After an eight-year battle, justice for Life Esidimeni 144 hinges on inquest judgment

In 2016, shocking newspaper headlines across South Africa shook the nation to its core, relaying the first horrific deaths of mental health patients at the hands of a system that was supposed to protect them. What became known as the Life Esidimeni tragedy sparked a long and very public fight for justice for the 144 patients who died from gross neglect and starvation. 

This fight will come to a head on Wednesday, 10 July, when Judge Mmonoa Teffo will hand down judgment in the historic inquest.

While news of the first deaths sparked widespread outrage, nationally and internationally, the fight for the right to dignity began long before the avoidable tragedy, when rumours started circulating in June 2015 that the Gauteng Department of Health’s (GDoH) planned to end a decades-long contract with Life Esidimeni and close the facility. 

Civil society organisations including SECTION27 and South African Depression and Anxiety Group (Sadag) and the families of patients sounded the alarm that patients with mental illness would be at risk if they were moved to places without specialised care.

Their pleas and ensuing litigation were brushed aside, and in October 2015 the then MEC for health in Gauteng, Qedani Mahlangu, decided to terminate the contract with Life Esidimeni. This sparked a three-month scramble, between April and June, to move 1,700 mental health patients from the highly specialised, long-term psychiatric care hospital to 27 unlicensed NGOs that were ill-equipped to care for them. 

Some were loaded en masse into the buses without their belongings, shoes or medical records. Others were tied to bakkies with rope. They were moved without their families’ knowledge. The decision thrust the patients into cruel and inhumane conditions, which ultimately resulted in 144 people dying in undignified conditions.

Speaking to Daily Maverick, Cassey Chambers, operations director at Sadag, who has been fighting for justice alongside the victims’ families, said she had had goosebumps thinking back to when news first broke of the first death on 26 March 2016.

“I still remember exactly where we were when we heard of the first death that happened at Takalani. I remember feeling so devastated because it’s exactly what we hoped to prevent.

“That was such a pivotal moment because I think, going into it, we had never thought, when we were talking about the patients, that that’s where it would lead to.”

Following the first known death, at Takalani, desperate family members spent months searching for their loved ones, mobilising and protesting in a bid to get answers. More deaths were uncovered as the months passed.

It soon emerged that many of the patients at the unlicensed NGOs had been tortured, abused, punished and in some cases deprived of food, water and adequate shelter and sanitation. The patients were not given the medicine or treatment they needed. Many developed dehydration, secondary infections like pneumonia and uncontrolled seizures. The NGOs were not staffed with trained healthcare professionals, lacked appropriate medicine and equipment and in some cases even basic infrastructure such as beds, bedding and sanitation.

Ombud report

On 15 September 2016, the then Health Minister Aaron Motsoaledi requested that the Health Ombud, Professor Malegapuru Makgoba,  investigate the deaths in the aftermath of the closure of Life Esidimeni. After months of investigation and delays, his report was finally released on 1 February 2017, detailing the inhumane conditions and deplorable treatment patients endured at NGOs such as Ubuhle Benkosi, Mosego Home and Takalani Home.

Makgoba’s report, titled “94+ silent deaths and still counting”, found that there were 94 unlawful deaths, which had not been caused by conditions other than mental health. Another major finding was that all 27 NGOs were operating with invalid licences. Makgoba also found that the Department of Health had been negligent in moving 1,900 patients from Life Esidimeni.

“There is prima facie evidence that certain officials and certain NGOs and some activities within the Gauteng Marathon Project violated the Constitution… [and] have shown a total disregard of the rights of the patients and their families, including but not limited to the right to human dignity; right to life; right to freedom and security of person; right to privacy; right to protection from an environment that is not harmful to their health or well-being; right to access to quality healthcare services, sufficient food and water; and right to an administrative action that is lawful, reasonable and procedurally fair,” the report read.

MEC Mahlangu resigned the night before the ombud’s report was released.

Nine months after its release it emerged that the death toll stood at 144.

While the ombud’s findings were shocking, they were the first sign that the families’ pleas for justice had been finally heard. This paved the way for a historic arbitration which will see the families compensated for the injustice they suffered at the hands of the GDoH.

Watershed arbitration

In June 2017, former Deputy Chief Justice Dikgang Moseneke was appointed to arbitrate an alternative dispute resolution between the government and the families of the deceased (legally represented by SECTION27) and survivors in line with the recommendations of the ombud’s report.

For 45 gruelling days, 60 witnesses testified, finally peeling back the curtain to reveal the inhumane conditions and sheer scope of negligence that characterised the tragedy.

The arbitration not only uncovered evidence that could lead to criminal charges against top health officials and exposed attempts to cover up their culpability, but it finally allowed families and victims to express their anguish over what happened when their relatives were moved from Life Esidimeni.

Recalling the arbitration, SECTION27 executive director Sasha Stevenson told Daily Maverick that a moment that truly stuck with her was how the families of the deceased formed long-lasting bonds in their fight for justice. 

Read more in Daily Maverick: Life Esidimeni Tragedy

“In the course of the arbitration, when we were sitting and listening to this horrific testimony every day for 45 days, I remember seeing one of the family members walk hand-in-hand with another [person] from a different family down the stairs at [Emoyeni Conference Centre]. Just seeing that solidarity, these people didn’t really often didn’t know each other before then, but, through this absolutely unmitigated disaster, became a collective, a community that supported each other. Just seeing this very human connection that was created through this tragedy was really striking to me, and I think it’s also what propelled the very long-lasting fight for justice.”

In a watershed moment, Moseneke found in favour of the families and ordered the state to pay R1-million in damages to each claimant for the gross violation of various rights enshrined in the Constitution. In terms of common law damages, he ordered the state to:

• Pay claimants R180,000 for psychological injury and trauma;
• Pay claimants R20,000 towards funeral costs;
• Erect a memorial for the victims of the Life Esidimeni Marathon Project; and
• Pay for counselling for up to three family members of the deceased.

Chambers described this as a true moment of vindication in the fight for justice.

“For 40-plus days, family members were being bused in, and many of them had lost jobs. They sacrificed so much to be there, and they stood in this hall, in this room, when Judge Moseneke read out his closing judgment with such care and compassion. It was so emotional and heavy, but it was the first time that I felt like we had been heard. Like someone had said, ‘Yes, this was wrong, and we were right in bringing this up’. I think, for me, in that moment, there was a lot of vindication for what we had been pushing for so long.”

The inquest

During the inquest, which began in July 2021, SECTION27 argued for culpable homicide charges to be brought against Mahlangu, former Gauteng mental health head Dr Makgabo Manamela, and the owner of the Precious Angels NGO, Ethel Ncube.

The inquest was inundated with blame-shifting and finger-pointing. Mahlangu testified that the premier’s budget committee, chaired by former premier David Makhura, had decided to terminate the contract.

Manamela’s lawyer argued that the district and not the Gauteng health department were responsible for identifying and licensing NGOs, adding that it would have been impossible for her to inspect all the NGOs tasked with taking in the Life Esidimeni patients.

The lawyer for Ncube — at whose Precious Angels NGO 20 patients died –  should bear no responsibility for the department’s inability to do due diligence. 

Two years after the inquest started, Judge Teffo will hand down the judgment in the Pretoria High Court on 10 July. It will determine whether Mahlangu, Manamela and Ncube are criminally liable for the deaths.

“It’s taken a really, really long time to get answers or to get more information. And I think this is also where we, as much as the family members and SECTION27 and even the press and the public, are expecting so much from this inquest judgment. We’re expecting some more answers, some more explanations and some more justice. I think that’s one of the things that we’re hoping for, whether we get what we’re needing. I think in such a tragedy, there’ll always be some element of what kind of justice would be enough for this very tragic loss,” Chambers said. 

Activist and SECTION27 co-founder Mark Heywood said that while he hoped the inquiry would find criminal liability for the tragedy, he was cautiously optimistic about the judgment.

“I don’t know whether I’m hopeful or worried about the judgment being handed down. I know in my mind that people like Qedani Mahlangu and some of her officials have criminal culpability for their conduct and the consequences of their conduct. I hope that the inquest will find the same. I’m not a praying man, but I hope the judge comes to the same conclusion because there needs to be criminal prosecution for there to be ultimate justice and for there not to be impunity for the loss of so many lives,” he said. DM