nationwide and allowing me to observe something I have long studied: what it means when the military plays doctor. Whether a military intervenes to provide necessary humanitarian aid, or whether it incorporates health services in pursuit of a larger security goal, this intersection of soldier and doctor was on full display in South Africa.
My first encounter with the labor dispute strike was outside Durban's Addington Hospital. The hospital is within sight of the former location of the FIFA World Cup Fan Zone, where thousands of spectators, including myself, watched the games. Weeks before, thousands of World Cup visitors had ambled past the hospital along Durban's waterfront. This time, a crowd of workers clustered outside the hospital's entrance.
These striking health workers, represented by the trade union federation, were the forerunner of the countrywide strike that started less than a week later. Unlike American protests, South African demonstrations look more like a cross between a tailgate party and a street festival. Instead of marching in circles, protesters dance and sing to show their grievances. Less than two weeks later, the strikes spread nationwide and brought the entire country, including hospitals like Addington, to its knees.
The strike devastated the government-run health system, which provides health services to all but the small minority able to afford private insurance. Nurses and orderlies abandoned patients into the care of non-striking doctors and hospital security guards. Hundreds of newborns were left in intensive care units. Strikers wielding whips stalked the halls in one Durban hospital, chasing health workers from their posts. Nurses refusing to strike were subject to threats, kidnappings, and violence. By the second week, government hospitals were almost completely abandoned and patients left to fend for themselves. Patients with HIV/AIDS avoided coming to hospitals to collect their medication out of fear for their safety. Outside Addington Hospital, police fired rubber bullets at protesters blocking patients and non-striking workers from entering the building.
Facing a collapsed health system, the South African government turned to its military. During the first week, over one thousand military doctors, nurses, and other health workers deployed to hospitals throughout the country. By the end of the strike, 4700 military health professionals were serving in 73 hospitals across eight of South Africa's nine provinces. Additional soldiers provided security and even stood in for striking hospital janitors. While it replaced only a fraction of the civilian health system the military was able to keep at least some hospital doors open. This mission is not a new one for the South African military. Twice in the last four years, South African Military Health Service personnel deployed to maintain essential health services during health worker strikes.
South Africa is not alone in using the military as a stopgap health system during labor crises. Sierra Leone, Zimbabwe, Guatemala, and Nigeria have all relied on their militaries to provide medical care when health workers went on strike. The military is an appealing health provider of last resort for two reasons. First, military health services are uniquely equipped to provide health care during crises. Military medical personnel have access to their own pool of supporting services including security, transportation, and maintenance. This capacity can be critical during general strikes, when the civilian sector is crippled and many of the services regularly provided by private businesses and civil service workers are shuttered. Second, it is almost universally illegal for military personnel to go on strike. The simple fact is that in major strikes like the one last month in South Africa, the military becomes the only fully staffed health care service available to governments.