SA cholera outbreak — ongoing governance failures serve to worsen human rights and climate catastrophe

On his visit this month to the town of Hammanskraal after South Africa’s recent cholera outbreak, President Cyril Ramaphosa admitted to the community that “we have not lived up to your expectations … we have failed you”. 

This is a painful admission for a pioneering country in the domain of water and human rights. The right to water was declared by the United Nations in 2010 — more than a decade after South Africa’s constitution did so in 1996. This was enshrined in the National Water Act in 1998. 

On the back of this human rights approach, South Africa dramatically increased coverage in the years of then president Nelson Mandela and water affairs minister Kader Asmal. By 2013, 95% of the population had access to water — up from 60% in 1994. Asmal was awarded the Stockholm Water Prize. But the country has regressed since. 

The current cholera outbreak has seen at least 31 deaths in three provinces — Gauteng, Mpumalanga and the Free State. The epicentre is Hammanskraal — 50 km north of the City of Tshwane which houses the country’s administrative capital — with 29 deaths. The situation represents the cascading failure of governance at both local and national levels, a reluctance to invest in infrastructure, neglect of poor communities, corruption and the misuse of funds.

Read more in Daily Maverick: Hammanskraal cholera outbreak

The key to preventing vector-borne diseases such as cholera, hepatitis A and typhoid is clean water access and safe sanitation. Efficient treatment of wastewater is fundamental. This is the frontline of health security, and investments in WaSH (water, sanitation and hygiene) and the pursuit of Sustainable Development Goal 6 (clean water and sanitation for all) are critical. 

South Africa’s cholera outbreak highlights the government’s extreme negligence and slow pace in ensuring clean water access and safe sanitation and eradicating open defecation and the bucket system. It is also due to the dithering of successive Tshwane administrations — now across political parties and different coalition combinations — on the pressing issue of wastewater treatment. 

Progress on ensuring the functionality of the Rooiwal Wastewater Treatment Works, 24 km south of Hammanskraal, has been dismal. In 2004 the national water department recognised the facility’s shortcomings and decided to expand the works to process a target of 120ML/day. The failure to do so could see a combination of class-action lawsuits and an adverse human rights commission report.

On top of these governance breakdowns, South Africa has not taken advantage of the available science and innovation to build a genuinely climate-resilient water system. Water is not only key to climate adaptation but is an invaluable instrument in climate mitigation. 

The rise in prominence of dams as an energy storage mechanism has highlighted the water-energy nexus as a solution for low-carbon trajectories. At its core is a climate-resilient, low-carbon sanitation solution. Along the lines of the Bill and Melinda Gates Reinvent the Toilet Challenge, these non-sewered systems use minimal water and rely on decentralised wastewater treatment. Using waste to derive energy also sees the recovery of various high-value chemicals, proteins and lipids for non-consumptive use. 

The government’s failure is reinforced by the Ministry of Water and Sanitation’s 2022 Drop Reports, in which the minister points out the poor health of the country’s wastewater, water treatment and water efficiency systems. South Africa has 334 wastewater treatment works in the critical category, and the average for unaccounted-for (non-revenue) water is 46%. This is a very poor status report, and points to a potential system failure similar to that in the electricity sector.

Recently announced remedial plans, including for Hammanskraal, are expensive infrastructure projects that will lock South Africa into high-carbon, water-intensive solutions. This neither appreciates the need for climate resilience nor sufficiently uses the available research and innovation assets and partnerships. 

The World Economic Forum reminds us that the infectious disease burden is a global problem, and climate change is “[fuelling] the spread of infectious diseases and aggravating other health problems”. This is a rapidly progressing malady. Higher temperatures mean the vector boundaries of many infectious diseases are expanding. Previous malaria-free and dengue-free zones are quickly losing that status as global warming provides the perfect environment for the mosquitoes that carry these diseases. 

The World Health Organization report on cholera and climate change is explicit on the projected impact of temperature rises and extreme weather events like floods. The disease burden isn’t restricted to infectious diseases — it includes cardiac-related and high blood pressure problems associated with heatwaves and higher temperatures.

Many strategies are emerging to stem climate change through mitigation measures. But with the greenhouse gases already accumulated in the atmosphere, the world’s average temperature is 1.15oC above pre-industrial levels, and investment in climate adaptation falls grossly short. While we catch up on building long-term climate resilience, short- to medium-term coping strategies must be accelerated. 

In South Africa, such strategies are unlikely to succeed without sound basic water governance. A collapse of the water system could spark a socio-politico-economic crisis scenario. The knock-on effects in Southern Africa and potential retardation of Africa’s Agenda 2063 development ambitions could be dire.

Without rapid improvements in governance, accountability and climate adaptation, apologies like Ramaphosa’s to the people of Hammanskraal will become frequent in future, and to many communities all over Africa. DM

Dhesigen Naidoo, Senior Research Associate, Institute for Security Studies (ISS) Pretoria.

First published by ISS Today.