South Africa faces escalating health crisis driven by hunger and nutritional inequality

As hunger in South Africa deepens, experts warn that malnutrition and food insecurity are evolving into a widespread health emergency, affecting children and the elderly alike and demanding urgent, multi-faceted policy responses.

Hunger in South Africa is increasingly being described not only as a social and economic failure, but as a health emergency that can begin long before a patient reaches a clinic or hospital. Health-e News’ latest instalment in its Hungry for Change series traces that burden through households across the country, while recent research and advocacy reports show how food insecurity is linked to child malnutrition, poor mental health, chronic disease and declining function in older people.

The crisis has drawn renewed attention since the South African Human Rights Commission opened an inquiry into the country’s food system late last year, as estimates suggest about 14 million people go to bed hungry. Recent child-health reporting from the University of Cape Town’s Children’s Institute says more than half of children who report hunger are in the poorest income group, while stunting remains common among children under five, a sign of long-term undernutrition. Researchers and child-health experts say the damage can start in pregnancy and continue through the first two years of life, when growth and brain development are most sensitive to poor diets.

That pattern is visible in the series’ reporting from households where parents and caregivers routinely sacrifice their own meals so children can eat. Health-e News describes mothers, grandmothers and children stretching limited income with grants, loans, food gardens, stokvels and even sex work. A recent South African study on the emotional dimensions of food insecurity found that hunger is also a source of anxiety, shame and guilt, especially for women who carry the burden of feeding families. That psychological strain adds another layer to the physical harm.

For children, the consequences can be immediate and severe. Health-e News reports that one toddler spent a week in Chris Hani Baragwanath Hospital with malnutrition after falling ill with diarrhoea, vomiting and weakness. Paediatric and nutrition specialists quoted in the series say poor intake can weaken immunity, slow development and make it harder for children to learn, play and keep up at school. The University of Cape Town report also warns that child hunger is concentrated among the poorest households, underscoring how closely malnutrition tracks poverty.

Schools can offer some protection, but not a complete solution. In Nyakallong in the Free State, a daycare centre kept its kitchen open during school holidays because many children depended on its meals. South Africa’s National School Nutrition Programme feeds millions of learners each year, and a nutritionist who assessed meals in the Health-e News series said one of the more balanced plates contained samp, beans, pumpkin and tomato-and-onion relish. Yet even when a child gets one good meal, experts say that is often not enough to sustain energy, concentration and normal growth through the day.

Older people are also paying a heavy price. Health-e News reports that some grandparents skip meals so grandchildren can eat, while clinicians say hunger can speed up muscle loss, weaken resilience and make chronic illnesses harder to manage. A study published in PLOS Global Public Health found that food insecurity in rural South Africa was linked with poorer health outcomes and a greater tendency towards conditions such as diabetes and high blood pressure. Another review on water, energy and food insecurity found that these deprivations often interact, worsening both communicable and non-communicable disease.

The series argues that the response cannot rest with families alone. FoodForward SA says its clinic-linked Mother and Child Nutrition Programme has helped hundreds of patients reach safer nutritional status, but the organisation warns that clinics cannot change the conditions people return to at home. Nutrition experts say the country needs a broader public-health response, including stronger food-security targets, less food waste and policies that address both the material and emotional costs of hunger. The government had not responded by publication to Health-e News’ questions about support for malnourished patients in food-insecure households.