Sometimes the things left unseen by others are the things right in front of you.
A child in pink leggings on a beach of sludge and rubbish. A schoolboy navigating a polluted stream. A minibus taxi swallowed by stagnant water. Algae soup brewing in a township swamp.
“This water, it’s all around the community,” says Lihle Tyala, a grade 11 learner from Khayelitsha on the Cape Flats, who captured some of these scenes on his camera for part of this year’s Wellcome Photography Prize. “It’s very easy for children to play around with that water. We know that water is not healthy for them to consume. But they might even take it [in their hands] like a book and drink it.”
Tyala is explaining why he and so many of the others who worked with the Cape Town-based nonprofit Eh!woza to show how they see climate change, mental health and infectious disease in their community initially came back with so many of the same images.
There’s something in the water. And whatever it is, it’s not good.
Still standing
The collection of photographs — “Things We Left Unseen” — is now hanging in a London gallery alongside the Wellcome prize-winners, where health science meets photography from around the world, from the molecular to the meta. The idea is to get people to see some of the most urgent health problems instead of just having research papers and chilling statistics that talk over many of us.
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Tyala had already seen those pools of water. During the Covid-19 pandemic, Eh!woza learners worked on a documentary series with Bhekisisa after a sewage pipe burst near the informal settlement of Ethembeni in Khayelitsha. It flooded the area with polluted water, leaving residents with homes seeped in it for over two months.
That pipe may have been repaired but those pools of stagnant water — a common feature across the township — were still there when Tyala came back four years later.
The water, he says, is just a symbol of the infectious disease that’s endemic in the community.
“When you ask people about their health in Khayelitsha, very often their living conditions and social conditions will come up, because obviously poor living conditions are linked to a lot of the diseases we have in South Africa,” says Eh!woza co-founder Anastasia Koch, who is an infectious disease researcher.
“In waterborne conditions, where there’s already poor wash systems and poor water systems, what is climate change going to do to [or already doing to] people’s health? Is it going to raise the potential for diseases like cholera and other kinds of diseases?”
Waterborne disease
It’s a rhetorical question. Reams of research say the answer to that is an unequivocal yes.
The connection?
An increasingly hotter Earth means climate-related rainstorms could happen twice as often as about 150 years ago, when the atmosphere’s average temperature was at least 1.2°C lower, found scientists at the World Weather Attribution Service.
This means more opportunities for flooding that could result in germs that cause waterborne illnesses ending up in rivers used for drinking water, especially in poorer communities without running water or good sanitation. It also means more stagnant water pools where hosts of parasitic diseases such as malaria (caused by parasites living in mosquitos) can breed.
Cholera, a waterborne disease, spreads when someone eats food or drinks water contaminated with the germ that causes it. The bug travels through faeces and if it spills into water, infects it. Most people won’t have any symptoms, or will have a bout of diarrhoea. But people with weak immune systems, such as those with untreated HIV, or malnourished children — both common in South Africa — often fall ill with severe watery diarrhoea, vomiting and dehydration, and can die in hours if left untreated.
According to figures obtained by Medicines sans Frontières, an outbreak of cholera in Sudan has led to a suspected 100,000 cases and over 2,700 deaths in the past year. That might seem like some faraway place wrecked by war and poverty, but infectious diseases are not confined by borders.
In 2023, when cholera spread in South Africa, with dozens dying from the disease, officials tracked it to two sisters who had gone to a wedding in Malawi. South African officials are worried about cases closer to home, in Zimbabwe, Mozambique and Zambia, and noted that flooding “could undermine sanitation systems and facilitate cholera transmission”.
After the 2023 outbreak, Tom Boyles, a senior researcher at the Clinical HIV Research Unit at Wits University, explained to Bhekisisa’s monthly TV programme, Health Beat, that contaminated water and bad sanitation play a role in the transmission of a number of diseases. These include hepatitis A and typhoid, both of which can cause fever, diarrhoea and nausea; E. coli, some strains of which can lead to diarrhoea, urinary tract infections or pneumonia; and organisms that can cause infections such as amoebic dysentery, which result in stomach cramps and diarrhoea and can be fatal.
Bilharzia, also called schistosomiasis, is common in parts of the Eastern Cape, Mpumalanga, KwaZulu-Natal and Limpopo, and can be picked up by bathing or swimming in water contaminated by tiny parasitic worms (cercariae) that carry it and can slip through people’s skin. This leads to stunting and learning problems in children and is also associated with anaemia, liver and kidney failure and bladder cancer. In some cases, it is fatal. The cycle of illness needs humans and freshwater snails, which host the parasitic worms, says Boyles.
“In the Western Cape, there are none of these snails because the climate isn’t right. So there’s no bilharzia. But as temperatures rise, the range where the snails can live will likely shift. We know that when the climate warms, many diseases will rise. The impact of climate change on waterborne diseases is going to be large, and I suspect it will mostly be through disruption from extreme weather events.”
Controlling the narrative
For the young photographers, it wasn’t all doom and gloom. It was also about art.
“I always think about the colours and how they connect with each other,” says Tyala. “There’s this one [photograph I took] where you see the sunset, and you see the water there.”
The 17 young people who were selected as part of the project were taught by Zeitz assistant curator Thato Mogotsi and photographers Musa Nxumalo and Mikhailia Petersen, along with science workshop leaders from UCT: Alice McClure, Marc Mendelson, Rudzani Muloiwa and Esmita Charani.
Together they helped learners tap into something deeper through their art — a worrying mix of infectious disease, mental health and climate change, something scientists are only beginning to understand.
“Think about how a person would be affected,” Tyala says. “Let’s say you were living in a certain shack, and then there’s heavy rainfall and your house is flooded, and now you have to move out of the house. It would affect you mentally.”
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But the images captured for the project are not all dire — there’s a lot of hope and beauty in the township. There’s the community recycler and the KwaCaleni Soup Kitchen, which opened during the pandemic; Gxarha’s Kraal, a makeshift zoo where anyone is welcome to stop by, and a hopeful essay on trees, solitary and sparse and against all odds.
Eh!woza’s Koch says the project helps rein in “how stories are told about health from the Global South, giving a platform for the most affected people to start changing the narrative around health”.
And that’s what Hlumelo Tshingana and Anathi Vumazonke, who shot a collection of images they call “The Dirty Truth” that focused on stagnant water, want South Africa’s leaders, and the world, to see through their eyes.
“Many other people just use [these pools of water] for drinking and cooking as they don’t have other water sources,” Vumazonke says. “Some people may depict us from Khayelitsha as people who do not care about ourselves or the environment … we actually do. But sometimes we have no control over our solutions.”
“Things Left Unseen” is on show at the Francis Crick Institute in London until October 18, with plans to exhibit in South Africa later in the year.
Catch more learners’ documentaries on YouTube.
Bhekisisa receives funding from the Wellcome Trust for reporting on the impact of climate change on mental health. Bhekisisa, however, has no connection to the Wellcome Trust Photography Prize, and doesn’t receive funding for any reporting on it.
This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.
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