Delays in shutting down South Africa’s coal-fired power plants could result in up to 32,000 preventable deaths between 2026 and 2050, according to a new report by climate and health advocacy groups.
The report, released by Greenpeace, CREA, and GroundWork, warns that continued reliance on coal will deepen public health and environmental damage in Africa’s most industrialised economy.
South Africa currently generates about 80% of its electricity from coal. Last year, the government approved extended operating lifespans for 14 coal plants, with at least two expected to remain operational until 2050.
Researchers say the health impacts of delayed decommissioning would be severe, with projections including 41,000 pre-term births, 17,000 additional childhood asthma cases, and 370 deaths among children under five.
The report highlights that Gauteng Province—home to major cities such as Johannesburg and Pretoria—would bear the largest health burden despite not hosting coal plants itself, due to pollution drifting from the heavily industrialised Mpumalanga region.
Mpumalanga is described as South Africa’s most polluted industrial zone, with coal emissions affecting neighbouring regions through air pollution transfer.
Environmental advocates argue that the human cost of continued coal dependence is being underestimated.
“Coal’s true cost is being hidden in hospitals and in early graves,” said Cynthia Moyo of Greenpeace.
Residents in affected communities, including Middelburg in Mpumalanga, reported rising cases of respiratory illnesses, asthma, and other pollution-related diseases. One mother said she was forced to separate from her infant son after doctors linked his breathing problems to air pollution exposure.
The report also estimates that delayed coal phase-out could cost the South African economy about 721 billion rand ($38 billion) due to lost productivity and increased healthcare expenses.
Campaigners say progress on a just energy transition has been slowed by funding gaps and stalled international climate agreements, including reduced support from major economies following shifts in global climate commitments.
The findings add pressure on policymakers as South Africa continues to balance energy security concerns with long-term climate and health risks.
