Given its well-established impacts on human health, its inherent toxicity, as well as its tendency to accumulate in living organisms, mercury (Hg) pollution is of grave concern to humanity. Notable known toxicity of this non-essential element includes neurological and carcinogenic effects. The elimination of mercury in humans is therefore of considerable importance worldwide. The upsurge in independent artisanal and small-scale gold mining (ASGM) activities in South Africa is contributing towards the provision of employment and generation of wealth. However, economic gains are countermanded by health degradation and destruction of vital industries such as farming and fishing. Significant quantities of mercury are being used for amalgamation of gold (Au) (constituting a major source of mercury emission into the environment), despite the continued introduction of more efficient mining techniques. Our systematic review based on the PRISMA Protocol and backed by documented medical registry data, does show that occupational mercury exposure from ASGM activities in South Africa still (as at 2025) produces signs and symptoms related to neuro-psychological disorders, ataxia, tremor or memory problems. The absence of environmental concern or the lack of enforcement of regulations also persists in many instances. Geochemical surveys prior to operation and close monitoring to quantify emissions during various stages of the gold mining process can minimise contamination. Remediation schemes can also be devised and monitored by the application of sound geochemical techniques for identifying primary sources of mercury release, its mechanism of transport and other toxicokinetic variables. Strengthening efforts by the South African Government at formalising this industry will ensure rapid realisation of these proposals.