The Themba family lives in a one-roomed shack in the impoverished informal settlement of Hospital Hill, south of Johannesburg. Near their home is an open veld that serves as a rubbish dump. The horrible stench that wafts through the air is unbearable.

‘€œWe started living here in 1988. When this community was emerging, there were just a few shacks here, not more than 20’€, says the head of the family, Robert Themba.

Robert Themba is in his 70s. He lives with his wife and two grand-children. Surviving on two government pension and their grand-children’€™s grants, the frail man says they are struggling to make ends meet. With more people moving into Hospital Hill, situated in a fairly established urban area of Lenasia South, hoping for a better life, the number of shacks began to multiply. The high unemployment and poverty rate is glaring.

‘€œLife has not changed much since 1988 and there were many strikes in this area. Life is not too good. We had to fight for everything we have. Our government failed us, in a way, because they did not observe our rights. We are living in bad circumstances… we do not enjoy the freedom we fought for. We always hear on the radio about other communities getting RDP houses. But how many years will it take for us to get them?’€, Robert laments.

Three of the Themba family members are on chronic medication. The two elders are taking treatment for high-blood pressure and their youngest grand-child is on anti-retroviral treatment (ARVs). The ten year-old girl was born HIV-positive, but her late mother never disclosed her daughter’€™s status. Lumka has been on treatment for nearly three years. Her grand-father, Robert Themba, says her health has improved significantly since beginning her treatment.

‘€œShe used to be very sick. She would attend school for two or three days in a month. She used to eat lots of unhealthy food that would contribute to her illnesses. Even her weight is not where it should be.

We were taken for counselling on how to deal with her status and support her. Her mother did not inform us that the child had HIV. It is only after her death that we began investigating for ourselves’€, he says.

According to a study conducted by the Medical Research Council (MRC), the Themba family paints just a part of the picture of what we are likely to see happening in urban areas in years to come unless government plans ahead to accommodate emerging communities that flock to in urban settings in search of a better life.

Around sixty percent of the country’€™s population already live in urban areas and city authorities are struggling to keep up with the demand for housing, water and health services. The study was done in five communities in and around Johannesburg looking at various aspects such as mental health, acute illness and chronic health conditions. Professor Angela Mathee from the MRC says the findings revealed emerging environmental and health challenges associated with urban poverty.

‘€œWe have seen the proportion of houses that are food insecure, meaning they could be going hungry or they are worried that one day soon they may not have enough food to eat. We see this proportion of people going up, especially in the informal settlement of Hospital Hill and Riverlea. In these two communities, over 50 percent of people… either, there is nobody in the house who has a job… so, many people are living on grants… or the income is very low – under R1 000 a month’€, says Professor Mathee.

The study further revealed that other health risks included the increased levels of inter-personal violence, like stabbing and gunshot wounds, which were three times higher than levels of unintentional injuries. Professor Mathee says rapid urbanisation does not always mean good news.

‘€œAll over Africa, we are seeing the urbanisation rate is very high. People are moving to the city at a very fast pace, which is too fast for city managers to be able to provide the housing and services that new arrivals demand. Thus, you have so many people living in informal settlements in areas of inner-city degradation that becomes a threat to their health and mental health, especially’€.

Professor Mathee says part of the solution is encouraging people to generate their own income, like selling and growing their own vegetable gardens to feed their families.

*Note that we have used fictitious names to protect the identity of the family concerned in this report*