Mozambique – "It starts quietly in the chest, bringing coughing, fatigue, and weakness. Before you know it, it can take a person away. Down in the mines, it’s even worse. The dust chokes you, the air is heavy, and the disease creeps in without warning. It kills; it really does**.**"
Henrique knows this firsthand. Like many Mozambicans before him, he left home to work in South Africa’s mines, hoping to carve out a better future. "I wanted to change my life," he says, recalling how he followed friends who had already gone. The decision wasn’t easy, but the promise of stable work outweighed his fears.
Mozambican migration to South Africa’s mines dates back to the 1850s – first driven by labour demands on sugar estates, then by the discovery of gold and diamonds. For generations, thousands of workers, many from rural communities, have crossed the border in search of opportunity. But with that opportunity comes a silent threat: disease.
At first, the sacrifice seemed worth it. Henrique could send money home, buy shoes, and visit his family. But the reality underground was grueling. "The elevators were the worst," he remembers. "My ears would hurt so much, it felt like they were closing up." Long shifts in narrow tunnels, thick with dust and poor ventilation, left him exhausted. What he didn’t know was that the air he breathed every day was also poisoning him.
His body sent warning signs – persistent coughing, swelling in his feet – but like many miners, Henrique pushed through, unaware of the real danger. It wasn’t until he grew too weak to work that a doctor diagnosed him with tuberculosis (TB), a disease that remains one of the leading killers of miners and ex-miners worldwide.
TB spreads through droplets from coughs or sneezes by an infected person. Among miners, its effects are worsened by prolonged exposure to silica dust, poor working conditions, and limited access to health care. Many migrant workers face additional barriers: cross-border movement, lack of specialized services, and late diagnosis. The risk doesn't stop at the mines – when sick workers return home, they can unknowingly spread TB to their families and communities.
"I never knew the risks," Henrique admits. By the time he began treatment, he had to take many pills daily to recover.
But unlike many others, Henrique got help. After returning to Mozambique, he visited the IOM-managed occupational health centre in Ressano Garcia, Maputo Province, where he received medical evaluations and qualified for compensation. Today, despite the toll TB has taken on his body, Henrique has found a new purpose. He farms his machamba (traditional agricultural land) and raises goats, determined to provide for his family in a different way.
Mozambican
Photo: IOM 2024/Amanda Nero
To address these long-neglected health risks, IOM, in partnership with Mozambique’s Ministry of Health (MISAU), is working to strengthen occupational health services along key migration corridors. Health centers in Maputo and Gaza provinces – the main regions for mineworkers migrating to South Africa –offer TB screenings, lung disease evaluations, and essential care. These services also ensure continuity of care across borders, connecting Mozambican miners with treatment in South Africa and supporting patients from diagnosis to recovery.
With support from health sector partners, the plan is for these centres to transition to full Mozambican government management – ensuring long-term, sustainable health care for workers like Henrique.
TB is preventable and curable, yet it remains one of the world’s deadliest diseases. In 2023 alone, TB claimed 1.2 million lives, according to the latest global TB report. For Henrique, the cost of chasing a better future was his health. But his story doesn't have to repeat. By investing in early diagnosis, proper treatment, and occupational health programmes, we can break this cycle – before it’s too late.
This initiative is supported by the World Bank through Mozambique’s Ministry of Health (MISAU) and implemented by IOM.