Thirty-five-year-old Patrick Mdluli considered himself healthy until he moved two years ago to Mpumalanga province - South Africa’s coal mining heartland. 

The area has the worst air quality in the world, according to a recent study by environmental group Greenpeace. The 12 large coal mines in this area make it the world’s hotspot for toxic nitrogen dioxide emissions.

Soon, Mdluli said, he began to develop health problems, including tuberculosis and nasal issues. 

“The mines, the dust, pollution - you go to doctors, they tell you the very same thing," he said. "‘Are you living next to a mine?’ Yes, I am. ‘Are you living next to a dumping site?’ Yes, I am.”

A large coal mine operates, literally, in Mdluli’s backyard. The mine has conducted blasts every day, shaking his small home to its foundation, filling the rooms with dust and causing a large crack in the wall. Residents in this impoverished area complain that their walls are crumbling because of the incessant blasts. 

But the real damage is on the inside, says the head of one of Middelburg’s main clinics, Dr. Mohammed Tayob. 

Tayob has lived in the area his entire life and says the emissions from the mines have made many of his patients sick. In his lifetime, he says, he's seen a flurry of new mine openings in the area as the nation has tried to profit off its vast coal reserves. 

“Children and adults are paying the ultimate price," he told VOA." When we say ultimate price, it’s the loss of neurocognitive development, children’s infant mortality rate is higher in our area than other areas, adults, heart attacks and respiratory diseases are much higher. So people are paying with their lives, across the board, because of these pollutants in the air.”

Mpumalanga province, South Africa

Although mines are big money, locals say the coal companies have done little to improve the community. Middelburg is poor and many people lack basic services like electricity and running water. 

Tayob says the government is also failing to enforce environmental laws and crack down on the mines. He blames the coal mining industry and poor governance for the current situation. Corruption scandals are prevalent in South Africa, and often grab headlines. 

“One cannot be faulted in thinking, ‘Is there some level of corruption operating in this area as well, where these big boys are getting away with murder, literally?’ he said. "They’re literally getting away with murder. It's just the reality. I’d like someone to come up and dispute this fact and challenge me on that.”

VOA contacted three of the larger mines in the area for comment. None responded to our request. 

Environmental activist Bafana Hlatshwayo says he and other activists are preparing to lobby decision-makers at an upcoming mining industry gathering in Cape Town. 

They want the coal industry to shift to a cleaner resource: the region’s abundant sunshine. 

Bringing solar panel production to the area, says Hlatshwayo, would also create jobs. 

 “We are not saying we want to close down the mines," he said. "...We must go the renewable energy way, we are saying, people will manufacture solar panels inside South Africa, and they are the ones who are supposed to install the solar panels and they are the ones who are supposed to maintain the solar panels.” 

But that is a faraway dream for people like Mdluli and his neighbors, who complain unemployment is high and all of them - including the children - have health problems. 

This province, says longtime resident and environmental activist William Jiyane, used to be beautiful. 

“It’s endless agony, now, Mpumalanga," he said, standing in a neighbor's yard, and gesturing at a belching mine. "It’s not bread and butter anymore. It’s endless agony.”