Colds and flu

Updated 11 October 2017

1918 - South Africa's death toll

South Africa was the fifth hardest hit country in the world. Almost as many South Africans died from the 1918 flu as did Americans.

South Africa was country fifth hardest hit country in the world by the 1918 flu. Almost as many South Africans died from the 1918 flu as did Americans.

  • South Africa was the fifth hardest hit country in the world

  • The SA death toll was almost as high as the total for the USA
  • Almost half a million people probably died from the flu epidemic in South Africa
  • 62 percent of those who died lived in the Cape
  • 1,6 - 3 million people out of a population of almost 7 million were affected by the flu
  • Between 22,8 and 43,97 out of every thousand people in the country died from the flu (2 - 4 percent)
  • 140 000 people died in seven weeks from September - October 1918

"The single most devastating episode in South Africa's demographic history," Professor Howard Phillips calls the Spanish Influenza epidemic of 1918. While the exact cause of the infection remains uncertain, its effects were not.

In South Africa, it is estimated that almost half a million people died. It is estimated that 20 million people died worldwide and the global mortality rate was approximately one in fifty. In India, four percent of the population died.

Why no definite figures?
Exact figures are difficult to determine in South Africa, as legislation did not provide for the recording of death tolls amongst large sections of the black population - especially those living in rural areas.

Under normal circumstances recording of these details was sketchy, so it could be assumed to have been even less reliable during the crisis brought on by the epidemic in the last quarter of 1918, when even the recording of deaths amongst whites in urban areas was incomplete.

How did historians arrive at figures indicating official death tolls in South Africa? Prof Phillips speaks of having to rely on a well-informed estimate extrapolated from figures supplied by the government-appointed Influenza Epidemic Commission and the figures released for the May 1921 census.

The latter found that, based on expected population increase statistics, the total for the African, coloured and Indian populations was almost half a million short.

The Union Government, in their census report, concluded that this shortfall "was undoubtedly due to the enormous mortality during the devastating epidemic of influenza in the intercensal period, and corresponds almost exactly with the number of deaths estimated as having occurred during the epidemic."

The long-term effects of this killer disease on the development of South African society are difficult to determine, but they were obviously devastating and far-reaching.

Sources for the whole section on the 1918 epidemic in South Africa: SA Railways and Harbour Magazine, December 1918; Phillips, Howard. South Africa's worst Demographic Disaster: The Spanish Influenza Epidemic of 1918. (South African Historical Journal, (20), 1988.


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Dr Heidi van Deventer completed her MBChB (Bachelor of Medicine and Bachelor of Surgery) degree in 2004 at the University of Stellenbosch.
She has additional training in ACLS (Advanced Cardiac Life Support) and PALS (Paediatric Advanced Life Support) as well as biostatistics and epidemiology.

Dr Van Deventer is currently working as a researcher at the Desmond Tutu Tuberculosis Centre at the University of Stellenbosch.

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