“We Are All Sick”: Sanitation, Structural Neglect, and the Embodied Politics of Informality in Cape Town
Drawing on interviews and theoretical frameworks like urban political ecology, this paper argues that in Cape Town's Khayelitsha, systemic sanitation neglect and the "temporary" classification of informal settlements produce embodied suffering and political marginalization, transforming residents' private illness into a collective demand for infrastructure as a fundamental right of citizenship.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the study of how cities function, researchers often look beyond the visible skyline to the invisible systems that keep people alive: the pipes that bring clean water and the drains that carry away waste. When these systems fail, the consequences are not just technical glitches; they are deeply human experiences that shape who belongs in a city and who is left behind. This field of inquiry, known as urban political ecology, examines how power and money decide where infrastructure goes, often leaving the poorest neighborhoods without basic services. Another key idea is "slow violence," which describes harm that happens gradually over years or decades rather than in a single, dramatic explosion. It is the kind of damage that accumulates quietly, wearing down health and hope until the suffering becomes a normal part of daily life. Understanding these concepts is crucial because they reveal that a lack of toilets or clean water is rarely an accident. Instead, it is often a result of long-term decisions that treat certain communities as temporary or less important, turning their bodies into the first line of defense against a failing system.
In the RR Section of Khayelitsha, a settlement on the edge of Cape Town, South Africa, a researcher named Alex Kihehere Mukiga set out to understand what happens when a community lives in this state of permanent neglect. The area is built on a wetland, densely packed with self-made homes, and has been labeled by authorities as "temporary" for decades. This label has allowed the city to withhold permanent infrastructure like sewage pipes and paved roads, leaving residents to rely on bucket toilets and open drainage. Mukiga did not just count the number of broken facilities; he listened to the people living there. He conducted interviews with thirty residents and sixteen activists, asking them to describe their lives, their health, and their relationship with the city government. The goal was to move past statistics and understand how the lack of sanitation feels in the body and how it shapes the way people see themselves as citizens.
The most striking finding from these conversations was a single, repeated phrase: "We are all sick." This statement was not a medical diagnosis from a doctor, but a collective declaration from the community. Residents described a reality where illness is constant and unavoidable. Children suffer from persistent coughs and skin sores, while adults deal with tuberculosis and other diseases that thrive in the damp, stagnant water surrounding their homes. One resident explained that when they go to the clinic, the staff immediately recognize their address and assume the sickness is inevitable, offering only temporary relief rather than a cure. The researchers found that this sickness is not just a biological fact but a political one. The body itself becomes a record of the city's failure, carrying the physical weight of a system that refuses to provide basic care. The residents' testimonies revealed that the danger is not just in the waste itself, but in the fear and vulnerability it creates, particularly for women and children who must navigate unsafe paths to reach communal toilets or face the risk of crime in the dark.
The study also uncovered a deep sense of frustration and broken trust between the community and the local government. Residents know that the city officials are aware of their situation; councilors live nearby, and the municipality knows the area is a wetland with no drainage. Yet, the neglect continues. This has led to a feeling of abandonment, where the promise of democracy and service delivery feels like a lie. When residents try to organize, they often find their efforts fragmented. Community leaders and street committees, which are meant to bridge the gap between neighbors and the government, have become strained by conflict and a lack of resources. Activists who once worked with larger organizations to demand change now find themselves without support, forced to rely on desperate measures like burning tires to get attention. The research suggests that while the community is not passive, their ability to fight for change is worn down by years of being ignored and the collapse of the groups that once helped them.
Ultimately, the paper argues that the crisis in Khayelitsha is not a simple problem of building more toilets. It is a structural issue where the city treats these settlements as if they do not belong, denying them the rights of full citizenship. The phrase "We are all sick" transforms private suffering into a public demand for recognition. It forces the city to see the human cost of its inaction. The study concludes that as long as these areas are labeled "temporary," the cycle of neglect will continue, and the health of the residents will remain tied to the whims of political decisions. The solution, the author suggests, requires a fundamental shift in how the city views its own people: recognizing that sanitation is not a privilege to be granted, but a basic right that defines what it means to be a citizen in a modern city. Until that recognition happens, the slow violence of neglect will continue to shape the lives of those on the margins.
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