Lessons from the global leader in water management
South Africa’s Constitution guarantees the right to sufficient water. Water is recognised as a condition of dignity, health, and citizenship, and the state is obliged to take reasonable measures to realise that right.
Constitutions do not pump water.
When water systems fail, consequences for healthcare are immediate. Maternity wards, operating theatres, dialysis units, neonatal ICUs and hospital laundries require continuous, pressurised, clean water to function safely.
Recent reports from Hammanskraal describe hospital wards without running water, toilets that don’t flush and prolonged reliance on tankers. These are conditions incompatible with good medical care.
Day Zero was a warning
Cape Town’s 2017–2018 “Day Zero” crisis made water insecurity visible to the country and the world. Dam levels fell below 20%, approaching the 13.5% threshold at which household taps would have been shut off and residents were to be redirected to communal collection points.
The crisis exposed deep vulnerabilities: limited reserves, slow supply growth and long-standing reliance on surface water.
Fortunately, demand fell sharply, emergency measures were implemented, and the rains returned. Cape Town became an international case study in urban demand management.
The deeper lesson was structural. South Africa’s water problems are about chronic water system fragility.
How dry is South Africa?
By global standards, South Africa is a water-scarce country.
To understand the challenge, it helps to compare South Africa with a country that has faced severe natural water scarcity for much longer and responded successfully: Israel.
Average annual rainfall
- South Africa: 450 mm
- Israel: 430–450 mm
- Global average: 860 mm
Both South Africa and Israel receive roughly half the global average rainfall. In South Africa, rainfall is highly uneven spatially and seasonally, with much of the country’s economic activity concentrated in inland regions with limited natural water endowment[1].
Rainfall alone, however, does not explain outcomes. The decisive differences are in how water is managed, allocated and protected.
An ancient Nabatean water channel, engineered to capture and direct scarce rainfall in an arid environment – an early Middle Eastern example of water security achieved through design | https://en.wikipedia.org/wiki/Nabataean_architecture
Where the water goes
Beyond climate, several quantitative differences are relevant:
Agricultural water use
- South Africa: 60–62% of total water withdrawals
- Israel: 50–55%, largely non-potable (treated wastewater and brackish water)
In both countries, agriculture dominates water use. Israel’s distinction is that it reserves high-quality water for domestic and health uses while their agriculture relies predominantly on recycled and lower-grade supplies. This practice has been studied extensively by Israeli scientists and shown to be safe for when supported by high treatment standards, monitoring, and crop restrictions, with no measurable increase in foodborne or environmental health risks.
Wastewater treatment and reuse
- South Africa: Less than half of wastewater treatment works consistently meet compliance standards; 14–17% is reused, but mostly indirectly (via rivers)
- Israel: 95% of wastewater is treated; 85–90% is reused, primarily for agriculture (the highest rate globally)
From a health perspective, this difference is decisive. Poor wastewater treatment contaminates rivers and dams, seeding enteric disease and increasing healthcare burden. High reuse simultaneously protects ecosystems and stabilises supply.
System losses (“non-revenue water”)
- South Africa: 40–45% nationally
- Israel: typically <10%, often 5–7%
Losses at South Africa’s scale exceed the yield of several major dams.
Supply diversification
- South Africa: a small number of operational coastal desalination plants supply local municipalities and facilities at very modest scale[2].
- Israel: 50-60% of domestic water is supplied by large-scale seawater desalination integrated into a national conveyance system
Desalination is feasible, especially if solar-powered, but even then expensive and not universally applicable in South Africa, particularly inland. The transferable lesson is supply diversification and redundancy.
Per-capita domestic use
- South Africa: 235-250 litres/person/day (26% above the world average of 173 litres/person/day, but highly unequal)
- Israel: 170-180 litres/person/day
Despite universal availability, Israel uses less water per person, reflecting universal metering of all water consumption, pricing without subsidies, and sustained conservation norms.
Israel: global leader by design
By most technical measures Israel is the global reference case for water management.
As described in the 2015 book Let There Be Water this leadership reflects decades of coordinated policy, engineering and institutional continuity.
Several features of Israel’s experience are particularly relevant to SA and other countries.
Agriculture and drip irrigation
Israel invented drip irrigation in the mid-20th century. Compared with flood or sprinkler irrigation, drip systems typically:
- reduce water use by 30–60%, and
- increase yields by 20–50%, especially in high-value crops.
Today, roughly 75-85% of Israel’s irrigated agriculture uses drip or micro-irrigation. Despite its dry climate, Israel is a net agricultural exporter, producing food largely with recycled or brackish water. This decouples food security from competition with domestic and clinical water needs.
The vineyards of Carmey Avdat Farm in the Negev desert, where it rains four days a year and the temperature exceeds 30°C half the year | Nevo Perez | https://www.abramundi.org/post/from-sand-to-flowers-israel-brings-life-to-the-desert-2
Wastewater as a strategic resource
Israel treats nearly all municipal wastewater and reuses almost all of it, mainly for agriculture. This protects rivers and aquifers from faecal contamination, frees potable water for households and hospitals, and stabilises supply during droughts.
Desalination at national scale
Israel is the world leader in large-scale seawater desalination as a routine public utility. Five major plants supply more than half of domestic demand. Desalinated water feeds into a national grid, allowing redistribution and aquifer recovery. Israel can now produce more water than it consumes in an average year.
Efficiency and measurement
Universal metering, cost-reflective pricing, and rigorous leak detection keep losses exceptionally low. Water is valued strategically and operationally.
Politics and water diplomacy
Israel’s water system developed in a complex political environment. It supplies water to neighbours, including Jordan and the Palestinian territories, recognising water as a stabilising necessity. Between 1962 and 1979, Israel even assisted Iran with water management until cooperation ended after the Islamic Revolution. Today, Tehran faces a severe water crisis driven by aquifer depletion and mismanagement, arguably more acute than Cape Town’s Day Zero episode.
Water security is a health system issue
Water security determines whether healthcare can function safely.
- Locally, unreliable water undermines hygiene, sterilisation, food preparation, waste handling and staff safety.
- Regionally, failing wastewater systems contaminate rivers and reservoirs, increasing infectious outbreak risk and loading already constrained services.
- Nationally, water insecurity is like load shedding for health: raising costs, disrupting services, and eroding trust.
Israel’s experience shows that it is possible to decouple health system reliability from rainfall variability. South Africa’s experience shows the cost of failing to do so.
What South Africa can do next, starting with health
The World Health Organisations says water, sanitation and hygiene (WASH) are crucial to human health and well-being. Stakeholder in health therefore have both a constitutional and professional obligation to work on water issues.
Compared to Israel, South Africa is larger, poorer, more unequal, lacks comparable technical and scientific resources and is institutionally fragmented. But certain principles are transferable from the Israeli experience.
- Treat water as critical health infrastructure
Hospitals should have audited water-security plans: storage, redundancy, quality assurance and escalation thresholds. Water outages in hospitals should be treated as serious safety incidents. Accreditation bodies like OHSC should make water redundancy a critical, non-negotiable standard.
- Fix wastewater before chasing new supply
Restoring wastewater treatment compliance is among the highest-yield public health investments available.
- Aggressively reduce non-revenue water (losses and leaks)
Leak detection, pressure management, and billing reform are faster and cheaper than building new dams. Preventing water loss is fiscal hygiene; wasting 40% of the water budget should be as unacceptable as wasting 40% of the drug budget.
- Strengthen central coordination where rights and safety are at stake
National standards and enforcement should be non-negotiable for systems that underpin constitutional rights – and patient safety.
- Don’t wait for the next crisis
Day Zero was a warning. Health systems, and countries, require reliable water systems and must plan and work towards this goal.
Israel has shifted from relying almost entirely on natural water in 1985 to a diversified portfolio in which desalinated and recycled water dominate today. South Africa is still stuck in the ‘1985’ pie chart. Water Management in Israel: Key Innovations and Lessons Learned for Water-Scarce Countries. Washington, DC: World Bank; 2017 Aug
Conclusion
South Africa’s Constitutional right to sufficiency water is a moral imperative we should uphold. Israel’s experience shows that natural scarcity can be overcome through systems and execution.
Sources and Further Reading
- Constitution of the Republic of South Africa, 1996. Chapter 2, Section 27: Right of access to health care, food, water and social security. Available from: https://www.justice.gov.za/constitution/SAConstitution-web-eng-02.pdf
- Department of Water and Sanitation, Republic of South Africa. National State of Water Report 2024 – Water Security. Pretoria: DWS; 2024. South Africa’s average annual rainfall and water scarcity context. Available from: https://www.dws.gov.za/Projects/National%20State%20of%20Water%20Report/Documents/National%20State%20of%20Water%20Report%202024%20-%20Water%20Security%208.pdf
- GCIS (Government Communication and Information System, South Africa). Water and Sanitation 2023/24. Pretoria: GCIS; 2023. Agricultural water use, municipal/domestic share, access to sanitation. Available from: https://www.gcis.gov.za/sites/default/files/docs/gcis/pdf/yearbook2023-24-21%20Water%20and%20Sanitation%202023-24.pdf
- AQUASTAT – FAO’s Global Information System on Water and Agriculture. Food and Agriculture Organization of the United Nations. Water Use by Sector and Country Profiles. Standard international dataset on water withdrawals by agriculture, industry, and municipalities (global and country-specific). Available from: https://www.fao.org/aquastat/en/overview/methodology/water-use/
- OECD. Water Governance in Cape Town, South Africa. Paris: OECD; 2021. Discussion of water governance, non-revenue water levels and institutional arrangements. Available from: https://www.oecd.org/content/dam/oecd/en/publications/reports/2021/03/water-governance-in-cape-town-south-africa_9ea13a18/a804bd7b-en.pdf
- Some observations on the water resources development and management transition in Israel WRC. The Water Wheel September/October 2016. Available from: https://www.wrc.org.za/wp-content/uploads/mdocs/WW%20Sept%202016_International%20water%20resources.pdf
- World Water Council / International Reports on Water Scarcity and Demand. Water Supply and Sanitation Economic Dynamics. Various reports. Background on demand, non-revenue water, infrastructure challenges, and reuse potential in South Africa. Available from: https://www.worldwatercouncil.org/fileadmin/wwc/About_us/HQ_Staff/WWC_-_6e_Forum_mondial_de_l_eau_-_VE.pdf
- Wikipedia. Witsand Solar Desalination Plant. Example of a small solar-powered desalination facility in South Africa. Available from: https://en.wikipedia.org/wiki/Witsand_Solar_Desalination_Plant
- Wikipedia. Western Cape Water Supply System. Local usage patterns and sectors in South Africa (household vs. agriculture). Available from: https://en.wikipedia.org/wiki/Western_Cape_Water_Supply_System
- Siegel S. Let There Be Water: Israel’s Solution for a Water-Starved World. New York: St. Martin’s Press; 2015.
- OECD. Water. Available from: https://www.oecd.org/water/water-governance-in-israel.pdf)
- Tal, A. (2025). Thinking Outside the Basin: Evaluating Israel’s Desalinated Climate Resilience Strategy. Sustainability, 17(23), 10636. Available from: https://doi.org/10.3390/su172310636
- WHO & UNICEF. Water, Sanitation, and Hygiene in Health Care Facilities: Global Baseline Report 2019. Geneva: WHO; 2019. Foundational evidence on why water security matters to healthcare quality and outcomes globally. Available from: https://iris.who.int/server/api/core/bitstreams/3f07284d-7563-4b46-8283-59f197461bff/content
- Marin P, Tal S, Yeres J, Ringskog KB. Water Management in Israel: Key Innovations and Lessons Learned for Water-Scarce Countries. Washington, DC: World Bank; 2017 Aug. https://documents1.worldbank.org/curated/en/657531504204943236/pdf/Water-management-in-Israel-key-innovations-and-lessons-learned-for-water-scarce-countries.pdf
[1] Gauteng produces approximately one-third of national GDP but lies on a continental watershed divide with no major natural lakes or perennial rivers. The region depends on long-distance inter-basin transfer schemes, notably the Lesotho Highlands Water Project which is in danger of shutdown. The project feeds the Vaal River system for municipal, industrial and energy supply.
[2] South Africa has several small operational reverse-osmosis desalination plants serving coastal towns and specific precincts, including Mossel Bay (~10 ML/day), Bushman’s River Mouth (~1.8 ML/day), Cannon Rocks (~0.75 ML/day), Knysna, Plettenberg Bay, Lambert’s Bay, and the V&A Waterfront (~2 ML/day). These plants provide local supply resilience but do not currently contribute materially to national or metropolitan bulk water systems.