After serving as a paramedic for 30 years in the South African city of Durban, Mangaliso Musoni resigned from his job with a heavy heart last August. He felt like he had no choice but to resign. Two months earlier, in June 2021, Musoni was attacked and shot twice while on duty.

“We received an emergency call and we rushed to the location, only to be met by a group of about five armed men who forcibly diverted us to a secluded dark area. They robbed us of all our belongings,” he told The Real News with tears in his eyes. “They then told us that we were supposed to go and treat their fellow gang members who had been injured during a shootout.” 

When Musoni and his fellow paramedics arrived, the shootout began again.  

“When we got to the place, it was unfortunate—the shooting started again, bullets being fired indiscriminately,” he said. “My crewmate was shot [in] the chest and head. She succumbed to the gunshot wounds, but I made it with two gunshots—one on the arm and the other on the thigh.”

The incident left Musoni traumatized and he has yet to fully recover, which was one of his major reasons for leaving the job. 

Since the COVID-19 pandemic began, the security of health officials has been an ongoing issue throughout South Africa, and medical personnel have become soft targets for gangs looking to take advantage of a climate of social and economic desperation exacerbated by the public health crisis.

In July, one month after Musoni was shot, four paramedics were attacked and robbed in Blackheath, Capetown, while attending to a patient. In a separate incident in the KwaZulu Natal Province, one paramedic was killed and another sustained critical injuries when their ambulance was shot at en-route to the scene of another shooting incident.

In another incident last May, former special adviser to the national Health Department and general practitioner Dr. Esthras Tlou Moloko was attacked at his Germiston practice. Dr. Moloko was severely beaten by two men who entered the practice. Dr. Norman Mabasa, a general practitioner in Kagiso, Krugersdorp, and a former Limpopo Health Member of the Executive Council, was also a victim of a criminal attack at his practice. 

According to a December report by The 77 Percent, there were 78 recorded attacks on medical personnel in South Africa in 2021, the highest in the last five years. The situation has been described as another “national disaster” by the Medical Association of South Africa. 

As in other countries, including the United States, crime statistics over the past two years need to be analyzed in context (something that is often abandoned in a sensationalist and competitive media economy). In South Africa, when compared to the previous year, rises in crime in 2021 are certainly alarming, but it also shouldn’t be surprising that a country that instituted strict lockdown measures and alcohol bans in the first year of the pandemic saw dramatic reductions in many types of crime but increases in others. Enforcing compliance with these emergency measures, writes Anine Kriegler, a postdoctoral fellow at University of Cape Town, may very well have corresponded with a decreased focus on other law-breaking activities. Moreover, with fewer people on the street while stay-at-home measures were in effect, emergency medical personnel likely became more visible targets for assailants. 

“South Africa’s latest crime statistics do not show a sudden escalation in crime,” Kriegler argues. “Instead, they show a return to the trends seen before this exceptional period of lifestyle disruption. But this should not lead to complacency. Levels of crime, especially violent crime, are still among the highest in the world.”

It is important to note that workplace violence against medical professionals has been a critical concern both beyond South Africa and before the pandemic. However, COVID-19 appears to have amplified the sociological and socioeconomic pressures that drive increases in such violence, and medical personnel—and the patients who depend on them—are feeling the strain. 

“The pandemic led to many job losses and widespread hunger, hence many people are forced into illicit goods markets and robberies,” Lizette Lancaster, manager for Crime and Justice Information at the Institute for Security Studies, told The Real News.

More than two million people lost their jobs due to the pandemic, according to data provided by Statistics South Africa, with unemployment numbers reaching new highs at the end of last year.

“The high unemployment rate, low education levels, high violence levels, and inadequate safety nets in many communities lead to high levels of despair and desperation,” Lancaster said. “Health care workers and paramedics offer high-reward, low-risk opportunities to local street gangs or at-risk drug dependent youths to get cash and other services.”

Shamila Batohi, head of South Africa’s National Prosecuting Authority (NPA), explained that communities are “feeling the financial pinch due to the pandemic, indicated by the rise in crime.”

In one of the latest incidents, which occurred on Dec. 5, 2021, a COVID-19 vaccination team was robbed at gunpoint in Soshanguve township. “Vaccination gadgets including three tablets, one smart phone, and six cellphones belonging to the team were stolen,” Gauteng Province Health spokesperson Kwara Kekana confirmed. All of these items can be sold quickly, making them a prime target for those looking for—or in desperate need of—fast cash. 

For Musoni, however, navigating the dual threats of COVID-19 and gang violence put not only him but his family at risk. 

“I am the breadwinner in my family. I have three children and they are all in school. Because I fear for my life if I continue working, my children will be affected,” Musoni said. “I had to resign because I am now living in fear. I am fatigued, injured, morally battered and shattered. Paramedics are supposed to help communities but if the same communities we are serving are harming us, then we are doomed.” 

South Africa can ill afford to endure more constraints on its healthcare workers and public health institutions, but these work hazards can have devastating repercussions not only for medical professionals and their families but for the communities that depend on them. In a country that has been the hardest hit in the Southern African region by pandemic-related infections and deaths, compromising the effectiveness and efficiency of the nation’s healthcare system is a major setback. 

It isn’t only medical personnel responding to emergencies who are under attack. Staff working inside of South Africa’s hospitals and clinics have also reported being traumatized and fearing for their lives due to robberies.   

In August, equipment worth R30 million (approximately 1.9 million US dollars) was stolen from Charlotte Maxeke, one of the biggest hospitals in Johannesburg City. This kind of incident is of great concern to healthcare workers like Martha Ndlovu, a nurse at Charlotte Maxeke Hospital, who notes that security at hospitals is severely lacking. 

“We are not safe at work,” Ndlovu told The Real News. “We work in fear everyday.”

Ndlovu recalled an incident where she was assaulted by a patient. “A patient slapped me before pointing a gun at me after a misunderstanding,” she said. “Security personnel are not enough or well equipped to deal with such situations at the hospital.”

A private security officer who spoke to The Real News on condition of anonymity said security personnel are “not allowed to carry guns in hospitals.” 

Doctors who work in private facilities have not been spared. Some have been robbed and killed, some have been maimed on the job, while others have closed business out of fear. 

Urologist Dr. Mike Unene was stabbed to death by armed robbers who raided his premises in January of last year. His family is still traumatized, Unene’s daughter Miranda told The Real News.

“We lost a father, a grandfather, a husband, and above all a people’s doctor. Around seven robbers entered the premises and one of them was pretending to be a patient,” Unene said. “They took everything, including cough syrups, and then they told daddy to give them his bank cards and the pin codes. They then stabbed him.”

Dr. Josias Naidoo, chairperson of the National Health Care Professional Association, an organization that advocates for the rights of health practitioners in South Africa, told The Real News that practitioners are vacating townships that are regarded as “red zone” areas. 

“Attacks on practices are happening all over—in shopping centers, stand-alone GP practices or pharmacist stores, across the board,” Naidoo said. “We engaged security experts early this year and they advised us that practitioners need to make themselves harder targets. Install CCTV cameras, have stricter access control, and not keep extra laptops and other gadgets lying around.” 

And these are only the attacks that were reported. Many more go unreported. Even when victims might be able to identify and report their assailants, many do not believe they will get enough protection from the police and the judiciary if they do.

“Sometimes people actually know the perpetrators. Some are patients and some are children of the patients, so sometimes health officials fear that if they report to the police, they will be targeted,” Naidoo said.  

While crime increases, moreover, fear rises and collective trust in the efficacy of the criminal justice system drops, thus resulting in fewer people turning to that system if they are the victims of a crime. 

At a time when the country is battling a harsh fourth wave of COVID-19 driven by the highly contagious omicron variant, a more efficient health system is vital. However, according to Dr Naidoo, “practitioners are now hesitant to see people at night because they are increasing the risk.” 

This is impacting how communities get care. After attacks, practitioners often close down. When they leave the townships that depend on their services, no one replaces them. Most community-based practitioners have departed for safer areas, which only exacerbates existing disparities in the accessibility and quality of medical aid for South Africans.

Insofar as there inevitably are complex sociological and personal factors that contribute to rises in violent crimes, addressing the root causes of this violence requires more than just throwing more police at the problem.

Socioeconomic hardships increased due to the pandemic, and South Africa needs better social welfare support, healthcare services focused on drug treatment, and youth skills development in order to create decent sources of income. Multi-stakeholder violence prevention strategies need to also be prioritized in many communities—especially in urban areas—to reduce levels of crime. 

In response to the attacks, Emergency Medical Services (EMS) paramedics are now required to have a police escort to attend to emergencies in most risky areas. The process, however, compromises the efficiency of paramedics who, in many cases, have to wait for hours before police respond to their request.

“There are cases where lives are lost because the emergency team fails to respond within the expected time—because they would be waiting for police escort,” said EMS spokesperson Deanna Bessick. 

According to police spokesperson Brigadier Vaishinu Naidoo, “police only escort paramedics in hot spot areas and […] they give priority depending on the seriousness of the matter. For example, if someone is reported to be having a headache, we won’t avail police escort for that.”

Last May, paramedics employed by the government staged a demonstration at the Ministry of Health, demanding pay for overtime and protective clothing to improve their safety.  

Paramedic Amanda Mutisi says she is fortunate since she works for a private emergency organization and they have been equipped with bulletproof vests to protect themselves.

“I was fortunate because, hardly a week after we were given bullet proof vests, I was stabbed [in] the chest and I don’t even know why he stabbed me,” she said. “We had to abandon the assignment and unfortunately the patient we were supposed to help passed away. It affects me up to this day. My job is to save lives but crime has made it very difficult of late.”

The pandemic has exacerbated economic pain and joblessness, disproportionately affecting the poor in South Africa. And the longer that global vaccine apartheid persists, the longer this pandemic will go on, and the more it will continue to tear our societies—starting with the most disadvantaged and despoiled—apart. The more our nation’s populations are vaccinated, the better the chances of controlling the spread of the virus, the more economies can get back to functioning normally, the more lost jobs can be recovered, etc.  

This is why the ongoing situation regarding global access to COVID-19 vaccines, and roll-out gaps in low-income and middle-income countries compared with high-income countries, should be addressed with urgency. If wealthy countries won’t fight harder to end global vaccine apartheid and healthcare disparities for the sake of poorer countries like ours, they should at least do it for their own sake. 

Two years since the first case of the virus was confirmed in South Africa, over 95,000 people have succumbed to the disease. The country’s president, Cyril Ramaphosa, has been on the forefront in the fight against vaccine apartheid.

“I have personally been disappointed by the approach the rich countries have taken on the issue of vaccines. They hoarded vaccines, ordered more than their populations require. The greed they demonstrated was disappointing,” said Ramaphosa. European Council President Charles Michel denied the existence of global vaccine apartheid and stressed that “EU had been looking at ways to assist Africa.”

Just 11% of Africa’s 1.2 billion people have received two vaccine doses.

Developed countries have blamed the low vaccination rates on hesitancy among individuals and communities, but African leaders maintain that vaccine availability is the primary challenge. 

As large parts of the South African population are living barely above the poverty line, the COVID-19 crisis reduced progress in poverty eradication and pushed large numbers of people back into poverty, increasing crime and reducing safety. This global health crisis, compounded by a major economic and financial crisis, has put significant strains on already vulnerable economies, rolling back progress in increasing living standards.

For former paramedic Musoni, his wounds are a permanent reminder of the harsh side of humanity when calamities hit and local, national, and international support is absent.

“The gunshot wounds are a mark of how selfish and heartless people can become in a crisis. I served my country with pride but now I am being counted among the unemployed because of bandits who thrive in robbing and killing fellow citizens to make ends meet.”