Introduction
Another festive season which, amongst other things, was dominated by celebrations of the return home of young men who had gone to the bush to be initiated as men (imigidi), has concluded. Amidst the celebrations of the safe return of many young men from the bush, there are families who were burying their young men who died during the ritual. Many others have come home alive, but with physical and emotional scars due to horrific things that happened to them while undergoing ulwaluko. The 22 reported Eastern Cape deaths for the summer season (November/December 2025) are maintaining a trend that has lasted over 30 years. Despite the passing of two provincial legislation- the Application of Health Standards in Traditional Circumcision Act (No.6 of 2001), otherwise known as the Circumcision Act, and the Eastern Cape Customary Male Initiation Practice Act (No.5 of 2016) – and the national Customary Initiation Act (No. 2 of 2021) to legislate who can undergo the ritual, how and by whom, the crisis continues with no signs of waning. These policies are accompanied by many interventions, such as monitoring visits in initiate spaces by district initiation forums, traditional leaders, health officials, the public, as well as political leaders. In addition to these stakeholders, there are non-government organizations that provide various support, depending on availability of finances at any one time. Most of these stakeholders vehemently condemn the poor success of measures to stop the deaths. The message from public figures remains the same, such as ‘this is unacceptable’, ‘perpetrators must face the full might of the law’ or ‘we need to do more to stop this’. These snippets or sound bites of comments do nothing to the big picture, but only serve to delay a forceful approach to the crisis. As a medical anthropologist who has worked on these issues, and in some of the affected communities, I agree with research and other opinions that these problems persist because there is no collective strategy for dealing with the crisis, that is based on evidence from the ground. My experience is that different stakeholders, particularly those who do not work in the space or those who are populists, tend to be reactive, and sometimes naïve in their comments and in how they intervene in the crisis facing ulwaluko. Where does that leave things? Are there interventions that hold hope of success in dealing with the crisis, whether locally initiated or supported by external agencies or individuals? My opinion is that some initiatives hold promise and do make a contribution to averting some crises. In this opinion piece I reflect on personal experience on ‘initiate rescue centres’.
Initiate Rescue Centres in the Eastern Cape
A multiplicity of issues have over the last three deades or so made it necessary for initiates to leave the initiation areas (the bush or amabhoma). These are not confined to ‘botched’ circumcision, but include what I broadly call ‘a deadly violation of initiates’ rights’. This has resulted in the idea of rescuing initiates from the bush, to facilitate their healing or safety from abuse. Ikamva Lesizwe Institute, an organization that I founded and manage, has gone beyond the idea of simply ‘rescuing’ initiates to go to hospital or to some ‘hut’ away from the bush, in order to heal or be fed. Over the last eight years Ikamva has reconceptualized rescue centres to serve a broader and urgent purpose in light of the death and injury crisis facing ulwaluko in the Eastern Cape. My on-the-ground experience of operating rescue centres in the Alfred Nzo and O.R. Tambo Districts over the last few years shows me that they make a significant contribution to mitigating the crisis, and thus position me to reflect on what they are, how they operate, as well as give my opinion on what the bright and the blind spots are.
Purposes of rescue centres
Initiate rescue centres that Ikamva has operated are convenient spaces (often huts) near villages or towns that allow for continued observance of the customary practices related to the initiation, but also meet many other identified needs of the initiates, such as hydration, wound management, adequate sleep, protection from violence, good nutrition, etc. Admission to a rescue centre is initiated by the local initiation forum, often accompanied by the police, along with Ikamva. Initiates who are rescued from ebhomeni fall under the following: Under-age initiates; initiates who have not received permission from the local traditional leader and/or the parents; initiates who have not completed the required health pre-screening that is required under the law; medically distressed initiates as a result of complications in the circumcision wound; initiates who had pre-existing health conditions that are not related to the circumcision wound, such as TB, HIV, heart problems, mental illness, epilepsy, etc, but who were not receiving proper attention in the bush; and initiates who are targets of assault from men who visit the bush, or other initiates who may bully them.
Back to ‘School’ with a Different Approach on Reducing Deaths and Injuries in Ulwaluko
The rescue centres operated by Ikamva have traditionally provided several key services, including:
- Accommodation – a large house/hut that can accommodate a large number of initiates at a time, as well as provide adequate blankets, is an important feature of the rescue centre.
- Medical attention –clinicians (medical team) who regularly examine the initiates who are admitted, and makes decisions on whether the initiates remains at the centre or need to be referred to hospital in severe cases.
- Food –all the initiates at the rescue centre are provided with three nutritious meals per day.
- Water – water for cooking, as well as to allow initiates to drink and wash their hands is provided.
- Security –security guards are present 24 hours a day. This ensures that the initiates are safe, including from people who may want to remove them by force or who seek to assault them.
- Traditional nurse – a traditional nurse is present 24 hours a day to work hand in hand with the medical team, as well as with local leaders and parents. They defer all serious cases to the medical team.
- Sleep and rest – initiates are allowed adequate sleep and rest as they recover from their wounds.
A recent research study conducted with initiates who had successfully completed their stay at Ikamva rescue centres revealed that in addition to the vast majority of them being rescued due to illegality of their school or age, many were admitted to the rescue centres because they were sleep-deprived, violently assaulted, denied water and food. It is no surprise that, overall, initiates who participated in the study appreciated a kind treatment at the rescue centre, compared to what they believed was rough treatment in the bush.
Bright and blind spots in rescue centres
The overall message of this reflection is that initiate rescue centres work, and they do make a significant contribution to averting further harm to initiate health in the Eastern Cape. However, again based on my personal experience of operating rescue centres in Alfred Nzo and O.R. Tambo districts over the last few years as part of Ikamva, caution is needed on how this approach is upscaled to many other areas in the province. Misconceptions, watered down versions, quick-fix approach, poor experience and commitment, can easily make rescue centres ineffective. Based on my experience operating rescue centres over the last few years, I have identified a few things that need wisdom, experience and seriousness. I outline these below:
- The act of rescuing from the bush to the rescue centre is not as simple as it may sound. Initiates cannot just be taken to the rescue centre. There needs to be negotiation involving key stakeholders, to incorporate push and pull factors, as initiates themselves, as well as the communities they come from, can refuse, often because they do not understand the need for the rescue. If the act of rescuing from the bush is not well managed, this sets a tone for possible conflict-ridden process throughout. In short, saving or rescuing initiates can fail very early in the process, if it is not done properly.
- Importance of a medical assessment cannot be overstated. When rescued initiates arrive at the rescue centre, it is a mistake to see that space as a ‘legal initiation school’ and nothing else, irrespective of the reason why the initiates were removed from the bush. There must be a medical approach from the beginning, whereby each initiate is assessed, to determine whether they stay at the rescue centre or are taken to hospital. Clinical judgement is crucial; so is co-operation among the stakeholders involved.
- Open communication with the medical facilities (e.g. hospitals) is crucial for those initiates who were deemed in need of hospitalization. This is important so that only medical teams at the hospital can decide when and if initiates can return to the rescue centre.
- Experience with, and understanding of, legal processes is crucial. Accountability is an utmost necessity when dealing with initiates, some of which are under-age, and the fact that many may have come to the rescue centre against their will. Administrators of rescue centres should take the law, including Constitutional rights of all involved very seriously. There should be a good record keeping, including statements that may be used in the courts of law, should that be needed. An inexperienced rescue centre administrator can easily make legal challenges even more challenging if they are not careful.
- The rescue centre administrator should have the wisdom and leadership skills to manage visitors to the rescue centre. To avoid possible mixed messages, the rescue centre operator should brief all visitors and respectfully explain the particular rescue centre’s standard operating procedures, all of which is in the interest of the welfare of the initiates, and their Constitutional rights. Poor management of visitors could have devastating impact.
- Administrators of initiate rescue centres should be people with appropriate skills and who have the necessary academic background, on-the-ground experience, respect for science, as well as the ability to make tough decisions. Remotely controlled rescue centres can easily prove a disaster.
All the above information is based on my own experience as an administrator of initiate rescue centres that have operated in the province over the last eight years. I am aware that there are more lessons to learn, but in the midst of continuing crisis in ulwaluko, there need to be voices that tell stories on the ground, especially on things that have proven to work. I wish to end by emphasizing that, in addition to initiatives such as rescue centres, a unified, research-based and science-led approach is needed in ulwaluko. I emphasize unified approaches because currently there are many parallel approaches that are not helping. People are talking about the same thing, but very few of them are listening to one another. It is more like a dialogue of the deaf. But we can’t give up. The health of our young men is at stake; so is the amaXhosa’s sacred rite of passage from boyhood to manhood.
