A new report released on Wednesday, April 22, 2026, by Greenpeace Africa, the Centre for Research on Energy and Clean Air (CREA), and GroundWork reveals that delaying the phase-out of coal-fired power in South Africa will result in devastating health and economic consequences.
Titled “Unmasked: The Health and Economic Cost of Delaying Coal Phase-Out in South Africa”, the report finds that keeping these plants open beyond their planned retirement dates will cause an estimated 32,000 additional premature deaths between 2026 and 2050. The health burden extends heavily to children. The delay will result in 41,000 additional preterm births and 17,000 new cases of childhood asthma.
The economic toll of these health impacts is staggering. The report calculates the cost to the South African economy at ZAR 721 billion ($38 billion). This includes lost working days and overwhelming pressure on the public healthcare system.
The report highlights a critical geographic disparity. Gauteng is projected to absorb the largest share of additional deaths, with over 15,000 fatalities. The province has no Eskom coal power stations. The transboundary pollution originates in Mpumalanga and settles over Johannesburg and Pretoria.
“For too long, communities living in the shadow of coal have carried the cost with their health, their livelihoods, and their lives. The smoke in their lungs. The dust on their children’s chests. It’s an unacceptable price to pay to keep the lights on for the rest of the country when solutions exist. This report makes that cost impossible to ignore. It is a call for accountability and for urgent action to protect people, not polluters,” said Dr Oulie Keita, Executive Director of Greenpeace Africa.
Dr Keita emphasised that the energy crisis does not justify the health crisis. South Africa has more than 220 GW of renewable energy projects in the pipeline, demonstrating that continued dependence on coal is a policy choice rather than a technical necessity.
Cynthia Moyo, Climate and Energy Campaigner at Greenpeace Africa, said: “This report makes it clear that there is no safe or responsible way to extend the life of coal. South Africa has more than enough wind, solar, and storage capacity to replace every coal plant currently on life support. Keeping these polluting plants open is a deliberate political choice that sacrifices human lives. We demand the government accelerate the coal phase-out immediately and implement a just transition to renewable energy that protects workers and communities.”
Daniel Nesan, Analyst at CREA, said: “Our analysis shows that the health impacts of coal pollution are severe, widespread, and entirely preventable. South Africa has the means to transition to clean energy. The cost of inaction will be measured in lives lost and communities harmed.”
Thomas Mnguni, spokesperson at GroundWork, said: “Communities on the frontlines of coal pollution have been raising the alarm for years. This report validates their lived experience. The right to clean air is a constitutional right, and it is being violated every day that coal plants continue to operate.”
Key Findings
- 32,000 additional premature deaths projected between 2026 and 2050 if coal plant retirements are delayed under the 2025 Integrated Resource Plan (IRP)
- 41,000 additional preterm births and 17,000 new childhood asthma cases: health burdens borne disproportionately by children in coal-affected communities
- Over 370 deaths in children under five linked to extended coal operations
- Gauteng bears the largest provincial death toll – more than 15,000 additional deaths – despite having no Eskom coal power stations: pollution from Mpumalanga travels across provincial boundaries
- 27 million additional lost working days and mounting pressure on an already strained public health system
- U$38 billion in health-related economic costs – far exceeding any economic case for keeping coal plants operational
- South Africa has over 220 GW of renewable energy in the pipeline, making the continued extension of coal a political choice, not a technical necessity.
The report was launched on Earth Day in Middelburg, Mpumalanga, a region at the heart of South Africa’s coal industry and among the most affected by air pollution.
Coal is South Africa’s dominant energy resource, supplying around 77% of the country’s primary energy needs and playing a key role in both domestic power generation and exports.