Structural barriers prevent meaningful mental health support in South Africa

South Africa faces a challenging summer, as the El Niño weather pattern has emerged in the Pacific Ocean, signaling below-normal rainfall and above-normal temperatures across the country. This natural fluctuation in ocean temperatures and atmospheric circulation can lead to food insecurity, unsafe water, heat illness, and infectious disease outbreaks. Colleen Aldous, a clinical scientist and professor at the University of KwaZulu-Natal, warns that these consequences are not unforeseen.

The South African Weather Service predicts a drier-than-average summer, while the Southern African Development Community's outlook suggests below-normal rainfall in much of central and southern Africa, including South Africa, during the rainy season. However, El Niño's impact varies across regions, and local outcomes depend on other oceanic and atmospheric systems.

El Niño typically brings hotter and drier conditions to southern Africa, but the 1997/98 event resulted in slightly above-normal rainfall in some areas. Localized rainfall patterns and other influencing factors must be considered to avoid overgeneralizing the effects of El Niño.

The impending hot and dry season can lead to a cascade of health and socioeconomic issues. Heat stress, reduced water supplies, struggling farms, elevated food prices, poorer diets, unsafe water storage, and disrupted livelihoods can culminate in malnutrition, diarrhoeal diseases, displacement, and strained healthcare systems. Although the forecast is probabilistic, the vulnerabilities are already present.

El Niño does not create these challenges but exposes existing failures. Climate change exacerbates the situation, but it does not single-handedly cause every disaster. Proper preparation and mitigation efforts are crucial to minimize the impact of El Niño-induced events.

Extreme heat can cause dehydration, heat exhaustion, and heatstroke, aggravating cardiovascular, respiratory, and kidney diseases. Vulnerable populations, such as older people, infants, pregnant women, outdoor workers, and those using certain medications, are at higher risk. In rural areas, poorly ventilated informal housing offers little protection against the heat.

Drought-induced crop and livestock losses reduce food supply and household income, causing prices to rise. Poor families may opt for less-healthy, cheaper food, leading to dietary deficiencies. People with chronic conditions, like HIV, diabetes, and hypertension, may face difficulties accessing healthcare when finances tighten.

Water scarcity exacerbates the risks, as inadequate water storage and sanitation can increase the spread of diarrhoeal illnesses and cholera. Heavy rainfall during El Niño can also contaminate water sources and displace communities.

Despite these challenges, South Africa has a buffer in place. Improved dam levels and soil moisture from above-normal rainfall during the previous season provide some relief. However, this does not guarantee water or food security. The hotter, drier summer could still impact maize and other summer crops, livestock, fruit, and vegetable production, leading to increased supermarket prices, household expenses, unemployment, and demand for social support.

Urban South Africans are not immune to agricultural drought. Municipal infrastructure failures and long food-supply chains can be problematic during prolonged heat and water scarcity. The interconnectedness of Southern African food markets, economies, migration patterns, and disease risks underscores the importance of proactive measures to mitigate the impacts of El Niño.