Traditional circumcisions can carry fatal risks including poorly trained practitioners and cutting tools that are unsanitary or used more than once. Dehydration and badly managed septic wounds are among the main causes of death, and the remote settings mean help is usually far away.
The 22-year-old Lamkelo Mtyho had no known health issues when he joined his peers, wrapped in blankets and smeared in clay, for the most important ritual of his young life: the highly secretive process of traditional circumcision. His family in South Africa expected him to return triumphant, full of cultural knowledge and officially a man.
Three weeks later, they learned that he was dead.
He was one of at least 48 boys and young men who died during the latest round of initiation ceremonies in South Africa.
It is rare to hear the story of an initiate who died.
Because of participants’ silence around the ritual, families and authorities have struggled to understand and police a deeply traditional but often abused practice. At least a half-dozen former initiates would not speak to The Associated Press. Meanwhile, hundreds of illegal initiation schools attract people who can’t afford registered ones.
Police and government officials usually announce deaths only when a significant number occur. There are few court cases or autopsies.
Traditional circumcisions can carry fatal risks including poorly trained practitioners and cutting tools that are unsanitary or used more than once. Dehydration and badly managed septic wounds are among the main causes of death, and the remote settings mean help is usually far away.
“Imagine this number: 476 young people died in a five-year period and yet they were well before going into initiation. These deaths are unacceptable and should never have happened,” former health minister Zwelini Mkhize told parliament last year.
But these are risks that hundreds of thousands of South Africans are ready to take.
The next season begins in June. They happen twice a year.
‘He started losing strength and collapsed’
Mtyho attended a registered initiation school outside Ngqeleni village in Eastern Cape province, with his parents’ blessing. Most schools take place in mud huts or shacks shared by dozens of young men, away from public glare.
His grandmother, Nozinzile, recounted what came next. A relative who worked as a guard at the school arrived with the news.
“They were walking to the river to go and bathe, and along the way he started losing strength and collapsed. That is what we were told,” she said. “It is said that it was an emergency situation, that the others ran to get water and tried to resuscitate him. When other people arrived there to help, it was too late.”
She spoke between long pauses. She sat outside the hut where Mtyho used to help with chores like carrying wood. She refused to blame anyone, and there was no attempt to verify the cause of death.
Initiation is not an easy thing, she said, but the thought of him dying had never crossed her mind. Mtyho was her eldest grandchild. He had planned to find a job in town so he could be “the man of the house.”
While announcing the latest initiation deaths in December, South Africa’s Traditional Affairs Minister Velenkosini Hlabisa said some of the unproven advice often given to participants is to avoid drinking water in order to heal faster.
Initiates are a source of community pride
For families in South Africa, a successful initiation concludes with the participants’ return. They present themselves to the community with traditional hymns and the recital of their clan names. Villagers join in with songs, chanting and dance.
A boy or young man who completes an initiation enjoys the benefits of higher status for marriage and the right to participate in certain cultural activities, important considerations for many of South Africa’s ethnic groups.
They could have been medically circumcised at an early age, but cultural pressures mean that many prefer the traditional way.
“Initiation is a culture left behind to us by our elders. We grew up practicing it, as it teaches a young man to respect everyone, including those who are not initiates in society,” said traditional leader Morena Mpembe, who oversees a registered school in Phuthaditjhaba in Free State province.
The spread of illegal schools
High unemployment and economic inequality in South Africa mean that fees for government-regulated initiation schools can be out of reach. That is where illegal schools come in.
Some boys slip away to illegal schools long before they are 16, the age that South African law now requires, in their eagerness to “become men.”
“It is very difficult for the government to monitor initiation schools which are not registered. They are not known until there is a tragedy of some sort,” said Mluleki Ngomane, an official with the Gauteng provincial body overseeing the schools there.
A 2022 visit by lawmakers to the Eastern Cape found more illegal schools than legal ones, 68 to 66, in the OR Tambo municipality alone.
Government and independent investigations over the years have found abuse of participants, violence between initiates, drug and alcohol abuse at illegal schools — even the kidnapping of boys for participation.
“We are seeing a rise in gangs because they want to grow their initiation schools, and we see that as a wrong way of practicing initiation,” said Motlalepule Mantsha, a leader at an initiation school in Phuthaditjhaba.
“This is damaging the initiation’s image.”
Dozens of arrests have occurred
South African law since 2021 requires initiation schools to meet strict health and safety standards to be registered, and boys 16 and above are admitted with parental consent. Over 5,000 such schools exist.
Requirements for schools include being registered three months before each initiation season starts, having enough surgical tools so they are not used for more than one circumcision and training for traditional “surgeons” and “nurses” in hygiene, infection prevention, wound care and HIV awareness.
In January and February, at least 46 people were arrested for links to illegal schools. They included 16 traditional surgeons, 28 traditional nurses and two parents, who were accused of colluding with surgeons and nurses to falsify ages of younger boys.
Separately in February, after a rare conviction, a 26-year-old man was sentenced to two years in prison for unlawfully circumcising two boys, aged 17 and 18, last year.
An investigation by the Cultural, Religious and Linguistic Rights Commission, a public watchdog that reports to Parliament, said in 2017 that “due to the principles of sacredness and secrecy of this practice, also compounded by the inaccessibility of rural locations,” it is difficult to monitor the schools, and there was “clear confusion” about what role local authorities should have.
By the time a circumcision has complications, the report said, it is too late for medical treatment. It said other deaths are due to initiates’ preexisting illnesses, and suggested that boys and young men get medical exams first.
A mother of two initiates, Makhanya Vangile, said she regards initiations as an important part of the culture that should be safeguarded, but she is concerned about the reports of what happens at illegal schools.
“Here, we have guardsmen from our chief who go and check up on how the boys are being fed, their living conditions and safety,” she said. “They are able to stop things like boys bringing harmful stuff like alcohol, knives and guns instead of traditional sticks.”
