Background. Intellectual disability (ID) is a relatively high-incidence disability, with an increased risk of poor physical and mental health. Persons with ID also have lifelong support needs that must be met if they are to achieve an acceptable quality of life. Little is known about these health conditions and support needs in the African context. This study examines persons over the age of 18 years with ID in residential facilities in Western Cape Province. Objective. To analyse the health conditions and support needs of persons with ID in Western Cape Province. Method. A survey of residents’ health conditions and support needs was conducted in face-to-face interviews with the managers of 37 outof 41 identified facilities. Results and conclusion. The survey comprised 2 098 residents (54% of them female), representing less than 2% of the estimated populationof persons with ID in the province. The survey suggests that such persons experience a wide range of health conditions (notably mental health and behavioural issues) but have limited access to general healthcare and rehabilitation services. Furthermore, the daily living supports required for an acceptable quality of life are limited. The findings highlight the need for better health and support provision to persons with ID.