A truck drives toward Eskom’s massive Duvha Power Station, where 300-metre-tall chimneys spew smoke. (Photo: Thom Pierce/Spotlight)News & Features
10th September 2025 | Sue Segar
Journalist Sue Segar and photographer Thom Pierce recently visited Emalahleni in Mpumalanga to report on how air pollution is impacting the health of people in the area. In part 3 of this Spotlight special series, we zoom in on the science of air pollution and what it does to the human body.
Towards early evening when the sun starts fading, the smoke-filled communities of Emalahleni have an apocalyptic feeling to them. It’s a landscape of open and abandoned coal mines, industrial sites and tall power stations. If the wind comes up, the black dust starts swirling, and people bow their heads and cover their mouths and noses as they walk in the streets. And, always, the coal trucks hurtle one after the next along the potholed roads.
As we reported in part 1 of this special series, it is not hard to find people in Emalahleni who suffer from asthma and other health issues. In fact, we could hear from the raspy, chesty voices of most of the locals we interviewed that something isn’t right. But to what extent does the science back up their stories of ill-health driven by air pollution from the mines and coal-fired power plants in the area?
What unsafe stuff is actually in the air?
One of the complexities in reporting on air pollution in an area like Emalahleni is that the air often contains not only one problematic substance, but a soup of potentially harmful stuff. This can include gasses – like nitrogen dioxide (NO2) and sulphur dioxide (SO2) – and small particles of dust, metals, industrial chemicals, and other substances that are suspended in the air. Such small particles are referred to as particulate matter, with PM10 referring to particles that are ten micrograms per cubic metre or smaller and PM2.5 to 2.5 micrograms per cubic metre or smaller.
As with most potential poisons, the key is how much of it one gets into one’s body and over what period of time. The World Health Organization (WHO) publishes what it considers to be safe levels of the key air pollutants. These levels, as government itself admits, are often exceeded in Emalahleni and other parts of the Highveld Priority Area (HPA).
“We are usually worried about what we call the criteria pollutants,” explains Professor Caradee Wright, Chief Specialist Scientist at the South African Medical Research Council. “Those are the ones that are managed using the South African National Ambient Air Quality Guidelines – so PM2.5, PM10, NO2, SO2, Ozone, Carbon Dioxide and Carbon Monoxide.”
These pollutants can get into the air in several ways. Burning coal or other substances can send fumes into the air, as can blasting, and the wind blowing over piles of dust.
Comparing the levels of air pollution in different parts of the country throws the problem into sharp relief.
“Air pollution on the Highveld is a worry, as it is in the industrial South Basin of eThekwini where for many years, petrochemical plants contributed to high emissions. Both these sites are very different in terms of air quality when compared with Cape Town where PM2.5 levels are about half the levels seen in hotspots like Emalahleni and eThekwini,” says Wright.
While Eskom admits that its coal-fired power stations contribute to air pollution in Mpumalanga, the utility points out that it is not the only source of pollutants in the region, “with other industries, mines, road traffic, agriculture, biomass burning, waste burning and household fuel use all contributing to the pollution load and ultimately to exceedances of WHO-recommended standards”.
The situation in Mpumalanga is further complicated by the local climate and the absence of the types of winds that could reliably blow the pollution away. There is also a strong seasonal effect, with levels of harmful air pollutants typically being much higher in the winter months.
How air pollution impacts people’s health
Globally, the WHO estimates that air pollution is to blame for around 6.7 million premature deaths per year. The WHO’s list of substances “with the strongest evidence for public health concern”, includes several pollutants such as particulate matter, nitrogen dioxide and sulphur dioxide, which are common in South Africa’s HPA.
Spotlight spoke to doctors in Emalahleni, including one doctor in a medical centre in Ackerville, who told us he admits “one or two” people into hospital every day with respiratory issues, “mainly pneumonia which can be associated with lower respiratory tract infections”.
Another doctor, in Masakhane, told us she had regular referrals from “almost all the mines” in the area, of people presenting with asthma and Chronic Obstructive Pulmonary Disease, as well as people with allergy related sinus, eye and skin problems.
But what is the link between air pollution and such symptoms?
“Both nitrogen dioxide and sulphur dioxide are harmful air pollutants that primarily affect the respiratory system,” explains Wright. “Nitrogen dioxide can cause shortness of breath, cough, and worsen respiratory tract infections, while sulphur dioxide can irritate the eyes and throat, increase mucus production, and trigger bronchospasm, particularly in vulnerable populations like children, the elderly, and those with underlying lung conditions. Long-term exposure to these pollutants has also been linked to cardiovascular disease, asthma, and other chronic health problems,” she says.
These air pollutants, says Wright, can negatively impact asthma by triggering exacerbations, such as hospital and emergency room visits, and worsening respiratory symptoms. “Sulphur dioxide tends to cause a more prominent bronchoconstriction by acting on the upper airways due to its high water solubility, while nitrogen dioxide, which is less soluble, penetrates deeper into the bronchial tree to affect the small airways, leading to inflammation and mucus production,” says Wright.
There are also good scientific explanations for why particulate matter can be so harmful. Wright says that because particulate matter consists of very, very small particles, it can hang in the air for a very long time and it can also “be inhaled very deep into the lungs and that means they can also cross through the lungs into the blood and therefore can go to any parts of the body – the brain, the foetus, anywhere”.
What the studies say
According to a report released in May by the Life After Coal Campaign, over half of 400 respondents in Phola reported experiencing shortness of breath, more than half had throat, nasal and eye issues. “These symptoms suggest widespread respiratory distress that is consistent with long-term exposure to polluted air,” the report states.
According to a report from Greenpeace and the Centre for Research on Energy and Clean Air, PM2.5 exposure led to an estimated 42 000 deaths in South Africa in 2023. The authors reckon that violations of the national PM2.5 standard are responsible for approximately 9 300 premature deaths annually.
In addition to several such reports linked to advocacy groups, there has also been a good deal of independent research that has been done on health and air pollution in the HPA – all of which seem to point to there being a real and serious problem. But while this body of research include several studies of air quality and surveys of reported symptoms, there is a scarcity of studies of air pollution linked to objectively measured health indicators such as lung function tests.
But that seems to be changing. For example, one recent SAMRC study has found compelling evidence that individuals living near coal-fired power stations face an increased risk of respiratory disease and early death. Another study found very high rates of asthma among children in the HPA and detected an association between fluctuations in air pollution and the children’s performance on lung function tests.
According to Rico Euripidou, an environmental health campaigner at groundWork, only a few of South Africa’s health research agencies are looking systematically at the country’s health and environmental Air Quality data. “Worryingly few are doing systematic health impact assessments and quantifying the economic costs routinely,” he says.
What can be done about it?
At one level, the solution is simply that emissions in the HPA must be reduced so that air quality levels meet safe standards. But who should reduce their emissions by how much is not a straight-forward question, nor can we take enforcement of existing laws and regulations for granted.
In addition, activists point out that they had to go to court before Environmental Minister Dion George recently released regulations aimed at reducing emissions. Earlier this year, government published its second air quality management plan (AQMP) for the HPA. The plan includes monitoring, evaluation, and enforcement mechanisms to reduce emissions and achieve ambient air quality standards. It also sets new emission reduction targets, which are informed by historical air quality data and dispersion modelling (the mathematical simulation of how air pollutants spread in the atmosphere.)
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Under the previous AQMP (from 2012) for the HPA, some improvement in air quality was noted, although levels of several pollutants remained well above safe levels.
While “not a bad idea”, Euripidou says that the AQMPs are only as good as the targets they set out to achieve with measurable and timebound milestones. “Of course they are only as good as their implementation overall. In the past, this is where the AQMP’s fell short,” he says.
For the new air quality plan to work, we need to have some basics in place, such as local officials who are properly trained and a monitoring system that actually functions, but “right now, those gaps remain”, says Ntombi Maphosa, an attorney at the Centre for Environmental Rights. The organisation is a party to the litigation described in part 2 of this series.
Maphosa adds: “The plan says industry must cut emissions by 40%, but in the Highveld, where Eskom’s power stations are the biggest polluters, it’s hard to see how that will happen, especially since Eskom has just been allowed to keep operating five plants above the legal air pollution limits.”
The South African government’s failure to ensure that abandoned coal mines are rehabilitated puts communities at risk of injury and death and risks polluting resident’s water sources, Human Rights Watch warns in this video.
As outlined in a response to questions from Spotlight, Eskom has invested over R3 billion in emissions reduction projects, with another R15.6 billion allocated over the next five years. “Looking ahead, Eskom is exploring new technologies and supporting a Just Transition to a low-carbon economy. The utility aims to reduce fleet-wide emissions by 40% by 2030, in alignment with the revised Highveld Priority Area Plan,” says an Eskom spokesperson. (See Eskom’s full response for more detail on their emissions reduction work so far.)
In addition to reducing industrial emissions, there are other ways in which people in the area can be helped. For example, providing more households with reliable electricity can help reduce the indoor burning of coal for heating, as Eskom is doing with its Masibambisane AQO project.
Ultimately, however, the calculus remains grim for the people of Emalahleni. Given that South Africa has very little excess energy and has suffered massively due to energy shortages, the coal fires in Mpumalanga will keep burning for several years to come. And with recent emissions exemptions granted to some of Eskom’s power plants, air quality in the area is likely to remain at unsafe levels.
Different people clearly have different views on the role of coal in South Africa’s energy mix and whether or not the switch to cleaner forms of energy should have happened more quickly. This debate has often been framed mainly in terms of economic development and climate change – as we’ve hopefully shown in this Spotlight special series, the health impacts on those living near coal-fired power plants and the mines that feed them should also be taken into account.
In the meantime, Wright advises that if you can see pollution in the air, you should try and close your windows. “Don’t burn coal and wood in your homes if you can help it. Better to start the fire outside and wait for the smoke to die off and then bring it in,” she says. “The ultimate way of reducing exposure in your home is to have electricity. The sad thing is that electricity in SA comes from burning coal not from renewable energy, but it does mean in the breathing zone where we live, the air is clearer. Living near mines, that is a really difficult problem to solve.”
*Additional reporting by Marcus Low.
*This is part 3 of a Spotlight special series on air pollution and health in the Emalahleni area. In part 1 we asked what people in the area are going through when it comes to their health. In part 2 we explored how despite a landmark court judgment that upheld the right to clean air, air pollution remains rife in South Africa’s coal country.
