Mathatisi Sebusi / Billy Ntaote
IN Ha-Mamathe’s Kolone village, 68-year-old ’M’e Makopano Kobile keeps a plastic folder of medical papers that record how her husband, Teboho, died. He had worked for years at Harmony Mine No. 2 in Virginia, South Africa, before being sent home after doctors declared him unfit for underground work. He had tuberculosis (TB).
“His papers show that the mine doctors confirmed he had TB,” Ms Kobile said.
“He died while still on treatment. Yet the Tshiamiso Trust (which is mandated to compensate former gold mineworkers across Southern Africa who contracted TB and Silicosis while working at the mines) says he does not qualify for compensation”.
Her experience is shared by hundreds of Basotho families. Men who spent their working lives underground in South Africa’s mines are now home in Lesotho, struggling to breathe. Widows and children remain trapped in poverty while the compensation system set up to address the mining legacy moves slowly or not at all.
A Dual epidemic
According to Dr Llang Maama, who heads Lesotho’s National TB Department, long-term exposure to silica dust is the common factor linking many ex-miners’ illnesses.
“Silicosis destroys lung tissue and makes a person extremely vulnerable to tuberculosis. Once TB infects a person with silicosis, recovery becomes very difficult. The lungs are already damaged.”
Her explanation matches findings from a 2020 study published in Occupational Health Southern Africa. Researchers examined 2 758 Basotho ex-miners at the Mafeteng Occupational Health Service Centre under the Tuberculosis in the Mining Sector (TIMS) project.
- 42.5 percentwere diagnosed with silicosis.
- 60.9 percentshowed evidence of previous or current TB.
- 25.7 percenthad both silicosis and TB.
- 30.7 percentwere also HIV-positive.
Dr Maama, explained that “silicosis is an occupational lung disease caused by prolonged exposure to silica dust, especially in gold mines. Patients with silicosis will experience longstanding coughs, difficulty in breathing, and progressive destruction of their lungs”.
She emphasizes that while silicosis itself is not contagious, it significantly weakens the lungs, leaving miners vulnerable to tuberculosis (TB).
“Miners with silicosis easily contract TB because their lung health is already compromised,” Dr Maama said.
Dr Hatane Hatane, an occupational-health physician at Mafeteng OHSC added that, “These figures show a continuing public-health crisis”.
“Silicosis has no cure. TB is curable, but together they cause severe disability and early death. Many patients require oxygen therapy we cannot always provide.
“Silica particles disrupt the lungs’ immune defenses, increasing the risk of TB, and when both diseases occur together, patients face severe respiratory symptoms, chronic hypoxia, and even risk of death”.
Together, they underline that the combination of silicosis and TB, often called silico-TB, can be fatal and requires urgent medical attention and careful management.
Patients left behind
Former miner, Khotso Thebeli from Mahlatsa in Berea, worked 36 years in various South African mines.
“I was diagnosed with TB at Royal Bafokeng Platinum Mine. When I claimed compensation, they told me I don’t qualify. I still have my medical certificate showing I was declared unfit for work.”
Another ex-miner, Ramahetlane Thelele, spent four decades in the gold mines of Rustenburg and Welkom.
“Tshiamiso Trust said I am not eligible for compensation but did not explain why,” Thelele said.
“I was sent home because of TB. Later TEBA gave me a small payment, but they did not tell me what it was for.”
Since 1912 (as the Native Recruiting Corporation), TEBA has been a key institution for recruiting Basotho men to work in South African gold mines. Lesotho has historically been a major “labour-sending” country for South Africa’s mining industry.
The ex-miners’ association in Lesotho says incomplete mine records and lack of coordination between South African and Lesotho authorities leave most claimants without proof required by the Trust. “Many have lost documents or cannot travel to verification centres,” Ex-Miners Association director, Rantšo Mantsi, said.
He said both governments are reluctant to work with their association to trace ex-miners and beneficiaries of deceased ex-miners who are currently unreachable.
“Many beneficiaries changed their contact details while others lost their sim cards due to failure to register them. If we were to be engaged, we would successfully trace them,” he said.
Tshiamiso Trust CEO, Munyadziwa Kwinda, acknowledges the frustrations but says the Trust operates under strict legal and medical rules that define who qualifies.
“The fact that somebody has a diagnosis of either silicosis or TB does not automatically mean that they will be compensated,” Dr Kwinda said.
“There is a medical certification process that determines who is eligible and at what compensation class.”
He said that of nearly 54 000 claims lodged in Lesotho, about 32 000 had been processed and 9 300 paid.
“We recognize the challenges, but our commitment is to reach as many eligible claimants as reasonably possible before the Trust’s term ends in 2031.”
A national health strain
Lesotho’s tuberculosis incidence remains among the world’s highest — about 661 cases per 100 000 people, according to the World Health Organisation (WHO data, 2024). Nearly three-quarters of patients are co-infected with HIV.
Dr Maama says returning ex-miners have contributed to household-level TB transmission. “When they come home sick, they live in close quarters with their families. The infection spreads,” she says. Rural clinics often lack diagnostic tools and oxygen, and treatment adherence is weakened by poverty. “Many patients tell us they cannot take their pills on an empty stomach,” adds a community nurse in Mafeteng. “That fuels drug-resistant TB.”
The Trust’s CEO says the medical reality has also complicated the compensation process. “Doctors across the region often write causes of death as ‘respiratory failure’ or ‘natural causes,’ not silicosis or TB,” Kwinda notes. “This made it difficult to confirm eligibility for dependents.” He said Amendment Number 7 to the Trust’s deed now allows the use of medical findings on cause of death, recommended by the WHO, “so that genuine cases are not excluded for lack of wording on a death certificate.”
He added that Amendment Number 8 was introduced to address cases where miners no longer had active TB but had clear historical medical records. “Those people can now be compensated based on previous TB records,” he said.
Compensation delayed
Although the Trust has begun outreach operations in Lesotho’s lowlands to clear backlogs and assist claimants with missing documentation, the scale of need remains immense. Kwinda confirmed that around 2 600 claimants are still awaiting Benefit Medical Examinations (BMEs) and that the Trust’s medical-eligibility rate remains around 30 percent.
“Out of ten claims that go through our medical certification panel, only three are medically eligible,” he said. “That is where the unhappiness comes in, because everyone has hope, but the Trust can only compensate within the rules of its deed.”
For those still waiting, like ’M’e Makopano, the process feels endless. “They told us Tshiamiso means justice,” she says. “But for us, justice is still far away.”
Lesotho’s government, meanwhile, has no comprehensive register of its ex-miners and lacks a dedicated compensation-support office. Coordination between ministries of health and labour on both sides of the border remains weak.
“This is a governance issue,” says a Maseru-based health-rights advocate. “Lesotho and South Africa benefit from these men’s labour but have not built systems to protect them afterward.”
Unfinished justice
Back in Kolone, Makopano depends on her adult children for food and medication. Her husband’s grave remains unmarked.
“If they could only admit he died from the mines, I would feel at peace,” she said.
Dr Kwinda insists the Trust is evolving to fix its shortcomings.
“We listen when people speak. We take those concerns to the trustees and founders, and where possible, we amend the deed. We are already working on further amendments to address outstanding issues.”
Lesotho’s highlands remain dotted with the homes of men who once filled South Africa’s mines men whose breath now comes short and whose families wait for answers. Without faster compensation, cross-border medical cooperation, and consistent screening for TB and silicosis, the crisis will deepen.
“Silicosis and TB are not just medical conditions. They are the unfinished business of the mining era. Until we address them properly, the suffering will not end,” Dr Hatane warns.
This work was produced as a result of a grant provided by the Wits Centre for Journalism’s African Investigative Journalism Conference
