When Mafeteng Hospital ran out of water between November 2024 and March 2025, surgeries were postponed, wards went unwashed, and patients with open wounds left at risk of infection.
Nurses whispered their frustration as families were told to fetch buckets of water from tanker trucks, and doctors lamented that they could not wash their hands between patients. This was not merely an inconvenience. It was a matter of life and death.
The newly released State of Africa’s Environment 2025 report by Centre of Science and Environment shines a light on invisible casualties of climate change: deaths that are not counted as “heat deaths” or “drought deaths,” but manifest in strokes, kidney failure, hunger, waterborne disease, and untreated infections.
As the report warns, “Heat threatens health, food security, labour productivity and migration, making Africa one of the most vulnerable continents to climate-linked mortality.”
In 2024 alone, the report estimates, 300 million Africans were exposed to life-threatening heat stress, three out of every four cases worldwide.
“Every heatwave that occurs today is made more intense, more frequent and longer-lasting due to climate change,” it states. Yet, it continues that few of these deaths are recorded as climate deaths. They appear instead as heart attacks, kidney failure, malnutrition, or pneumonia triggered by dehydration and heat.
The World Meteorological Organization puts the scale in perspective: “Every third death in the world from extreme weather, climate or water stress in the past 50 years occurred in Africa.”
Most of these deaths, the agency notes, were not caused by cyclones or wildfires, but by slow-burning droughts and silent heatwaves.
For Southern Africa, the agency says the outlook is dire.
The report further projects that the region could face temperature rises of up to 6⁰C in some areas by the end of the century, with more frequent and intense heatwaves.
The report notes that night-time temperatures are climbing fast, meaning no respite for exhausted bodies.
The World Health Organization Health (WHO) experts warn this will push up deaths from cardiovascular strain, kidney disease, and heat stroke.
Lesotho is no exception, the World Bank’s Climate Knowledge Portal confirms that the country is already experiencing more frequent droughts and erratic rainfall, while the Lesotho Vulnerability Assessment Committee reported in 2023 that over 500,000 Basotho faced acute food insecurity.
The International Monetary Fund (IMF) said, in its ‘addressing Lesotho’s climate and environmental challenges’ report, Lesotho is highly exposed to recurrent natural disasters, particularly droughts, floods, and storms.
“The frequency and severity of these disasters have increased significantly in the past decade. With over two-thirds of the population dependent on rain-fed subsistence agriculture, the share of the population directly exposed to natural disasters ranks fourth among sub-Saharan Africa (SSA) countries, well above the SSA and world average. And in the absence of augmentation measures such as increased bulk water supply, these frequent changes in precipitation exacerbate unmet demand for industrial and household uses.”
As one Mafeteng resident said, “We are dying slowly, not from bullets, but from thirst.” The report itself puts it plainly: “Climate hazards are no longer distant threats but present-day killers that strike hardest at the poor, the young, the old, and the sick.”
The health burden of climate change according to the report extends beyond heat. It notes that rising temperatures expand the range of malaria and dengue, diseases once confined to tropical zones.
The report warns of 775,000 additional deaths in Africa by 2050 from malaria alone if adaptation fails.
Food insecurity, too, is a killer: according to the United Nations Framework Convention on Climate Change (UNFCCC), 16 of the 19 global hunger hot-spots in 2025 were in Africa, with over 115 million people in Eastern and Southern Africa facing acute food shortages.
“Malnutrition, especially among children, magnifies mortality rates by lowering resistance to infections. Water scarcity adds another layer,” the convention said adding that Fourteen African countries are already water-stressed, with 11 more expected to join by the end of 2025.
The report warns that nearly half of Africa’s 1.45 billion people could face severe water stress by mid-decade. This is the hidden death toll: where climate change is not written on the death certificate, but where its fingerprints are everywhere.
The solutions are not mysterious. The report calls for Heat Action Plans that go beyond cooling to tackle vulnerability and resilience: reliable water, expanded green spaces in cities, retrofitted housing, and health systems that can respond to heat-related illnesses.
