The architectural history of healthcare in South Africa remains greatly understudied, as do the consequences of the 1918–19 Spanish Flu, which ravaged its population. Yet that pandemic had great consequences for South African society, spatial planning and the development of healthcare, of which the latter two were still in their infancy at the time. This article explores the link between disease and design in South Africa through the presentation of the histories of selected hospitals, maternity homes, orphanages and a special care school designed by émigré Dutch architects from the 1920s to the 1970s. It is the product of desktop and archival research, site visits and interviews undertaken in both South Africa and the Netherlands. It outlines the disparity of care that was provided for different groups and is a first attempt to identify healthcare ideas transposed into the subcontinent fuelled by the tragic experiences of the Spanish Flu pandemic. Due to this health crisis, communities – structured in terms of language, faith and race – attempted to develop their own facilities for the care of their own. Where communities had no means of their own, charitable organisations tried to fill the void. Over the course of the twentieth century, public healthcare was centralised, but many of the community and charitable institutions persist. By chance or choice, émigré Dutch architects made a disproportionately large contribution to the development of healthcare facilities in South Africa, not only in the number and range of facilities they designed, but also by introducing contemporary ideas into South African healthcare design.