It's time to treat gun violence as a public health crisis

Every day in South Africa, 30 people Is shot dead. Another 43 were shot and survived. That means more than one person was shot every 20 minutes, every single day of the year.

Those numbers are staggering, but they don't begin to convey the cascade of harm that extends beyond the bodies that took the pills.

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Consider this experience of Professor Sithombo Makungo, head of orthopedic trauma at Groot Schuur Hospital. A grandmother has been admitted for urgent surgery on Friday morning with a hip fracture. As she was being prepared for the theatre, a gunshot victim came in, bleeding. He dies, but Grandma's surgery is postponed as the weekend's trauma cases overwhelm the unit. By Monday, his condition had worsened – blood clots, pressure sores, pneumonia. She dies. His death certificate would not record “gunshot wound” as the cause. But without question she is a victim of gun violence.

This is a side effect of gun violence. One shooting does not kill one person. It consumes blood supplies, monopolizes theater time, depletes intensive care unit beds, exhausts health care teams, and drives skilled professionals – paramedics, nurses, surgeons – out of a system that can no longer support them.

South Africa's healthcare system is treating gun violence, not preventing it. And that distinction matters a lot.

South Africa's murder rate is six times the global averageAnd guns are the main weapons In murder, attempted murder and aggravated robbery. gun-related murders increased From 31% of all murders in 2020 to 44% by 2025. In many provinces, more people get shot Compared to dying on the streets, and in the Western Cape metropole, deaths by gunshot main reason Due to spinal cord injury.

young men Women are the primary victims and perpetrators of gun violence, but women are increasingly being killed by guns. After a decline, following the Firearms Control Act of 2000, gun-related femicides have increased – increasing by 84% Between 2017 and 2020/21. As of 2020/21, firearms were accounted for more than one third Among all femicides, the highest proportion was recorded.

failure in gun inspection And the increase in licensed guns has contributed to this reversal.

South Africa's own evidence shows that regulation work. When the Act was properly implemented between 2000 and 2010 – guided by a five-pillar strategy that tightened regulations and reduced the availability of firearms – gun deaths halved, with 34 people shot to death every day, while one woman died at the hands of an intimate partner. every eight hours Instead of every six hours because fewer women were shot and killed.

As monitoring weakened due to lack of resources, corruption, and policy drift, deaths increased again.

Today, license applications are up 66% compared to 2016, with a record 166,603 new applications In 2024/25 alone – expanding the pool of legally held guns that leak into criminal hands or are used to commit crimes.

Illegal guns don't come from nowhere

A common misconception is that tightening firearms laws is futile because most crime guns are unlicensed. But illegal guns do not appear out of nowhere: Nearly every gun in criminal circulation was once legally manufactured and legally owned before being lost, stolen, or sold on the illegal market. In South Africa, citizens are by far the largest source of this leakage. According to the South African Police Service's annual reports, over the past 20 years, civilians have lost or stolen an average of seven guns for every gun lost or stolen by police. In 2024/25 alone, citizens reported 7,895 firearms were lost or stolen – 22 per day – and this is almost certainly an underestimate, as some owners do not report losses for fear of being accused of negligence (informed the police During this period 572 service guns were lost/stolen).

Legal guns are also used to directly commit crimes, especially domestic violence, where murder-suicide is involved. licensed firearms are well documented.

Controlling legal gun ownership is not separate from addressing gun crime – it is the primary mechanism for doing so.

public health approach

A key question in responding to South Africa's gun violence crisis is why gun violence remains outside the mainstream public health framework – and what would change if it were treated as a preventable health crisis.

The public health approach treats guns the same way we treat other products that harm health – such as alcohol and tobacco – moving the response from treating wounds to preventing them by tightening controls on availability.

This will give healthcare workers overwhelmed by the constant flood of trauma the ability to recognize that gunshot wounds are not inevitable, but a preventable crisis dependent on political will and policy intervention.

This would create concrete opportunities for the health system to play an active role in prevention – examining gun access during domestic violence counseling to assist in removing guns from high-risk situations; linking young gunmen to gang exit programs in surgical wards; Using admissions and forensic pathology data to identify violence hotspots and inform targeted policing.

This will show policymakers and the public the true costs of gun violence – revealing how much of what could be spent managing a preventable crisis at limited resources and overwhelmed facilities could go toward primary health care, cancer treatment, or diabetes care. And crucially, it bases the debate on evidence rather than ideology – vital in a post-truth world where beliefs, opinions and rumors are routinely presented as fact.

This approach would also recognize that firearms are products sold for profit that harm people's health. Just as taxes on alcohol and tobacco reflect their social costs and reduce consumption, firearms, ammunition and shooting activities should also be subject to similar measures. This would generate revenue that could fund health services affected by the consequences of gun violence.

This also intensifies the policy response. South Africa's Firearms Control Amendment Bill, currently in Nedlac, proposes to strengthen limits on who can possess firearms, the types and numbers of firearms and ammunition that can be possessed, and for what purposes.

Treating gun violence as a public health crisis strengthens the case for these reforms: It positions the bill not as a safety measure but as a health measure, demanding the same immediate political commitment that we would expect for any major cause of preventable death and injury.

international framework

None of this can happen in isolation. South Africa needs international frameworks, evidence and solidarity – and that's where the World Health Organization (WHO) comes in.

On 10 February 2026, the WHO Global Coalition for Action on Gun Violence launched with over 100 organizations in 40 countries, including several South African organizations involved in health care, child and women's rights, legal advocacy, violence prevention and research. The formation of the coalition came with a clear conclusion: none of the World Health Assembly's more than 3,200 adopted resolutions explicitly mention firearms.

This is a profound difference. WHO sets global standards that shape national health policy in 194 member countries. When it fails to treat gun violence as a health priority, countries like South Africa are left without the international framework, evidence and technical guidance they need to take action.