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26 May 2023 |
Opinion 07
opinion
by Anja du Plessis
University of South Africa
Cholera in South Africa: a symptom of two decades
of continued sewage pollution and neglect
South Africans have expressed
outrage at the deaths of at least
15 residents of Hammanskraal,
in the city of Tshwane. The
deaths were caused by cholera – a
diarrhoeal disease caused by Vibrio
cholerae bacteria.
The disease can be fatal if left untreated.
The bacteria produces a toxin in the small
intestine. This causes the secretion of
enormous amounts of water, leading to
diarrhoea and a rapid loss of fluids and
salts (electrolytes).
The bacteria are shed in the stools of people
who are infected. People get infected when
they come into contact with or consume
water that has been contaminated with
the bacteria. Cholera is closely linked
to inadequate access to clean water and
sanitation facilities. Preventing it requires
more than practising individual hygiene.
Areas typically at risk include peri-urban
slums and rural areas where the minimum
requirements of clean water and sanitation
have not been met.
What is behind this crisis?
The current cholera outbreak is not
necessarily an issue of potable water. It’s
the result of a combination of factors.
These include dysfunctional and noncompliant
wastewater treatment works,
mismanagement, under-investment and
misappropriation of funds. Along with
the lack of political will and action over
the past two decades, these factors have
formed a perfect storm. It is a legacy issue
which has been emphasised by myself
and other researchers since as far
back as 2002.
The health crisis we
are seeing can be
attributed to the
legacy of sewage
pollution across
the country
b e c a u s e
wastewater
treatment
works are in
poor or critical
condition
due to underinvestment
and
mismanagement.
More than 80% (105 of
115) of wastewater treatment
systems have been identified to be
in a critical state. These water treatment
plants require urgent intervention and
rehabilitation. The partial or the complete
lack of functioning wastewater treatment
works is accompanied by significant
negative implications for public health,
the environment as well as socioeconomic
development and growth. It
should be managed in a proactive way to
ensure that people receive potable water
in line with the South African National
Standard 241 for drinking water.
South Africa has made progress in
expanding access to water infrastructure
on a national level. However, access
to water has declined in five of its nine
provinces between 2002 and 2019. Only
64%of households are estimated to have
a reliable and safe water supply service.
And having access to water supply
infrastructure does not guarantee reliable
and safely managed water supply. The
water might not be of suitable quality for
drinking and/or cooking.
What is needed for water to be potable?
Drinking water is considered to be potable
when it has been filtered and treated in
various processes. The water must be free
from contaminants and harmful bacteria
or pathogens. Water is suitable when it is
safe for both drinking and cooking.
Non-potable water can taste normal (like
potable water) but can cause serious
health problems – in this case, cholera.
What other issues are at play?
The country’s continued sewage crisis,
which has now led to a cholera outbreak,
is largely due to non-functional municipal
sewage systems. More than 90% of the
total 824 treatment plants across the
country release raw or partially treated
sewage directly into the country’s already
scarce water resources.
The Vaal River is a good example.
It has been reported to be “polluted
beyond acceptable levels” by the South
African Human Rights Commission,
significantly affecting the environment,
socio-economic growth and endangering
people’s health.
Additionally, a total of
151 municipalities
are close to
collapse. And 43
municipalities
have already
collapsed
and require
immediate
intervention.
Major issues
include weak
governance,
a l l e g e d
corruption, and
poor management
of assets, operations
and maintenance. There
aren’t enough experienced
individuals with suitable qualifications.
There has also been a lack of
accountability and political will over the
past two decades. These issues within
municipalities have led to the failure of
wastewater treatment works. Some have
reached crisis levels.
The combination of dysfunctional or nonfunctional
municipalities and dilapidated
wastewater treatment works has
significantly affected the most vulnerable
populations. Most of these people live in
informal settlements and urban slums,
and are defenceless against water-related
illnesses.
The main factors behind the country’s
sewage crisis and cholera outbreak are:
• lack of maintenance of basic
infrastructure at local government
level
• lack of capacity and suitable skills
• lack of implementation and
enforcement of existing legislation
and policy
• lack of accountability.
What must be done now?
South Africa’s water quality scores as
“tolerable” in terms of microbiology
standards and “unacceptable” by
operational standards. This shows poor
wastewater treatment works performance.
The microbiological score indicates the
possibility and presence of immediate
unacceptable health risks. On a national
scale the bacterial and/or pathogen
concentration values exceed the
numerical limits specified in SANS 241.
In other words the total Coliforms count
per 100ml is above the set standard of 10
counts per 100ml.
The unacceptable level for operations
indicates that the operation of treatment
systems and risk to infrastructure is
of concern and not efficient. The data
emphasises the non-functioning and
overall neglect of wastewater treatment
works.
To improve prevention and response to
health crises, such as the current cholera
outbreak, the government needs to test
supplied drinking water, from all sources,
on a frequent basis to establish compliance
and be clear about the results as well as
the amount and extent of cholera cases
across the country.
The current state of drinking water
supplied across the country also needs a
critical evaluation. The country can simply
not afford the continued dysfunction of
municipalities and wastewater treatment
works.
Reactive management, lack of political
will, transparency and unaccountability
over the past two decades have contributed
to the current state of affairs. The cholera
outbreak in Hammanskraal could have
been avoided and prevented if necessary
actions had been taken.