South Africa is host to a significant number of young migrants who are in institutional care. This study aimed to understand how migrant youth access care, who provides it and their views about the quality of care they receive, given the precarity of urban life in South African cities. The study used a mixed methods, explanatory, sequential research design. In this paper, we present some of the research findings that help understand how young migrants access care in contexts of urban self-settlement and how they create family through everyday care practices to meet their needs. The results show that they maintain ties with family members and meet their needs through a combination of NGO-provided material support and family-provided emotional support. Notably State support was largely absent, making it impossible to meet their needs when the State had a monopoly on service provision (such as documentation and asylum). Being listened to and being able to take decisions regarding their care were extremely important to young migrants and were significantly correlated with better optimism for the future, happiness with the services they receive and optimism for life in South Africa. These findings underscore the adaptive and largely effective ways that young migrants and families meet their care needs in a precarious urban setting. They provide important understanding to ensure that the design of services for young migrants recognise existing care practices that are effective and support rather than supplant them.