EMS workers and their union in the Eastern Cape say their ambulance fleet is so depleted that only a handful of vehicles is available to respond to emergencies on some shifts – with many of those lacking vital equipment – and that the system is close to collapse, reports Daily Maverick.
The DA, meanwhile, has attributed the crisis to crucial funds being diverted to settle the eye-watering medico-legal costs and negligence cases against the Eastern Cape Department of Health.
Although the department has said its ambulance fleet is operational, emergency services workers say that in fact, the supply of properly equipped vehicles is critically low, and the situation is far worse than official fleet figures suggest.
Staff in Nelson Mandela Bay describe a system on life support, with one saying the hollowing out of the division had reached a point where the public had little idea how close the service was to falling apart completely.
“The public don’t know half of it,” the source said. “I honestly believe that the emergency medical service in South Africa has collapsed.”
‘Impossible burden’
The system is continually plagued by broken-down vehicles, missing equipment, dangerous, life-threatening working conditions and a growing sense among personnel that they are being left to carry an increasingly impossible burden.
At the Dora Nginza Hospital ambulance base, which should serve a large part of Gqeberha, only one fully equipped ambulance had recently been available.
“Today they ran about four or five vehicles, but only one was fully equipped. None has stretchers,” the source said.
“For the better part of the day, only two or three ambulances can actually help with a call. If they are available.”
In a video provided to Daily Maverick, an ambulance is seen undergoing engine problems, with plumes of smoke surrounding it. Inside, there are neither oxygen cylinders nor a stretcher.
According to figures provided by Health MEC Ntandokazi Capa in response to a written question from DA MPL Jane Cowley, the province has 353 ambulances, with 161 of them being grounded and 192 operational. Four years ago, there were 244 operational ambulances.
Problem ‘continues to worsen’
Cowley, however, said that later reports show the problem has deteriorated.
“The Department now says that, of a provincial fleet of 350 ambulances, 211 are grounded, leaving just 139 vehicles operational and available for emergency calls. This means 60% of the province’s entire fleet is off the road.”
Only 44 of the grounded ambulances had been out of service for less than 30 days. The remaining 167 have been grounded for periods ranging from more than 30 to 120 days, Cowley said.
In Nelson Mandela Bay, Capa said nine of the metro’s 40 ambulances were non-operational, leaving 31 classified as operational.
A history of failure
But EMS workers and the Health and Other Services Personnel Trade Union of South Africa (Hospersa) have disputed those figures, saying the number of vehicles that can actually be dispatched to emergencies is substantially lower.
Thembisa Witbooi, Hospersa’s Eastern Cape provincial labour relations organiser, said an ambulance sitting at a depot should not automatically be regarded as operational.
“People might see ambulances parked at depots like Dora Nginza Hospital, but that does not mean they are operational. Some are parked because they lack the basic equipment needed to operate.”
Daily Maverick and other publications have frequently reported on the province’s ongoing ambulance shortages, compelling some patients to resort to private transport in emergencies.
In May 2021, a controversial scooter ambulance tender in the province was set aside. Six months later, the health department acknowledged it had only 439 ambulances against a required fleet of 650, with 190 of them out of service because of mechanical faults.
In August 2025, the department confirmed that staff shortages meant Nelson Mandela Bay could keep only 15 ambulances on the road despite having 36 vehicles available, forcing it to rely on private operators.
The province’s EMS crisis stretches way back: in 2015, the South African Human Rights Commission ordered that the problem be addressed. At the time, the Nelson Mandela Bay metro was ranked as the worst off in the province.
“While the Nelson Mandela Metropolitan Municipality hosts the second-biggest population in the province, it has the smallest number of operational ambulances,” said the SAHRC report at the time.
What exactly does the department class as “operational”?
“It’s not just about having the vehicle,” an EMS source said. “You need the stretcher. You need the equipment, the ECG machines, the jump bags, the medication…”
Even a single major incident could quickly overwhelm the limited number of ambulances available.
“If a plane fell this morning in PE, those people would have to save themselves. All it takes is one big accident on the N2 and a gang fight in the northern areas … and then you still have people getting sick… the emergency department will fall apart,” said the source.
Hospersa has similarly warned that the crisis cannot be measured simply by counting vehicles parked at government depots.
Witbooi said ambulances lacking basic equipment should not be regarded as operational.
“EMS members cannot be driving an ambulance that is not fully equipped. It’s just an empty box,” she said, adding that some vehicles lacked essential equipment like stretchers, oxygen cylinders and ECG machines. In some cases, practitioners had been forced to physically carry patients into ambulances.
Promises made, but…
The department has announced an ambitious programme to replenish the ageing ambulance fleet, with spokesperson Siyanda Manana saying they were working with Government Fleet Management Services (GFMS): 14 new ambulances had recently been distributed in the Sarah Baartman District, along with seven patient transport vehicles and nine response vehicles.
It also announced a schedule for additional ambulances, with 20 that were due by 21 August, 26 by 4 September, 35 by the end of October, 74 by February 2027 and a further 40 by March 2027.
But EMS sources say promises of new vehicles have done little to reassure frontline staff.
“Promises were made that they were going to deliver more vehicles,” the source said. “But when I came on shift recently, not only did they not deliver the vehicles, but we’re more short than what we were before we left four days ago.”
Cowley has called for an investigation into the failures surrounding the repair and maintenance of the provincial fleet, and written to Capa, seeking urgent intervention, and to Eastern Cape Premier Oscar Mabuyane, asking him to prioritise the crisis.
“The failure does not lie with EMS personnel. Paramedics and frontline managers continue to work under extraordinarily difficult conditions, often in vehicles that lack essential equipment or fail to meet occupational health and safety requirements.
“The problem is financial. Medico-legal claims against the Eastern Cape Health Department have left it factually bankrupt, and while measures have been put in place to address these claims, all programmes within the department suffer the fiscal fallout.”
Spokesman Manana said the challenges were being tackled, and that the province’s rural nature, ageing fleet, frequent breakdowns and the time required to repair and maintain vehicles had contributed to the difficulties.
The department said it could also draw on the Transport Department’s fleet for short-term replacement vehicles and had arrangements with private service providers to supplement the government fleet where necessary.
See more from MedicalBrief archives:
Ambulance crisis worsens TB burden in rural Eastern Cape – report
Eastern Cape teen dies while waiting for ambulance
Ambulance shortage places Eastern Cape patients' lives at risk
Eastern Cape's Nelson Mandela Bay has only 2 ambulances for pandemic patients
Understaffing halves number of Eastern Cape Health ambulances