Urban-rural migration systems involve complex reciprocal relationships between urban and rural areas that are impacted by illness. Migrants in cities like Addis Ababa, Johannesburg, and Windhoek maintain ties to rural homes through remittances, forming interlinked livelihood systems. If urban migrants fall ill, most Johannesburg and Windhoek respondents would return home, while most in Addis Ababa would rely on family/community in the city. Sickness disrupts these interlinked systems through loss of remittance income and increased care burdens on rural networks.