Five months after Health Ombudsman Professor Malegapuru Makgoba released his report, the deaths of Life Esidimeni patients has faded into the shadow of the scandal cycle. In retrospect, the level of callous incompetence and maladministration goes beyond the daily stories of self-enrichment that denies the majority of South Africans decent government services. Gauteng’s most vulnerable citizens, terminally ill psychiatric patients who depended on the state, were sent to die from neglect, hunger and cold.

We don’t even know how many patients died – at least 100. The Gauteng health department was repeatedly warned. In 2015, it decided to send Life Esidimeni patients to NGOs and home care, following the national policy of de-institutionalisation. But it was instituted too early, without preparation, and, as expected, patients died. Government officials insulted those who complained their relatives were moved like cattle to NGOs that could not provide adequate care. They allowed people to die. When they died, relatives were again neglected, denied details or lied to about how and when patients passed.

The extent of the massacre was exposed five months ago. If there is a national soul left in this country, a heart that still beats, those responsible must be held accountable. Today, rather than tomorrow. Spare a thought for the relatives of those who died, the patients who couldn’t care for themselves, how families feel about their terminally ill brothers, sisters, parents sent to die in neglect.

The state offered hope. Former Gauteng Health MEC Qedani Mahlangu resigned before the ombudsman’s report was released. Her replacement Gwen Ramokgopa and Premier David Makhura made justice a priority. Makhura and Health Minister Aaron Motsoaledi, who both denied they knew of the tragic plan before it claimed lives, took immediate action. Makgoba’s report opened up the possibility for justice.

On Tuesday, President Jacob Zuma announced the SIU would investigate the provincial department and NGOs where patients died. The SIU was tasked to investigate the procurement and payment of the 28 NGOs (it was previously thought that patients died at 27 NGOs, but another institution was recently discovered). It will investigate potential maladministration, unauthorised, fruitless and wasteful expenditure within government, non-performance by the NGOs, and improper or unlawful conduct within the Gauteng health department.

There’s little reason for the ANC government to sleep on the issue and the SIU’s investigation is one in a number of positive steps. The health ombudsman made a wide number of recommendations, both to ensure direct accountability and to prevent a repeat of the disaster.

“As far as I’m aware, all the recommendations have been implemented,” said Health Ombudsman Makgoba on Tuesday. He said some of the recommendations will take time to implement, but he has met with the provincial and national health heads nine times and is waiting for their final reports. He hopes he can soon finalise and release the final death toll.

“We think we’ve done the best we can to implement the recommendations,” said Minister Motsoaledi’s spokesperson, Joe Maila. The national and provincial departments established teams of health professionals to oversee NGOs where patients were transferred before successfully sending them back to reputable healthcare providers, particularly Life Esidimeni and Clinix Selby Park Hospital.

Preventing further deaths is one thing; justice for those who’ve died is another. Charges have been laid against key Gauteng health department officials and the police were mandated to investigate the deaths. Those investigations appear slow. After the process has passed through the SAPS, Hawks and National Prosecuting Authority (NPA), details of the investigations are still hazy at best.

It’s hard to get any information from the investigating authorities. The most official, and clear, response so far is worrying. In a June reply in the provincial legislature, Gauteng MEC for Community Safety, citing a letter from the office of the SAPS provincial commissioner, said there were 22 inquests opened on the deaths of Life Esidimeni patients. They included charges of culpable homicide, corruption and murder. Most of the charges were laid in Pretoria.

Jack Bloom, the DA’s Gauteng shadow minister for health, welcomed the SIU investigation and said the unit should collaborate with the SAPS and NPA teams, but he questioned whether the agencies would hold culprits to account and whether they had the capacity to conduct the investigations. Over 100 people died, but there were only 22 inquests opened.

“The police seem to only be focusing on the inquests and they haven’t even got that right.” He said the SAPS investigations were too narrow and was taking too long. Relatives of victims have expressed the same thoughts. While welcoming the SIU investigation, he noted the extended time past SIU investigations had taken to complete.

While criminal investigations are opaque, departmental measures have been delayed. The ombudsman said government officials must be held accountable and a compensation process must be initiated. We’re still waiting. Disciplinary hearings against top officials, particularly the former head of the Gauteng health department Dr Tiego Selebano and the former mental health department leader Dr Makgabo Manamela, have stalled since they challenged the report. The recommended alternative dispute resolution mechanism, tasked to provide compensation to victims’ families, is yet to be established.

“The trusted person should have been appointed months ago,” said Bloom on the premier appointing an independent person to head the alternative dispute resolution process. Makhura’s spokesperson Thabo Masebe on Tuesday said the national and provincial departments had agreed with the families on who they wanted to chair the process and an announcement would be made soon after the appointment was finalised with the candidate.

Christine Nxumalo, whose sister died after being moved from Life Esidimeni, said she felt “very frustrated” with the response from the government. After her interactions with government, she said she felt “I don’t get the sense that you’re understanding what I’m raising or the urgency or importance of what I’m raising.” She is part of the Life Esidimeni Family Committee. “I’m not going to lie, I’m really worried.”

Nxumalo said there are a number of issues still to be sorted out and it felt as though there was no urgency, particularly on administrative issues important to fully implement the ombudsman’s recommendations. “To have so many people die and it’s almost like there’s no change… I haven’t seen this shakedown or this fear that this can’t happen again.”

Motsoaledi’s spokesperson was sympathetic. “You can understand the frustration of the people if they feel the process isn’t going according to their pace,” he said. “We are working with them every step of the way.”

We live in a democracy where we can compare massacres. It’s grotesque. But the government has responded far better to the Life Esidimeni killings than those in Marikana, for many reasons. Years later, no one has been held to account for the Marikana Massacre. There have been no consequences. Actions have been initiated against those culpable for the Life Esidimeni killings, but starting the process is not enough. Those responsible must be held to account – to offer a semblance of justice to relatives of the victims. To show the country has a soul. To show it has laws. DM

Original painting: Scream by Edward Munch