South Africa has been warned. El Niño is established in the tropical Pacific and is expected to strengthen during the closing months of 2026. The South African Weather Service forecasts below-normal rainfall and above-normal temperatures across much of the country during the coming summer.
The regional picture is equally concerning. The Southern African Development Community’s 2026/27 outlook favours below-normal rainfall across much of central and southern Africa, including most of South Africa, during the early part of the rainy season. Drier conditions could persist into early 2027 in several countries.
This is not a prediction that every province will experience drought. Seasonal forecasts describe probabilities, not certainties. El Niño usually brings hotter and drier conditions to southern Africa, but local outcomes vary. The strong 1997/98 event was associated with slightly above-normal rainfall in parts of South Africa. Other oceanic and atmospheric systems will also influence the season. Uncertainty about precisely where the rain will fall is not uncertainty about the need to prepare.
We already understand how a hot, dry season can become a health emergency. It begins with heat stress, reduced water supplies and struggling farms. It progresses through higher food prices, poorer diets, unsafe water storage and interrupted livelihoods. It can end in malnutrition, diarrhoeal disease, displacement and health services facing increased demand when their own water and supply systems are under pressure. The forecast may be probabilistic. The vulnerabilities are already with us.
El Niño exposes failures. It does not create them
El Niño is a naturally occurring fluctuation in Pacific Ocean temperatures and atmospheric circulation. It changes rainfall and temperature patterns across the world. Climate change provides a hotter background against which these events now occur, but not every drought, flood or outbreak should be attributed simplistically to climate change. Climate hazards all too often become disasters through failures of preparation.
El Niño does not decide whether a municipality repairs its leaking water network. It does not determine whether a clinic has a back-up water supply, whether a school-feeding programme is protected or whether health authorities detect a diarrhoeal outbreak early. It does not prevent employers from protecting outdoor workers during a heatwave. What it does is apply pressure to systems that may already be weak.
Extreme heat can cause dehydration, heat exhaustion and heatstroke. It can aggravate cardiovascular, respiratory and kidney disease. Older people, infants, pregnant women, outdoor workers and people using certain medicines are particularly vulnerable. Those living in poorly ventilated informal housing may have little protection and no affordable way to cool their homes.
The health effects of drought are less dramatic at first but potentially more widespread. Crop and livestock losses reduce both food supply and household income. Prices rise. Poor families respond by buying less-healthy, cheaper food, reducing dietary variety or skipping meals. Children may receive enough calories to survive but insufficient protein and micronutrients for healthy growth and development.
For people living with HIV, diabetes, hypertension or other chronic conditions, a household income shock can mean choosing between food, transport and a clinic visit. Health deteriorates long before the consequences appear in official disaster statistics.
Water scarcity creates another chain of risk. When taps run intermittently, households store water, sometimes in unsuitable or uncovered containers. Handwashing becomes more difficult. Sanitation deteriorates. Communities turn to unsafe sources. These conditions increase the risk of diarrhoeal illness and can amplify cholera if the bacterium is introduced.
Drought does not exclude flooding. A season with low overall rainfall may still produce intense local downpours. When heavy rain falls on dry ground or overwhelms neglected drainage and sewerage infrastructure, it can contaminate water sources and displace communities.
The relationship between El Niño and infectious disease is not simple, nor uniform. Malaria and other vector-borne diseases depend on local patterns of temperature, rainfall, standing water, human movement and vector ecology. The answer is not to announce that El Niño will cause a particular epidemic. It is to strengthen local surveillance so that unusual increases are detected quickly.
South Africa has a buffer, not immunity
South Africa enters the season in a better position than it might have. Above-normal rainfall during 2025/26 improved dam levels and soil moisture in many summer-rainfall areas. That provides a useful buffer, but it does not guarantee water or food security. A hotter, drier summer could affect maize and other summer crops, livestock, fruit and vegetable production. The consequences will not remain on farms. They will appear in supermarket prices, household budgets, employment and demand for social support.
Urban South Africans are not insulated from agricultural drought. Cities depend on regional water systems and long food-supply chains. Municipal infrastructure failures that are inconvenient during an average season can become dangerous during prolonged heat and water scarcity.
As South Africans we are not separate from our neighbours. Southern Africa’s food markets, economies, migration patterns and disease risks are closely connected. Poor harvests in neighbouring states can increase regional food prices and humanitarian needs. People may move when water, grazing and livelihoods fail. Health threats do not remain neatly within national borders.
The private sector should therefore treat El Niño as an operational and human risk, not simply an environmental issue. It can affect water availability, supply chains, insurance losses, food prices, worker health and productivity.
Prevention must begin before suffering becomes visible
Africa’s familiar pattern is to wait. Forecasts are issued, warnings are acknowledged and committees meet. Significant funding becomes available only after harvests have failed, children are malnourished or disease has spread. Disaster relief is visible. Prevention is politically quiet.
A convoy delivering emergency food can be photographed. In contrast, a repaired borehole, protected school meal or prepositioned supply of oral rehydration salts attracts little attention. Governments receive recognition for responding to emergencies, not for preventing them. This bias is reinforced by funding systems. A humanitarian appeal can unlock money once suffering is measurable. Preventive action must compete with immediate priorities on the basis of an uncertain forecast. Officials fear being criticised for spending money on a disaster that may not occur.
But waiting is also a decision. It transfers the risk from government balance sheets to families with the least capacity to absorb it. Preparation does not require panic or premature declarations of disaster. It requires linking forecast thresholds to practical decisions.
The government should identify the water systems, clinics and schools most vulnerable to interruption. Municipalities should repair major leaks, monitor water quality and secure contingency supplies. Health departments should confirm that facilities can maintain sanitation and infection control during outages. Nutrition surveillance should intensify before severe malnutrition appears. School-feeding and maternal and child nutrition programmes should be protected. Essential supplies should be positioned where transport disruption could delay delivery.
Heat-health plans must move beyond general advice to “stay hydrated”. Authorities should specify when warnings will be issued, which services will respond and how schools, hospitals, care homes and informal settlements will be supported.
Employers have their own responsibilities. Agriculture, construction, mining, security and delivery businesses should review heat-exposure policies now. Workers need drinking water, shade, appropriate rest periods and supervisors who can recognise heat illness. A hotter summer cannot be treated as an unavoidable occupational hazard.
Health services should strengthen surveillance for diarrhoeal and vector-borne disease while protecting immunisation and chronic-care programmes from disruption. Continuity plans should account for patients who cannot travel because of heat, water shortages or lost income.
Agricultural policy must also be recognised as health policy. Advice on drought-tolerant crops, soil moisture conservation, livestock protection and planting decisions can prevent later hunger and displacement. Forecasts must reach farmers in a form that supports real decisions, rather than remaining in technical reports.
A warning is useful only if it changes decisions
The coming season may not unfold exactly as predicted. Some areas may receive adequate rain. Others may experience destructive downpours rather than sustained drought. Forecasts will need to be updated as conditions change. That does not weaken the case for action. Many preventive measures such as repairing water infrastructure, protecting nutrition programmes, improving disease surveillance and preparing for heat, are valuable even if rainfall is better than expected.
South Africa does not lack scientific warnings. It lacks reliable systems for converting warnings into timely, funded action. If food prices rise, water systems fail and clinics begin treating preventable heat illness or diarrhoeal disease, leaders will not be able to say that the danger came without notice.
El Niño is already here. The test is whether the government, business and health services act while prevention is still possible, or once again find money only after predictable risks have become human suffering. DM
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