Africa’s floods and droughts are messing with our minds. Researchers are trying to figure out how

The parched earth opened in jagged cracks. But it was the dead cows on the side of the road that did it.

By October of 2014, the government had declared a state of emergency in KwaZulu-Natal. The prolonged drought left some 40 000 cattle dead, with early losses of livestock and crops estimated at R400 million. Dam levels dropped, money was designated for borehole drilling, water tankers rolled in.

That’s when Collins Iwuji started making the connections. 

A researcher and HIV doctor, Iwuji was in the northern part of the province, in rural Hlabisa, with a team from the Africa Health Research Institute. They were working on what was then pioneering research. Going door to door offering HIV testing, they were referring those who tested positive to clinics to immediately start antiretroviral (ARV) treatment — something that would only become standard practice in 2017. 

Iwuji was stumped. Why weren’t people showing up at the clinic to take up treatment? Part of it had to be that they weren’t sick so they didn’t see the need. But there was something else.

Driving home from work one afternoon, he realised that the dead cows might have something to do with it. Could the drought be affecting how many people start on ARVs and how correctly those who are already taking the medicine take it?  

His instincts proved right. A few years later, he and his co-researchers followed up with a study tracking 40 000 patients on treatment in Hlabisa spanning the period before, during and after the drought. In January 2014, when the driest years first kicked in, the odds of remaining in care dropped by nearly one-third. By December 2014, one in five patients struggled to consistently take their medication.

The related qualitative research — the whys and hows of how the drought was keeping people away from the clinics or off their ARVs — filled in some of the layered blanks. 

In-depth interviews of 27 people living with HIV in the area allowed researchers to map the links. The cracked earth, dried-up river beds and dead livestock led to lost incomes, a lack of access to food and water for drinking and sanitation, and people being displaced from their homes. And that was on top of the existing poverty and unemployment.

“I’m an epidemiologist,” Iwuji says of his background and his research work tracking the patterns and causes of disease. “Earlier in my career, I didn’t care about the stories. I just wanted the numbers. I wanted to know: this is twice as likely to happen if those other things happen. But as I started to work more in interdisciplinary research and community engagement, I started to understand that it’s not just about the numbers, but the stories behind those numbers that give you a holistic picture.” 

That study is what eventually took Iwuji, who is also a professor of global health and HIV medicine at the UK’s Brighton and Sussex Medical School, off his HIV-focused research to lead an interdisciplinary study about the impacts of extreme weather events on mental health. 

Stretching 36 months and across communities in South Africa, Kenya, Burkina Faso and Mozambique, it will join epidemiology with the social sciences, community engagement, humanities and psychology, to gather the numbers as well as creative ways to capture the stories to help peel back some of the interconnected layers.

In sub-Saharan Africa, that’s where things can get complicated.

Little research, high risk

When the World Bank compared data from 1970-1979 to four decades later, in 2010-2019, it found the frequency of droughts in sub-Saharan Africa had nearly tripled. Storms quadrupled and floods increased more than tenfold. Because of that exposure risk, along with poverty, governance issues and stifled abilities to mitigate and bounce back from the damage caused, the UN Intergovernmental Panel on Climate Change (IPCC) says the continent is among the most vulnerable and least resilient regions in the world. 

As climate change intensifies, experts say our health and healthcare systems are going to suffer. But mental health often takes a back seat. Even the IPCC, which has spent decades warning about climate change, didn’t mention mental health in any significant way until 2022. 

Global studies on the subject are growing, but the data on Africa remains slim. 

In a May 2025 review of 21 studies, researchers found depression, anxiety and post-traumatic stress disorder (PTSD) — which can develop after someone experiences or witnesses something deeply frightening, shocking or life-threatening — were the most common forms of mental health consequences from climate impacts in Africa. 

Trauma was found among flood survivors in Ghana, while anxiety disorders were linked to communities forced to relocate by rising seas and by rural Kenyans experiencing chronic food and water insecurity. 

Two months after catastrophic floods killed over 450 people in KwaZulu-Natal in April 2022, South African researchers found rates of PTSD, depression and anxiety spiked in the 69 women from low-income settlements that they spoke with both before and two to three months after the floods. 

Mental health measurements showed about one in five of the women crossed into what is considered clinical ranges for mental health conditions they hadn’t shown before — 20% for anxiety, 19% for PTSD and 17% for depression. But the researchers’ pre-flood data also revealed that these conditions weren’t necessarily new — they occurred on top of already high levels of childhood physical, sexual and emotional abuse, neglect and intimate partner violence, as well as food insecurity. 

And that’s just one of the layers that don’t fit neatly into Western psychology’s definitions of conditions like PTSD.

Trauma with a small t

The World Health Organisation (WHO) says PTSD can manifest through intrusive memories, nightmares or flashbacks in which someone re-experiences the event or by avoiding anything that reminds them of what happened.

Nothando Ngwenya, an Ahri researcher who was part of the Hlabisa qualitative study with Iwuji, says that’s where standard measurements of mental health can falter. “So there’s the trauma, because a lot of the time, within psychiatry or psychology, you have the trauma, and the trauma is really something big. But there is a concept called trauma with a small t, and that basically means it’s chronic trauma.”

In environments embedded in ongoing trauma from high rates of unemployment, poverty and gender-based violence, the Western framework is more difficult to apply. The danger, say researchers, is that it can skew diagnoses like PTSD. One reason is that people from different cultures explain their trauma differently, which in turn affects how they experience it.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) — the latest edition of the “bible” that psychiatrists around the world use to diagnose and treat mental health disorders — tries to address some cultural context.

It now includes cultural concepts of distress, such as kufungisisa from the Shona in Zimbabwe, which translates as “thinking too much”. In a 2015 systematic review, researchers found the phrase appeared widely outside non-European and North American culture, including South Africa. Often it referred to ruminative, intrusive and anxious thoughts, overlapping with definitions of depression, anxiety and PTSD. It was also found to be less stigmatising than Western diagnoses. 

Meanwhile ubuntu, a concept in many African cultures, is generally understood as a person being part of “a larger and more significant relational, communal, societal, environmental and spiritual world”.

“Western help is really centred around the individual, their inner thoughts and emotions, whereas in some collectivist cultures it is about the people around me,” Ngwenya explains. “So, if something is traumatic, you find that people would first look at the reaction of the people around them before they can say it is traumatic. 

“So, even if something was traumatic, if the people around me are not seeing it as traumatic, then you may invite me for treatment or counselling, but I will never admit that it is traumatic.” 

The wider cultural contexts in Africa and South Africa also include other nuances, where researchers cite everything from apartheid intergenerational trauma to colonial influences and those less earthbound. 

Researchers like Ngwenya worry that there’s a risk of diagnosing an illness that might not exist from a cultural standpoint, including among traditional healers like sangomas or inyangas who are regularly consulted for mental health concerns in South Africa and other places on the continent. 

“Is somebody really having a spiritual calling? Or is somebody having hallucinations and schizophrenia? When you [only] use Western medicine frameworks, you risk pathologising illnesses, which may not be a mental health illness.”

Collins and his co-researchers hope their research methods, including something called digital storytelling (DST), will help them look deeper into the cultural nuances.

Screen by screen

The walls were covered in neon sticky notes and posters and the tables scattered with magazines, watercolours, markers and coloured pencils. The brainstorms scribbled about “strengths of your community” and “extreme weather events” and what words like thinking too much, trauma, stress and depression mean to you and what makes a good story. 

It was June in Hillcrest, about 55km west of Durban, and 10 men and women from the township of nearby Embo gathered for a five-day session to put together the first phase of their research. By Friday, they would complete a short video that tells their story about how recent extreme weather affected their mental health.

Bongeka Ngubane, who participated as a co-researcher on the project, told hers about the 2022 floods in Zulu, screen by screen, in images of fabric, bits of photographic images torn from magazines and so many tears made from coloured pencils. 

In the first image, she is sitting in the morning sun after a week of rain when she hears the news about her uncle. She runs to his home and finds it has been swept away by the floods and learns her aunt and 10-year-old cousin are missing. Her other cousin, a 15-year-old boy, was dead. 

Ngubane has drawn him pinned under a tree which had fallen on top of him. It took the whole night for the neighbours to cut the tree to free him, she tells us. The boy died on the way to the hospital. It took days and police dogs to find the bodies of her aunt and cousin, whose decomposed bodies were finally dug out of the mud in the ravine below the house with a bulldozer.

She talks about how she felt “cold as if she were in a refrigerator” when she heard the news. How she wished she was there to help, how she thought she would wake up from this bad dream, about how the church came with clothes and food and how her uncle waited until his wife and daughter’s bodies were finally found so he could bury his wife, son and daughter together. She talks about how she can’t stop thinking about it, about how her life changed forever.

Astrid Treffry-Goatley and Gillian Black are leading the community engagement part of the project, to which the community members are integral. In addition to creating the storytelling videos, the co-researchers will also help with analysing the study’s results.

As a scientific research method, researchers say DST, which results in videos like Ngubane’s, can help draw out nuances in health research that wouldn’t otherwise be captured. They say it is particularly useful in honing in on local and cultural knowledge.

Treffry-Goatley, who has a PhD in film studies, has been working in public health and social justice since 2010. She’s worked with the method often, saying it is also a powerful policy tool — something the project has built into its outputs — and helps “humanise” scientific evidence.

Because the process of storytelling can bring back the trauma of the event, a psychologist or social worker is in the room throughout recordings for mental health support, as well as to explain some of the mental health issues introduced.

“We never say, we want to hear about your anxiety and we want to hear about your depression and we want to hear about your stress or your trauma,” explains Black, who has worked with and studied the ethics and outputs of the method. “The psychologist or the social worker that is in the room does a session to say, ‘So if I say the word ‘stress’ to you, what does that mean to you? And can you tell us about a time when you think you’ve experienced stress? Or when I say ‘depression’, what does that word mean to you?’”

Healing with hair and friendship benches

Religion and spirituality are cited as a way for people to cope, including the support by the community. 

For the KZN flood survivors, researchers who spoke with 50 survivors said those elements did play a role in mental health and healing. One in nine interviewed believed that the cause of the flood disaster was an act of punishment from God and 39% felt that prayer would help them with their problems. 

But what seemed of most value to people, was talking to others in their community — almost half said it had a positive effect on their healing process. 

“You don’t need an expert,” Iwuji says. “You don’t need someone with a PhD in psychiatry. Having people, just at the community level, providing counselling and support makes such a big difference.” 

In September, mental health, for the first time, was officially addressed at the UN General Assembly during its session on noncommunicable diseases and mental health. For the occasion, WHO reported that 1 billion people — one in eight of the world population — have a mental health disorder. But just 9% of those with depression receive support. In Africa, the investment in mental health is well below what the WHO recommends, leaving many without any care at all.

But there are some initiatives that offer community-based solutions. 

The often-mentioned Zimbabwe’s Friendship Bench, where community health workers — who live in the community and are trained in basic healthcare — are given basic cognitive behavioural therapy training. People who need mental health support meet the workers on benches in their community to talk about their problem. 

And it’s a model researchers have said could work well in South Africa, where community health workers already exist. Wits RHI has, for instance, rolled out friendship benches among teen girls and young women using HIV prevention medication in 2023 in a study.  

Moreover, the Bluemind Foundation, which is based at the London School of Hygiene and Tropical Medicine, started up a Heal by Hair programme. It offers free, three-day training in basic mental health skills for hairdressers in French-speaking African countries, including Togo and Cameroon. 

Iwuji points out, mental health support is far less costly than the other policy intervention he knows will help — stable housing. As the researchers found, it wasn’t always the flood moments that damaged mental health the most — it was the aftermath with no clean water, electricity and food, lost income and homes and no way to reach loved ones. 

A new life

For Ngubane, the pain endures. 

Her uncle, Kweza Ngubane, talks about his wife and two children. There aren’t many photos of them, though. Everything was washed away with the house. But the remnants of the damage done five years ago still stand. The property is littered with concrete and some of the walls stand as artefacts from another life. 

Ngubane is still there in Embo, with his eldest daughter, who survived. The local counsellor told them to move, that his property isn’t safe. That his home stands in the water’s path. That the floods will come again. But he isn’t going anywhere. 

Because over there, where the clothesline stretches and its bright coloured laundry waves in the breeze, are the graves of his wife, son and daughter. He’s rebuilding his house and has even built two rooms he can rent out for income. Chickens here are free range. He has a new wife — no lobola yet, he laughs. Next year, he says. 

A new wife, he says. A new life.

This is the second in a series of articles about the impact of climate change on mental health. Here is the first. Bhekisisa is a collaborator on the Wellcome Trust-funded project, which the Africa Health Research Institute at the University of KwaZulu-Natal is leading. Bhekisisa, however, operates editorially independent of the project.

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.