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Still Paying the Price: Revisiting the Cholera Epidemic of 2000-2001 in South Africa


In 2000–2001 South Africa endured a cholera epidemic that spread throughout the eastern coastal region and to other provinces. Altogether it resulted in 265 deaths in five provinces and 117,147 people were infected; the majority were in the province of KwaZulu-Natal where it originated. The epidemic was, according to the World Health Organization, the biggest such outbreak in Africa for the reporting period. The epidemic demanded an urgent review of the state of water provision to the traditional rural areas and informal settlements where it was concentrated. What had led to an outbreak becoming an epidemic? How was it that many of the victims were those who were situated within areas where water projects were in operation? The answers came from rural development researchers and later from government itself: the policies of cost recovery had disadvantaged those for whom even a small charge of about R20 a month was too much. At its epicentre it was reported that those who could not afford the new charges being implemented in August 2000 were returning to traditional and untreated water sources and were falling victim to the disease. The cholera epidemic was handled as an emergency. First, the medical intervention with the help of the army medical corps was dramatic and after some time succeeded in breaking the force of the epidemic and reducing cholera to occasional and limited outbreaks. Second, there was the health promotion carried out by Community Health Workers to publicize the danger of taking water from unsafe sources, to treat water and to wash hands. Third, there was the national government’s promise to provide free water in the amount of six kilolitres a month to every household. Finally, there was a renewed commitment to provide improved sanitation and to end the water backlog. This paper examines the extent to which the response to the epidemic has led to sustained provision of safe water and improved sanitation to the poor. In the period since the cholera epidemic, events have shown that this was not a unique occurrence. The outbreak of typhoid in Delmas during August-October 2005 in which there were five deaths from the disease and 596 cases accompanied by 3,346 cases of diarrhea demonstrated the continued vulnerability of poor people in urban and rural settings to water-related disease. The evidence pointed to problems in the management of the detested bucket sanitation system, affecting the quality of water. The paper also suggests there is a clear relationship between cost recovery, indifferent management leading to interruptions in supply, and vandalism. The research drew on two studies at two sites: one at Nqutshini, a small settlement near the town of Empangeni on the banks of the Mhlatuzi River; and the other at Nkobongo, a developing low-cost housing area with continued informal settlements near Ballito, 40km north of Durban. In both cases there was significant fieldwork, a series of open-ended interviews with residents, followed by a small-scale survey.

David Hemson with Bongi Dube, Thami Mbele, Remigius Nnadozie and Dumisani Ngcobo
Publication Information: 
MSP Occasional Paper No.10
Publication Date: 
Publication Type: 
Occasional Paper