A six-month-old baby, shot in the head during a crossfire, was among the patients treated by Dr Suhayl Essa at central Johannesburg’s Hillbrow Clinic on Sunday.
Later that day, four foreign nationals, each stabbed in the chest in suspected bouts of xenophobic violence, arrived in the space of half an hour, followed a man whose eyeball was left almost hanging from its socket after being struck by a rubber bullet.
“I feel like the citizens of this country have lost their humanity for their fellow man,” said Essa, 28.
During his 14-hour shift, Essa could hear the crackling of gunshots outside. After each salvo, a new wave of patients would enter – many of them intoxicated and violent.
“Nothing could have prepared me for what was coming,” he told Al Jazeera on Thursday. “It was like a complete war zone.”
The deadly unrest which has gripped parts of the country since the imprisonment of former President Jacob Zuma last week has mounted pressure on a health system already grappling with the worst COVID-19 crisis on the continent – one that has already killed more than 65,000 people.
In the unrest-hit Gauteng and KwaZulu-Natal provinces, ambulances, pharmacies and health centres have been looted. Many health workers have been unable to make it to work because the commute has become too dangerous.
Others sleep at the workplace, fearing the violence in their communities. Some mortuaries have been unable to clear their dead because of roadblocks. Hospital resources have been pushed to the limit.
“I honestly don’t see how the Health Department can manage with this new wave of patients, whether it be from vigilantes catching and beating looters or people being caught in crossfire from police trying to contain these mobs,” said Essa.
“Already we were short-staffed. Already we were running out of oxygen. Already there were not enough beds – we had COVID patients waiting in hospital corridors for two days waiting for admission because of the pandemic.”
3.The team has had to use Mfezi, our armoured ambulance in responding to calls last night to transfer patients and staff.We plead with communities to stop attacks on paramedics and EMS vehicles so we can render services to those in urgent need. pic.twitter.com/MK32C6XnU6
— Official_GautengEMS (@GautengEMS) July 12, 2021
Possible increase in deaths
Health authorities have already described the acts of violence, which have led to at least 117 deaths and a total of more than 2,200 arrested across both provinces, as “super-spreader” events.
But Tulio de Oliveira, director of KwaZulu-Natal’s KRISP lab, which is responsible for about half of the coronavirus genomic sequencing in Africa, says it is too soon to tell if this is the case.
“Massive looting could be a super-spreader event. But at the same time, lots of people have been staying quietly at home. At the moment, we honestly don’t know what will be the effect on the spread of the virus,” he said.
“What we do know is that it [the unrest] has disturbed vaccination sites and diagnostic laboratories. It has also disturbed a lot of medical care in hospitals and the transport of oxygen, so we wouldn’t be surprised if we see a fast increase in the number of deaths.”
South Africa had been struggling to roll out the vaccines fast enough, even prior to Zuma’s imprisonment in the early hours of July 8. The temporary closure of numerous state-run and private vaccination centres as a result of the unrest adds further difficulty.
“Our vaccination programme has been severely disrupted just as it is gaining momentum,” President Cyril Ramaphosa warned earlier this week. “This will have lasting effects on our ability to consolidate some of the progress we are already witnessing in our economic recovery.”
The South African economy contracted by 7 percent in 2020, in large part due to the COVID-19 restrictions and a fall in external demand. Rising case numbers forced the government to move to a Level 4 lockdown last month, in which all gatherings were banned – adding another level of illegality to the current unrest. The unemployment rate sits at a record high of 32.6 percent, in a country with one of the world’s highest inequality rates.
“The COVID period has been particularly devastating for many communities already plagued by poverty and food insecurity. What COVID lockdowns have done is worsen inequality,” said Lizette Lancaster, of the Pretoria-based Institute for Security Studies.
“If we look at many of the areas where looting and general violence took place, they are places that are traditionally quite vulnerable for public violence – where shops often get looted or foreign nationals get targeted. When tensions run high, these are areas with communities that are particularly vulnerable. The hotspots shouldn’t have come as a shock to many people.”
The economic damage caused during the recent unrest will further compound the effect of the pandemic – particularly for some of South Africa’s least well-off.
“Although these may be opportunistic acts of looting driven by hardship and poverty, the poor and the marginalised bear the ultimate brunt of the destruction that is currently under way,” Ramaphosa said on Monday.
The number of soldiers deployed to quell the unrest has reached 25,000, with reservists being called up to reach this figure. Until their mission is complete, health workers will continue to work on a knife-edge.
During his distressing experience at the clinic, Essa recalls two patients arriving at the same time, both haemorrhaging badly.
“They brought me one guy who was almost dead and another guy, who had been stabbed in the chest but who I thought could be saved. I felt there was no time for me to resuscitate someone who was already gone.”
Essa had to break the news to the family of the deceased. They quickly pointed the finger at the young doctor, attempting to lunge at him, before being held back by security. The brother of the deceased then barged into the treatment room to get a glimpse of the corpse, angering others waiting for treatment.
A fight ensued with blows exchanged and blood spilled. The clinic descended into chaos. The police, already overstretched, did not arrive for an hour and a half – an agonising wait during which Essa feared for his life.
Essa was eventually escorted out of the clinic by police and despite displaying signs of post-traumatic stress disorder, he has returned to work.
Over the course of the week, his resolve has steadily returned.
“Yes, we have riots. Yes, we have mobs. But I do feel that there is a good reason for me to get up and go to work every day to do my job. It’s because there are still good South Africans that need my help,” he said.