At the South African TB Conference that took place in Durban from 1-4 June, the gold mining sector came under heavy criticism from clinicians, ex-miners, advocacy groups and the Minister of Health. Gavin Churchyard, a leading TB clinician and researcher, described TB in South African mines as an “unprecedented public health disaster”.

Churchyard was speaking at a session organised by the Chamber of Mines on TB in the mining sector, along with representatives from the National Union of Mineworkers (NUM) and the AIDS and Rights Alliance for Southern Africa (ARASA). ARASA produced a report on TB in the mining sector in 2008, and has since lobbied government and the mining sector to take action on the recommendations outlined in the report.

A study released on June 1 by Oxford University showed that increased levels of mining production correspond with higher rates of TB in the general population, and suggested that the mining sector could be responsible for more than 700,000 cases of incident TB in sub-Saharan Africa every year.

Although representatives from various mining companies, also speaking at the session, declared that the sector had undergone transformation in the past few years and presented various interventions to attest to this, Paula Akugizibwe from ARASA stressed that the mining sector, which she referred to as a “TB factory”, was over a century behind schedule with regards to its TB response.

Akugizibwe quoted the Milner report of 1903, which warned that “the extent to which miners’ pthisis [TB] prevails at the present time is so great that preventive measures are an urgent necessity”>, and emphasized that while the progress observed in the past few years is welcome, a much more drastic effort would be required to stem the public health and human rights crisis that has resulted from decades of neglect.

Gold miners are at increased risk of TB due to high levels of silica dust produced in the gold mining process, as well as the high HIV prevalence in mining communities. In 2003 the mining sector launched an initiative to eliminate silicosis and developed targets for silica dust reduction – however, as pointed out by Churchyard, the elimination of silicosis would require dust levels to be at least 50% lower than the targets that have been set by the sector.

The Department of Health estimates that TB rates in the mines are between 3,000 and 7,000 per 100,000 every year – in other words, they could be up to ten times the national incidence rate. This poses a grave health threat not only within the mines themselves, but for labour-sending communities throughout the region – Minister of Health, Aaron Motsoaledi, in his plenary speech, expressed his concern that the mining industry is “exporting TB and HIV”  to neighbouring countries from which migrant labourers come.

Speaking at a press conference with the Treatment Action Campaign and Medecins Sans Frontieres, Cebisamadoda Nxumalo from the Swaziland Ex-Miners Cooperative Union added that many miners are sent back home without any referral note from the company, which can result in interruptions to their treatment and thus put them at risk of drug resistance.

The allegation of mines exporting TB/HIV was further demonstrated by the emotionally charged personal testimony that was shared by a former mine worker from Lesotho at the close of the Chamber of Mines session. After contracting TB in 2007, he was subsequently dismissed and has since had to make several taxing and costly trips between Maseru and Johannesburg in his efforts to secure the compensation to which he is legally entitled, but is yet to receive.

The compensation system for mine workers is rife with challenges – not least the parallel legislation that has been developed specifically for mine workers, the provisions of which are inferior to those granted to all other workers in South Africa. The process of assessing compensation claims is slow and extremely bureaucratic; and a 2005 audit by Deloitte found that the compensation fund is insolvent and that mining companies’ levies would need to be substantially increased in order to cover the deficit. Over the 21 month period during which the audit was conducted, only 400 of the 28,000 claims submitted were paid out.

Currently, the burden of responsibility for this shortfall is being shifted between different government departments and the mining sector and disagreements between the Chamber of Mines and the Department of Health regarding who should be held responsible for correcting the compensation fund’ s deficit – which will affect the calculation of levies that the companies are required to pay – have resulted in a court case that will be heard later this year.

However, Mr. Eric Gclilitshana, the NUM’s National Secretary for Health and Safety who attended the Chamber of Mines session, warned that the union will not support litigation against the mining houses, because experience has shown that “litigation does not benefit the ex-mine worker, as all the funds go to the lawyer’s fees.”

Lynette Mabote from ARASA expressed concern about this statement, which she said shows that, “former mineworkers, whose labour built our economy, have been left to the mercy of a system that was historically designed to maximise exploitation and impunity.”

Links to media related articles:

Aidsmap: Mining industry in South Africa is making TB epidemic worse
South Africa: Integrate TB-HIV Services!