More murders were reported in South Africa in the first quarter of 2022 than in six months of armed conflict in Ukraine, and globally, SA has the eighth-highest homicide rate, with firearms the second-leading cause.
In an editorial in the South African Medical Journal, Pradeep Navsaria, Sithombo Maqungo, Lea Marineau, Megan Prinsloo, Itumeleng Molefe and Peter Hodkinson write
that the Draft Firearms Control Amendment Bill 2021 published by the Civilian Secretariat for Police Services should be welcomed and supported, in hopes that it will save lives by strengthening gun control and reducing the number of weapons in circulation.
They write:
Despite an ~10% decrease in national homicides between 2009 and 2017 (38.4 to 34.5 per 100 000 population), there was no change in the firearm homicide rate, meaning guns now account for a greater share of overall homicides.
They were the most frequently used weapon for homicide from April to June 2022, corresponding to the 14.5% increase in illegal possession of firearms and ammunition when compared with the same months in 2021.
Nationally in 2017, men were 8.5 times more likely to be killed by a firearm than women, with those aged 20-34 years disproportionately affected.
Gun violence also puts tremendous strain on the healthcare system, with hospitals facing a large burden caring for patients with firearm injuries. District hospitals within the Cape Town metropole such as Mitchells Plain District and Wesfleur show predictable patterns of gunshot presentations, peaking on weekends and at the end of the month, with gunshot victims comprising ~7% of trauma presentations at both facilities.
At Groote Schuur Hospital, an average of 62 patients a month presented with firearm injuries (in 2020-2021), and 28% of in-hospital trauma deaths in 2021 were gun-related.
More than half of those admitted require exhaustive, complex management, including repeat surgeries, critical care and prolonged admissions, and extensive rehabilitation.
Ambulances and paramedics also run the gauntlet of armed attacks and gun violence: 56% of SA emergency medical services (EMS) personnel reported being assaulted or threatened while on duty in 2015, and there is no doubt that fear for their own safety hinders service delivery.
In 2020, there were 70 reported attacks on EMS personnel in the WC at gunpoint. In response, high-risk suburbs of Cape Town have been identified as “red zones”, meaning attacks on EMS personnel are so frequent in these areas that EMS, forensic pathology service and neighbouring primary healthcare facilities’ personnel are forbidden from entering without a SA Police Service escort.
A recent study found that 30% of EMS personnel reported post-traumatic stress disorder symptoms.
The drivers of firearm violence stem from complex intersections among social and structural determinants of health, such as poor access to education, poverty, high unemployment rates, exposure to community violence, racial residential segregation and high income inequality.
The Western Cape has one of the highest firearm homicide rates nationally, and is equipped with a local mortality surveillance system allowing for monitoring of homicide.
Western Cape mortuary data showed firearm homicides increased by 6% from 2019 to 2020, with incidence rates of 28.9 per 100 000 population and 30.4 per 100 000 population, respectively, while the proportion of stab-related homicides decreased by 6% from 2019 to 2020.
Gun injuries are more lethal than stab wounds, with the case fatality for firearm incidents 12%-15% higher at the scene of injury. In one large mortuary in the Western Cape south metropole, the average rate of homicide was 54.3 per 100 000 population between 2007 and 2016, to which firearms contributed 40.4% (22 per 100 000 population) and showed increasing trends that surpassed sharp force homicide since 2012.
Children are not spared. Guns have been the leading cause of homicide among children < 18 years from 2017 to 2021, with increasing trends annually, ranging from 36.2% in 2017 to 49.2% in 2021 (personal communication IJM, unpublished data). Firearms allow a person “to kill quickly, at a distance, with little strength or determination”.
Furthermore, robberies where firearms are used by the perpetrator and where the victim has a firearm independently increase the risk of homicide for the victim. In robberies where the victim is killed, guns are more frequently stolen, entering the illegal pool of weapons that help to sustain violent crime in SA.
Recent national SA crime statistics found that privately owned firearms accounted for >90% of lost or stolen firearms. Most of these were handguns issued for “self-defence”. A weapon like this in the home increases the homicide and suicide risk in a family, and it is less likely to be used for protection against intruders.
Globally, firearm legislation simultaneously targeting multiple forms of restrictions in a narrow period, such as restricting firearm access by safer storage, and regulating the carrying of guns, firearm licensing and purchasing, have been most effective in decreasing firearm-related deaths.
Colombia, a country with the world’s fourth highest rate of gun deaths, had a 22% reduction in firearm mortality among cities that implemented bans on carrying weapons in public.
The Firearms Control Act (FCA) No 60 of 2000 was signed into law in SA in 2001, requiring training tests for licences and background checks, banning certain types of firearms, setting limits on types of gun owned, and increasing the age requirement for ownership.
Before the law was enacted, SA’s homicide rate was 67 per 100 000 population; by 2009 this decreased to 38 per 100 000. This reduction was attributed to the reduction in the proportion of firearm homicides, which continued until 2011, undoubtedly credited to the successful implementation of the FCA in 2004.
Unfortunately, studies examining the effectiveness of the FCA on firearm homicide rates showed that the benefit of this legislation was limited to the first decade of its implementation.
Firearm homicides started to increase in 2012 due to relaxed enforcement of the FCA, including the police finalising >1m outstanding gun licences in 2010.
We are concerned about the considerable number of illegal firearms circulating in criminal networks. New clauses to strengthen gun control in the FCA must be accompanied by strict enforcement, clear regulations and extensive operations to retrieve illegal weapons.
We support all restrictions to reduce the risk of loss or theft that may result in firearms transferring from the legal into the illegal pool. This includes mechanisms to introduce ballistic sampling of all legally owned guns, including those owned by private security companies, to aid in investigating crimes committed with firearms, to enhance reporting of loss and theft of firearms, and amnesty to dispose of unwanted firearms.
We support and welcome the Draft Firearms Control Amendment Bill 2021 that was published by the Civilian Secretariat for Police Services. This will strengthen gun control and reduce the circulation of weapons in our country, thereby saving lives.
The proposed changes will align SA’s law with international firearms protocols, and are based on the evidence that limiting access to firearms reduces firearm violence.
Pradeep H Navsaria, University of Cape Town/ Groote Schuur Hospital; Sithombo Maqungo, University of Cape Town; Lea Marineau, Johns Hopkins University School of Nursing; Megan Prinsloo, University of Greenwich, London; Itumeleng Molefe, University of Cape Town; Peter Hodkinson, University of Cape Town.
See more from MedicalBrief archives:
Violence turning the Western Cape into a ‘war-zone’
Robbers attack EMS crews, steal ECG machines, equipment, phones
Paramedics threaten to withdraw night services after attacks
Four gunshot wounds but a two-week wait for surgery at George Mukhari Academic Hospital