Khayelitsha hospital in Cape Town. Medical staff have been the target of several robberies and extortion attempts in recent years.
Three gunmen appeared just 10 minutes after security guards had arrived for the early morning shift at Khayelitsha's Town Two clinic in Cape Town. Tshiamo Nere, a security guard, admits he was frozen with shock as the men aimed weapons at him and two colleagues while nurses and patients fled. The intruders demanded a protection fee from the security company employed to guard the clinic. Patients scattered, and nurses ran for their lives. The men promised to return and cause havoc if their demands were not met. Nere's security company has still not paid the fee, and he fears the men will return.
This incident is not isolated. A surge of extortions and robberies targeting medical staff and healthcare users in impoverished areas has been reported over the past few years. Muggings outside clinics and hospitals in Khayelitsha are becoming more common, with thieves demanding something for safe passage. Nere no longer walks to work in uniform, wearing civilian clothes to avoid detection.
Thapelo Mohapi, secretary general of Abahlali baseMjondolo, a grassroots union for slum dwellers, notes that the Cape Town incident gained attention but is not unique. Similar attacks occur in Johannesburg and Port Elizabeth. Last year, two healthcare workers were shot and killed in Lusikisiki, Eastern Cape. In November, two nurses were shot at while guarding a clinic in the same province. Most violence, extortions, and muggings go unreported, says Mohapi.
South African police do not keep specific data on violent crime targeting healthcare centres or personnel, but anecdotal reports from the Democratic Nursing Organisation of South Africa (Denosa) and other healthcare organisations indicate the problem has grown. The South African Medical Association (SAMA) published a 2023 analysis calling it an epidemic of workplace violence in the healthcare sector, with the poorest suffering most.
Unathi Sula, a 32-year-old patient from Khayelitsha, arrived early at Town Two clinic for medication but found it shuttered for three days. Pregnant with her fourth child, she needs anti-retroviral medications to manage HIV. She cannot afford taxi fare to more secure hospitals in other parts of Cape Town, and her medical files are on paper and inaccessible elsewhere.
Mohapi warns that such attacks could create medical deserts in the poorest areas if doctors and nurses stop working in high-risk zones. He says mafias have not been suppressed because crime does not affect middle and upper classes who use private, highly secured hospitals. He believes criminal gangs have infiltrated the police.
Denosa raised alarm in 2023 over security problems and corrupt arrangements after three nurses were shot dead and a spate of violent muggings occurred at Eastern Cape clinics. Denosa spokesperson Simphiwe Gada said nurses were too afraid to go to work.
Colonel Andrè Traut, commander of the South African police service in Western Cape, says the force takes the incident seriously. An investigation has identified an extortion group operating in the area and is at an advanced stage. Targeted operations and high-visibility deployments are yielding positive results. Extortion is now a priority focus in the Western Cape as it undermines community safety and disrupts essential healthcare. Police have appealed for people to report attacks.
However, Mohapi questioned the call for communities to report gangs, noting that whistleblowing is deadly in South Africa, with people killed or forced into hiding for speaking up.
Dr Owami Dube in Johannesburg says impoverished people on chronic medications are becoming collateral damage of organised crime. Two of his colleagues have been killed: Dr George Koboka was shot dead in his Soweto surgery in March 2022, and Dr Michael Isabelle was killed during an apparent robbery in February 2024. After his friend's death, Dube shut his Soweto practice and relocated to an affluent Johannesburg district. A further 23,400 health professionals have left the country to work abroad.
Dube notes that poor black-majority townships like Khayelitsha are at the centre of the HIV and TB infection crisis yet have the fewest specialists willing to work in so-called poor areas.
