Flooding repeatedly disrupts daily life in Khayelitsha. When heavy rains come, homes take on water. Children miss school. Food and medication can be lost when water enters homes, or when power cuts affect storage. Clinics become harder to reach, often as health needs increase.

These impacts are tied to wider conditions, including poor drainage, shared sanitation, unsafe water, insecure housing, poverty, and Cape Town’s long history of spatial and infrastructural inequality. For residents, flooding cuts across health, housing, care, finances, mental wellbeing, and everyday survival. It also raises urgent questions about whose knowledge is taken seriously in decisions about risk and response at city level.

Responsive Dialogues for Urban Climate and Health is working in this context. Led by the Climate System Analysis Group at the University of Cape Town in partnership with Eh!woza, the project uses an iterative dialogue process to understand how flooding shapes health risks in Khayelitsha. It aims to bring residents, researchers, health practitioners, municipal actors, and other stakeholders into conversation around issues that are often felt most sharply in people’s homes, routines, and everyday decisions.

The project started with two scoping dialogues with Khayelitsha residents to discuss which health impacts of flooding were most urgent for residents. Diarrhoea was highlighted as a key concern and scoping workshops were followed by by three responsive dialogue sessions focused on diarrhoea as a flooding-related health concern. Together, these five engagements have shaped the direction of the work, built shared understanding, and suggested pathways new questions for the next phase.

Why Responsive Dialogues?

Responsive Dialogues create spaces for collective shared learning, reflection, building trust and collaboration. Working with Eh!woza, who has built long-term partnerships with residents of Khayelitsha meant that the conditions for effective shared learning were already seeded. Instead of defining the problem before the process begins, the dialogues allow priorities to be shaped through conversation with the people most affected.

This matters in climate and health work, where the impacts people face are rarely the result of a single event, because the most visible risks are often shaped by underlying systems. Flooding may appear as a physical event, but its health impacts are linked to broader systems that shape everyday life, including water, sanitation, housing, energy, mobility, finances, caregiving, clinic access, and trust in institutions.

By centering lived experiences and knowledge of residents, Responsive Dialogues help reveal how these interconnected challenges are understood and navigated within communities. This process therefore aims to ensure residents’ knowledge shapes the questions, priorities, and potential responses to the challenges

Narrowing the focus to diarrhoea

During the first scoping engagement, residents shared how flooding affects daily life. The group spoke about damaged homes, financial loss, anxiety ahead of winter, food insecurity, unsafe water, difficulty reaching clinics, and health concerns such as skin problems, stomach illness, injuries, mosquito exposure, and breathing symptoms.

During the second scoping engagement, residents examined the health effects of flooding more closely. Diarrhoea became the main concern residents wanted to explore further during the three responsive dialogues, especially because of its impact on children and its links to contaminated water, unsafe storage, shared toilets, and floodwater entering homes.

This priority emerged through interactive and iterative processes, with residents’ lived experiences forming the core of the engagements. Diarrhoea is immediate, familiar, and difficult to separate from the daily conditions flooding creates.

Residents also described the added costs and obstacles involved in prevention and care. Boiling water requires electricity or fuel. Storing water safely requires containers and space. Flooding can block access to clinics. Lost or damaged ID documents can affect access to services. These details matter because they shape what households can realistically do before, during, and after illness.

Knowledge carried through everyday life

Residents have spoken about the things people do long before formal help arrives: mixing oral rehydration solutions, boiling water when electricity or fuel is available, changing roofs so water runs off more easily, using cement instead of sand, and moving quickly when heavy rain begins. These are practical acts of care and preparation, and also show how much work households are already doing to manage risk, often with very little support and at costs residents must bear themselves.

The stories shared in these sessions matter as evidence. They show the parts of flooding and illness that can disappear from formal records: a child treated at home because the clinic is too hard to reach, a household trying to keep water safe during a power cut, symptoms that are never counted because the family is focused on getting through the flood. Community knowledge is often treated as anecdotal or secondary, but in Khayelitsha it helps show how climate and health risks are actually lived.

What is becoming clearer in the room

Across the dialogues, residents have described many linked concerns: contaminated water, shared toilets, flooded pathways, food safety, children playing in dirty water, handwashing, clinic access, household costs, and the wider infrastructure that shapes what is possible before, during, and after a flood. Diarrhoea was chosen as the main health outcome to focus on, but it sits within this wider set of pressures.

That is part of what makes the dialogue process useful. It creates space to stay with those connections, rather than separating them too quickly into neat categories. Residents’ experiences show how health risks are lived amid ordinary routines, difficult choices, and repeated disruptions.

Some learning is already moving beyond the sessions. Residents have spoken about what they have taken from earlier discussions, including boiling water when possible, using rehydration solutions, and seeking care early when children show serious symptoms. One participant shared that she had already passed this advice on to a neighbour whose child had diarrhoea after heavy rain.

The emotional weight of flooding has also come through strongly. Stress does not begin when water enters a home. It begins in the planning before winter, in the memory of what was lost last time, and in the knowledge that another rainy season may bring another round of repair, replacement, and financial strain.

Trust and translation remain central to the work. Sessions move between isiXhosa and English, with time taken to check meaning and expectations as the conversation unfolds. That care matters in a context where residents have often been asked to share their experiences without seeing those experiences valued in decisions that affect them.

Learning alongside the community

The Responsive Dialogue work will continue over the next six months, with further support linked to CASCADE. In this next phase, the Khayelitsha resident group will continue exploring diarrhoea as a flooding-related health concern, while the process also begins engaging City actors to understand their perspectives on flooding, diarrhoea, and possible responses.

This next phase will deepen the learning already underway and help shape responses grounded in the realities of Khayelitsha.

Responsive Dialogues for Urban Climate and Health is led by Romyne Karan from the Climate System Analysis Group at the University of Cape Town, in partnership with Eh!woza. It is funded under the DELTAS Africa II programme through the Science for Africa Foundation and Wellcome Trust.

Photo credit: Image used with permission from Eh!woza.

Co-authored by Alacia Armstrong, Romyne Karan, Anastasia  Koch, Mbali Jiyane

This piece reflects a collaborative project partnership perspective.