Toxic Crisis: What's Really Killing Our Children?

South Africa is currently grappling a public health crisis that once again lays bare the cracks in our social fabric and regulatory systems. In the past few weeks alone, fatal cases of suspected food poisoning have claimed the lives of over a dozen children—six in Naledi, Soweto, three in Mdantsane NU2 in the Eastern Cape, and others in Alexandra, Katlehong, and the South Coast of KwaZulu-Natal. Toxicology reports from the Minister of Health have linked the Naledi deaths to terbufos, a dangerously potent organophosphate pesticide. In the other cases, official findings or direct links to organophosphate poisoning have not yet been fully substantiated by public health authorities, however, food poisoning is suspected, reportedly involving items purchased at spaza shops. These tragedies, still under investigation, have ignited backlash against foreign-owned businesses, with migrant shopkeepers now facing blame and violence, targeted as convenient scapegoats amidst economic instability. The escalating tensions are disturbingly reminiscent of the xenophobic violence of 2008 and 2015—a brutal history that now threatens to repeat itself.

These events highlight the urgent need for social cohesion in South Africa and demand a unified response from government and communities alike to prevent cyclical violence. Yet, beyond these issues lies a critical discussion on organophosphates themselves- a class of chemicals that remain in use across South African agriculture and informal urban markets, despite overwhelming evidence of their dangers to human health. In the wake of these tragedies, it’s time we asked why these chemicals continue to circulate so freely in our communities—and what we must do to critically address this crisis.

What Are Organophosphates?

Organophosphates are a class of chemicals used as pesticides and remain legally available in South Africa despite their known toxicity. Terbufos, one of the most toxic of these, is widely used in agriculture and enters communities through various legal and illegal channels, including informal and unregulated street markets. It is often sold unlabeled, in either granular or liquid form, as an affordable means of pest control in communities where sanitation services are lacking and infestations of rats and cockroaches are prevalent. Terbufos and similar chemicals, such as Ethion, are considered highly hazardous, with the World Health Organization classifying them as Class 1A (extremely hazardous) and Class II (moderately hazardous) chemicals, respectively.

South Africa’s ongoing tolerance of these hazardous chemicals has allowed them to become part of the environment and food systems, exposing unsuspecting people—including children—to their toxic effects. In rural and peri-urban areas especially, where regulations are often not enforced and educational resources are limited, these chemicals pose grave health risks.

Organophosphate Exposure: Accidental and Intentional

Recent events have underscored the dangers of accidental exposure, but organophosphate poisoning is frequently encountered resulting from intentional ingestion, often linked to self-harm. Mental health struggles are prevalent in impoverished communities, where access to mental healthcare support is limited, and pesticides like terbufos, easily accessible, are sadly often used in suicide attempts. Organophosphates disrupt essential neurotransmitters in the body, leading to severe and sometimes irreversible damage to the nervous system and other bodily functions. Without prompt medical intervention, the effects of such poisoning can be fatal.

Recognising Organophosphate Poisoning

Diagnosing organophosphate poisoning is primarily clinical, as the symptoms are distinct and arise from both nicotinic and muscarinic receptor overstimulation. Key indicators include pinpoint pupils, excessive respiratory secretions (bronchorrhea), excessive salivation, and involuntary muscle twitching (fasciculations). In suspected cases, blood tests can confirm toxicity by showing a percentage decrease in serum pseudocholinesterase levels. Rapid recognition of these symptoms and immediate medical attention are crucial to improving outcomes in poisoning cases.

Treatment and Management

Treatment for organophosphate poisoning typically involves the use of antidotes like atropine and obidoxime. Atropine counteracts the toxic effects but has its own side effects, such as confusion, hallucinations, fever, and urinary retention. Adjunct treatments, including benzodiazepines, inhaled ipratropium, and vasopressors, are often used as supportive management. Studies show that incremental bolus administration of atropine followed by a maintenance infusion is most effective in reducing mortality. However, intubation and mechanical ventilation are frequently required due to respiratory failure in severe cases. A study conducted at a regional healthcare facility in Johannesburg reported a mortality rate of 13.4% in organophosphate poisoning cases, highlighting the critical need for prompt and effective management.

Is Targeting Foreign-Owned Shops The Solution?

The recent poisonings and tragic deaths of children have triggered an unsettling wave of finger-pointing, with some political figures fueling mistrust and resentment towards foreign-owned spaza shops. Statements like those from ActionSA, calling for a national emergency and urging action against foreign-owned spaza shops, are not only inflammatory but dangerously misplaced. Gayton McKenzie from the Patriotic Alliance has gone as far as to demand that foreign nationals leave South Africa altogether. And although the Minister of Health emphasized that recent raids targeted all spaza shops, not exclusively foreign-owned ones, this distinction is unlikely to curb the rising xenophobic sentiment. Instead, the arrests of a few shop owners for selling illegal substances risk inflaming suspicions and reinforcing harmful stereotypes rather than focusing on real solutions.

Putting the economic and regulatory concerns of illegal enterprises aside, blaming migrant-owned shops for these poisonings is an overly simplistic, short-term, and dangerously populist response to a far more complex issue. The crisis demands an examination of our systemic failures in regulating toxic chemicals like terbufos—substances still legally accessible despite the well-documented hazards they pose. Rather than singling out migrant-owned businesses, the real change lies in tightening pesticide regulations, educating the public on chemical safety, and immediately withdrawing terbufos and similarly hazardous substances from the market. What we need are not scapegoats or quick-fix solutions but systemic reform, supported by robust healthcare resources for managing poison exposure, and an effective surveillance system that alerts us to poisoning cases early on. These are the steps that can genuinely prevent such tragedies from happening again.

As the collective grief and outrage of these recent deaths reverberate through our communities, we are reminded of the urgency to address the real issues at hand. The focus must shift from knee-jerk reactions to thoughtful, sustainable, and health-oriented solutions. Only by holding the right people and institutions accountable—those responsible for regulating these poisons—can South Africa build an environment where all are protected, regardless of who they are or where they come from. This moment demands more than the empty, divisive rhetoric of political opportunism; it demands action that genuinely serves the public good.

I’d love to hear your thoughts on this pressing issue—do you think South Africa is doing enough to protect communities from toxic chemicals? Join the conversation below, and if this article resonated with you, please like, share, and spread awareness to help drive change.