A grandmother arrives in hospital with a fractured hip. She is scheduled for urgent hip surgery – a procedure that should restore her mobility and independence.
As she is being prepped for theatre, a gunshot victim is rushed in, bleeding out. The grandmother’s surgery is cancelled. She can wait; her condition is not immediately life-threatening. The theatre switches to emergency mode. The team fights to save the gunshot victim’s life. But his injuries are too severe. He dies.
Meanwhile, grandmother, her surgery cancelled, is returned to the ward.
It’s Friday. The weekend unfolds as it always does: theatre after theatre filled with trauma cases. By Monday, the grandmother’s condition has deteriorated. Blood clots. Pressure sores. Pneumonia. She dies – not from her fracture, but from the cascading consequences of a gunshot wound she never sustained.
This is the hidden pattern of gun violence in South Africa. One shooting doesn’t claim one life. It claims two, three, sometimes more. It consumes units of blood that could have saved other patients. It monopolises theatre time, ICU beds, orthopaedic implants, radiology resources, blood tests to monitor infections. It drains transport budgets as gunshot victims are ferried from one hospital to another. It exhausts healthcare teams already stretched beyond capacity.
Every day is a repeat.
As an orthopaedic trauma surgeon, I witness this relentless cycle all the time. It is replicated in many hospitals around the country.
The fatigue etched on to my colleagues’ faces. The moral injury. The resignation born of exhaustion. The gradual erosion of morale as capable professionals – paramedics, nurses, surgeons, physiotherapists – resign because the system cannot sustain them or the patients they’re trying to save.
We lose lives. We lose staff. We lose precious resources that should be building health, not overwhelmed from treating preventable gunshot injuries.
South Africa’s homicide rate was 34 per 100,000 in 2021 – six times the global average. Our growing murder rate is increasingly fed by guns – between 2020 and 2024, gun-related murders increased from 31% to 43%. More people are shot and killed than die on our roads in Gauteng, KwaZulu-Natal, the Eastern and Western Cape. In the Western Cape metropole, gunshots – not traffic accidents – are the leading cause of spinal cord injury.
Relentless toll
The crisis, which is already overwhelming to healthcare workers and crippling to limited resources and overstretched facilities, gets worse when the surgeon who, after two similar deaths in the same week, is not able to cope with the constant emotional and physical strain, resigns.
The gunshot cases don’t respect that the team is now one person down – they keep coming. The remaining staff stretch further. Burnout deepens. Moral injury accumulates. Young doctors are leaving medicine in droves, not because they lack skill or dedication, but because the system cannot protect them from the relentless psychological toll of preventable trauma.
On 10 February, the Global Coalition for World Health Organization Action on Gun Violence launches alongside new research revealing a stark reality – not a single one of the 3,200+ World Health Assembly’s adopted resolutions explicitly mentions firearms.
This matters profoundly for countries like South Africa. The WHO sets global standards that guide national health policy and shape health systems across the world. When it fails to prioritise gun violence, countries like ours are left without international support and evidence-based frameworks to act.
The coalition is calling on the WHO to take 10 key actions. These include strengthening guidance on gun-related healthcare and protecting health professionals from the trauma of treating gun violence. South Africa must not only support this coalition, but lead it by sponsoring a World Health Assembly resolution on firearm violence.
We need help
Gun violence is preventable. But until our political leaders prioritise public safety by strengthening controls over guns to reduce their availability, we, as health professionals, are literally left to treat the symptoms – gunshot-wounded bodies.
We need help. We need to be empowered with evidence-based guidelines and policies, with resources and support to not only treat gunshots, but to use healthcare spaces to intervene to prevent gun violence. At the moment, we are in survival mode, we are close to collapsing. Just like the impact of one gunshot ripples outward, WHO guidance and resources would restore our sense of agency and give us the tools to move from merely treating trauma to preventing it.
As I prepare for the weekend, I know what Saturday will bring. Gunshot wounds.
Young men with futures cut short. Families shattered. Resources strained. Staff depleted.
The grandmother who should have walked out of hospital, but didn’t. Her death certificate won’t list “gunshot wound” as the cause. But make no mistake – she is a victim of gun violence, as are the healthcare professionals who are burnt out and morally injured, casualties of a war zone they never enlisted in.
Until we recognise this truth and act accordingly, the ripples of loss will continue, claiming lives far beyond those directly in the line of fire. DM
Professor Sithombo Maqungo is head of orthopaedic trauma at Groote Schuur Hospital and the University of Cape Town, and a board member of Gun Free South Africa and Childsafe. He writes in his personal capacity.