Climate crisis hits health care

For Noford Liwane, missing a clinic appointment is no longer an exception, it has become routine whenever it rains.

The 67-year-old, who lives in rural Eastern Cape, relies on the nearby Gwadana Clinic, a dilapidated facility described by locals as no more than a single garage structure. A storm blew away the clinic’s only waiting area shelter more than two years ago. Since then, patients have had to wait in the open, exposed to searing heat, winter winds or heavy rain.

“When it rains, I just stay home,” said Liwane. “There is no shelter, and the building leaks. It is better to wait for another day than to sit in the cold and rain. This is a problem because I end up defaulting on my hypertension medication.”

Liwane lives in a remote village outside iDutywa, where travel to alternative health centres, often more than 30km away, is unaffordable for many residents who rely on social grants.

A 2025 study by Walter Sisulu University found that damaged health infrastructure in rural areas is a major contributor to non-adherence to medication. The study highlighted reduced access to medication, inadequate services and financial hardship as key reasons patients stop or skip treatment, with serious consequences for health and mortality.

As climate change intensifies, South Africa’s overstretched public health system is buckling under the weight of storms, floods and rising temperatures.

Gwadana is one of 142 public health facilities in six provinces that were damaged by extreme weather between 2023 and 2025, according to health minister Aaron Motsoaledi. The clinic serves about 20 villages under the Mbashe local municipality, treating hundreds of patients each month, many of them on chronic medication. But worsening weather and crumbling infrastructure have disrupted services and made access increasingly difficult.

“I live about 17km from the clinic. On appointment days, I leave home at 5am and hope to catch a village bakkie,” said Liwane. “People are forced to choose between paying for transport or buying food.”

Community member Malwande Jama said residents often hire private vehicles, sometimes paying more than R2,000, to transport patients to the closest hospital in Gcuwa.

“By the time you arrive, it is often too late. In some cases, the person has already passed away,” he said.

We have seen how the collapse of infrastructure affects the elderly, people with disabilities and those with chronic illnesses like diabetes and hypertension. Some people are now forced to travel over 20km just to collect medication. Our work includes emergency relief and partnering with mobile clinics

—  Siyanda Vazi, founder of the Ubomi Foundation

In Kariega, 55-year-old Vukile Mtika from KwaNobuhle, said his local clinic, Laetitia Bam, had been flooded twice, most recently in early 2024.

“Services were moved to a church building that was too small. I had to change clinics and now spend money on transport,” he said.

Last month Motsoaledi gave a provincial breakdown after a parliamentary question from the DA asking how many health facilities had been damaged due to natural disasters such as storms and floods in each province. The provincial breakdown given by Motsoaledi was:

• In Limpopo, during the 2024/2025 financial year, 12 health facilities sustained damage, with repair costs estimated at more than R4.2m.
• In the Eastern Cape, 17 health facilities were damaged by storms in the 2024/25 financial year, with the cost of repairs projected at more than R128m. The provincial health department is still awaiting a budget allocation for the repairs.
• In Gauteng, four health facilities were damaged in the 2023/2024 financial year, with repairs costing more than R15m.
• KwaZulu-Natal recorded six damaged health facilities in the 2023/2024 financial year, and 10 more facilities sustained damage in 2024/2025, bringing the total cost of repairs to over R88m.
• In North West, three health facilities were damaged by storms in 2023/2024, and 27 in 2024/2025, with estimated damages exceeding R40m. The department is awaiting funding for repairs. 
• In the Western Cape, 12 health facilities were damaged in the previous financial year, and 35 additional facilities were affected during 2024/2025. The total estimated cost of damages stands at over R19m.

Motsoaledi said the Free State and Northern Cape had reported no damage, while he was still awaiting figures from Mpumalanga. He admitted that delays in procurement and budget approvals have left many facilities unrepaired.

Siyanda Vazi, founder of the Ubomi Foundation, said his organisation had assisted storm-affected communities, focusing on the most vulnerable.

“We have seen how the collapse of infrastructure affects the elderly, people with disabilities and those with chronic illnesses like diabetes and hypertension,” said Vazi. “Some people are now forced to travel over 20km just to collect medication. Our work includes emergency relief and partnering with mobile clinics.”

In Limpopo, workers at the provincial medical depot said they had raised the alarm in 2021 when heavy rains damaged the roof.

“No repairs have been done. When it rains, water floods the building and the carpets smell for days. It is unsafe,” one employee said.

Motsoaledi acknowledged the severity of the crisis in his parliamentary response, saying infrastructure remains one of the biggest threats to service delivery in the public health-care sector. He said delays had been caused by budget constraints and slow procurement processes. In some provinces, funds earmarked for storm damage were reportedly redirected to upgrade ageing infrastructure, driving up costs while leaving storm-hit facilities unrepaired.

Thandeka Kathi, programme head of pollution & climate change at the Centre for Environmental Rights, told the Sunday Times extreme events such as floods, heatwaves and storms — exacerbated by climate change — are increasingly threatening the functionality and safety of public health facilities, especially in vulnerable communities.

“When clinics or hospitals are damaged or rendered inaccessible, this directly impacts the constitutional right to access health-care services, disproportionately affecting those who already face systemic barriers to care.”

Government should integrate climate risk assessments into the design, construction and maintenance of all public health facilities.

—  Ntombi Maphosa, Centre for Environmental Rights

She said in the event of flooding, emergency medical services may be unable to reach patients in time, resulting in preventable health crises.

“Studies have shown that extreme heat can have adverse health consequences, particularly for pregnant individuals and people with chronic conditions. Despite this many public health facilities remain ill-equipped to respond to or withstand such conditions, highlighting an urgent need for climate adaptation planning within the health sector.”

She said interruptions in chronic medication such as antiretrovirals, tuberculosis treatment or hypertension and diabetes care could have long term adverse health consequences, increase mortality and place additional pressure on already over-burdened facilities in marginalised communities.

There was limited investment in upgrading existing facilities to withstand extreme weather events, and emergency plans were underdeveloped or poorly implemented.

Ntombi Maphosa, an attorney at the Centre for Environmental Rights, said for the government to adequately protect health infrastructure it should allocate dedicated funding for climate mitigation and adaptation in the health sector.

“Government should integrate climate risk assessments into the design, construction and maintenance of all public health facilities,” Maphosa said.

National health spokesperson Foster Mohale said its infrastructure unit had been working closely with provincial departments to assess the extent of damage and draw up contingency plans to restore health-care service delivery while a long term plan is developed.

“The recent storm has negatively impacted health-care service delivery mostly in the Eastern Cape, and some parts of KwaZulu-Natal. A number of elective surgeries had to be postponed/cancelled, while some stable patients were discharged. Critical patients were transferred to other health facilities,” he said.

“Health workers such as forensic pathologists were roped in from other provinces to fast track postmortems or autopsies, which helped to ensure that families find closure and bury their loved ones without waiting longer.”

For patients like Zityebile, the consequences are devastating. “We want to take our medication. But how, when the clinic is falling apart?” she asked.