Eastern Cape Circumcision deaths: Provincial Department of Health; Hate Crimes & initiatives for LGBTI group: Department of Justice and Constitutional Development briefings

NCOP Women, Children and People with Disabilities

11 September 2013
Chairperson: Ms P Mabe (ANC, Gauteng)
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Meeting Summary

The MEC for Health, Eastern Cape Province, presented a report drawn by the Provincial Department of Health on the deaths arising from circumcision, and statistics on legal and illegal initiations in the Eastern Cape province from 2006 to 2013.  The number of illegal initiation practices, deaths and serious injuries were highest in the districts of OR Tambo and Alfred Nzo. The Department of Health, together with Department of Local Government and traditional leaders, had established a task team that aimed to support HIV prevention and curb and manage circumcision related complications and deaths, and this had visited all districts. Initiation statistics were presented for 2006 to 2013. In June 2013 there were12 169 legal initiations, but also 2 314 illegal initiations, which led to 359 hospital admissions, and  24 cases amputations and 40 deaths. Despite this, only 19 arrests were made. Injuries and deaths were not only attributed to infection and mutilations, but also beatings, dehydration, and “surgeons” being under the influence of alcohol. The Department was attempting to enforce proper clinical management at all the district hospitals, mobilise doctors and nurses to deal with the initiates, and set up planned medical supplies and emergency transport, as well as deploying SAPS to initiation locations to monitor the process. However, it had its own challenges such as insufficient staff, inadequate equipment, and lack of food and beds in hospitals. Members were horrified at the depictions of injuries and instruments used, commented that the approach of the department was still reactionary rather than preventative, and questioned how much of the R20 million budget specifically for curbing poor practices had been spent. Members questioned why so few people had been arrested in 2013, and none in 2006, and enquired as to the outcome of the cases. Members wanted to know what was being done to sensitise communities, children in schools, their parents, and the boys themselves, and enquired the difference between legal and illegal schools of initiation. The Committee also demanded the state of readiness of the province for the following season of initiations, and noted that it would be concentrating on the need for protection of women and children in the Eastern Cape for the rest of its terms of office.

The Department of Justice and Constitutional Development outlined its programmes and the setting up and work of the National Task Team (NTT), comprising representatives from different departments and civil society organisations, that aimed to address the problem of gender-based violence against the Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) groups. However, little progress had been made by the NTT until this year, because of lack of clarity on roles, tensions in the team and budget constraints. Lessons were learnt from those challenges and a new Working Group had been established to review the terms of reference and operations of the NTT. It had met four times and had revised he terms of reference and developed strategic work plans for public education and communication, development of training materials, civil society alliance building and case flow management of outstanding and pending cases. A national intervention strategy was being developed and should be presented to Cabinet shortly. Activities to protect LGBTI persons had been identified, and the NTT was trying to identify other structures with whom to coordinate, including provincial structures. Training manuals covering the specific category of hate crimes would be drawn, cases would be monitored, and the Department was intending to present a Hate Crimes Bill to Parliament in 2014. Members queried why so few meetings had been held, what had stalled progress, and how it was increasing its output, asked under which Department it would be budgeted, and called for a copy of the Baseline Report once approved. They also asked when the proposed legislation would be tabled, and what it would cover. Members were still concerned that this Department’s reports tended not to reflect exactly what was happening on the ground and would monitor this aspect carefully.

Meeting report

Circumcision deaths: Eastern Cape Provincial Department of Health report
Mr Sicelo Gqobana, MEC for Health, Eastern Cape, explained that traditional circumcision fell within the competency of the Eastern Cape Department of Local Government, but that the Eastern Cape Provincial Department of Health (ECDoH) was to work with and through the established task team led by the House of Traditional Leaders (HOTL). The ECDoH aimed to support HIV prevention and to curb and manage circumcision related complications and deaths through its circumcision strategy that promoted safety initiatives.

He explained that the Eastern Cape DoH had set up a Committee, comprising representatives from the Provincial Department of Local Government, Department of Health, Traditional Leaders and Local Circumcision to ensure safe passage of young boys to manhood. The Team was tasked with visiting all districts to monitor the progress and outcomes of circumcision seasons. The Team visited all districts within the period 17 June 2013 to 19 July 2013. The ECDoH supported the functioning of the Team by designating medical officers and providing logistical support to the team.

He presented initiation statistics for the province from the years 2006 to 2013. The statistics for June 2013 indicated that 12 169 legal initiations were carried out in that month while 2 314 illegal initiations occurred. There were 359 hospital admissions arising out of the initiations. 24 cases led to amputations,  40 deaths occurred but only 19 arrests were made as a result. The statistics for illegal initiates, admissions and deaths were highest in the districts of OR Tambo and Alfred Nzo.  The major causes of injuries and deaths identified include beating of initiates, dehydration, infections and mutilation during the initiation process. Other factors that contribute to the injuries and deaths include the fact that the custom had been hijacked by criminals who hade total disregard for human life and only carried out the practices for commercial purposes, and some so called “traditional surgeons” performed the procedure under influence of alcohol.

ECDoH response actions included correct clinical management which entailed dissemination of the Protocol on Management of Circumcision Complications, which had been developed by hospitals Department of Urology, to the districts, for onward distribution to all regional and district hospitals. There was resource mobilisation through designation of doctors and nurses to attend to the injured initiates. The Mthatha Depot was set up to handle medical supplies and EMS would transport referred initiates. Future areas designated for intervention included ongoing civic education, especially in the most affected districts such as OR Tambo, training of doctors in preparation for the next season of initiation and deploying the South African Police Service (SAPS) to initiation locations to monitor the process.

The ECDoH has identified a number of challenges that hampered its own response action. Poor staffing in the hospitals caused a strain with the admission of new cases. Inadequate equipment in hospitals led to sharing of equipment between wards. There was also a food shortage in hospitals and lack of space for admission of injured initiates in the hospitals.

The Chairperson commented that the approach adopted by the Eastern Cape province towards the poor initiation practices appeared to be more reactionary than preventive. The Committee had visited the province in 2011, and had pointed out that there was a need for a concerted effort to deal with harmful circumcision practices, but these statistics from 2013 indicated that little had been done to address the problem. She wanted to know how much of the R20 million budget allocated to provinces for curbing poor practices had been spent. She also wanted to know more about the number of arrests made, and whether those arrested ha been charged in court, and sentenced.

Ms A Qikani (ANC, Eastern Cape) also asked about the sentencing of the arrested individuals.

The MEC responded that the cases of all those arrested were still at various stages, and no judgments or sentences had been handed down as yet.

The Chairperson asked about the efforts made towards sensitisation of the communities. She asked if, for instance, there were visits to schools to sensitise the children about the harmful effects of these practices.

Ms Qikani expressed concern about the gruesome pictures that had been presented by the ECDoH and added her voice to the  need for sensitisation of the communities and the young boys in the communities where the most harmful practices were apparent.

The MEC responded that sensitisation in the communities was on-going and that traditional leaders had also been involved in driving the sensitisation exercise. There was consideration also being given to how to involve school teachers in the sensitisation exercise, because they usually had more information on the young boys who were to be included in the upcoming initiation during a particular season. Parents were called upon to take a more active role in protecting their children.

Mr G Mokgoro (ANC, Northern Cape) also expressed shock at the pictures of the injuries depicted in the presentation, asking whether all the injuries were suffered during the initiation process, and asked whether the knives shown were ones that had actually been used. He then asked about the stance of the community, the Province and the children’s parents against such practices.

Mr D Worth (DA, Free State) asked what exactly was being done to curb the illegal and harmful practices and also to ensure that the processes was carried out properly and hygienically.

Mr Mokgoro wanted to know the difference between the legal and illegal schools of initiations.

The Chairperson asked whether there were more deaths in the illegal or legal schools of initiations.

The MEC responded that the rudimentary equipment such as the knives that were depicted in the slides were predominantly used during the illegal initiation practices, which happened in the illegal schools of initiations. The illegal schools were those that were not formalised and approved.  The legal schools were formalised and had been authorised to carry out the initiation exercise.  Initiation practices under the legal schools would only be carried out after the young boy presented a letter from his parents giving consent for the initiation. Here the process would be carried out by certified personnel, using sterilised instruments, and these personnel were also supposed to examine the health of the initiate before-hand to establish whether they were fit to go through the process.

Ms Qikani wanted to know why there were no arrests in 2006, although in this year there were 285 illegal initiates. She also wanted to know why there were only 19 arrests in 2013, whilst it was known that there were 2 314 illegal initiations.

The MEC responded that the information on the 2006 arrests was not available, but the lack of arrests could have been linked to the fact that, at that time, legislation was not in existence then so it would be hard to decide with what offence the perpetrators would be charged. Another possibility was that there could have been confusion which provincial Department should handle the matter, whether it should be handled by Local Government or by Health. In respect of 2013 the low number of arrests was attributed to the fact that the SAPS sometimes had difficulty in effecting arrests or deciding upon an appropriate charge. Sometimes the victims were afraid to identify or had little recollection of their assailants.

The Chairperson wanted to know the state of readiness of the Eastern Cape Province for the next season of circumcisions, and the systems that were in place to monitor the initiation processes for next year. She was very passionate about the fact that children and women were not protected and still lived in fear of harassment, and their basic human rights were being violated. She wanted to also express concern over the fact that little was being done to protect women and children in the communities. She said the Committee would be suspending all other activities until the end of its term in order to focus on the situation in Eastern Cape and the issues of initiation schools and Ukuthwala. The Committee would be inviting several stakeholders to its next sitting including the National and Provincial Police, Department of Justice and Constitutional Development, Department of Health, Department of Education, Local Government and Traditional Leaders to discuss the issue of protecting the basic rights of single and child-headed families and also the issue of initiations and Ukuthwala.

The Chairperson noted that representatives from Mpumalanga Provincial Department of Health were not available to make their presentation on circumcision deaths in the province.

Programmes aimed at assisting Lesbians, Gays, Bisexual, Transgender and Intersex (LGBTI) people: Department of Justice and Constitutional Development briefing
The Chairperson explained that when Department of Justice and Constitutional Development (DOJ&CD) was invited to make a presentation on the protection of the Lesbian, Bay, Bisexual, Transgender and Intersex (LGBTI) group, it had requested that a civil society organisation, the Triangle Project, also be invited as it would be in a better position to answer some of the Committee’s questions. The House Rules had, however, not been followed in the way necessary to allow the Triangle Project to make a presentation. She sought guidance whether Members agreed that the Triangle Project could be allowed to make a presentation, in which case the Committee would seek approval from Parliament after the fact.

Members, after discussion, agreed that since a team from Triangle Project was present and ready to make a presentation, they should be given the opportunity to do so.

Ms Ooshara Sewpaul, State Law Adviser, Department of Justice and Constitutional Development (DOJ&CD) explained that the purpose of the presentation was to brief the Committee on the work undertaken by her Department, in collaboration with stakeholders, to address gender-based and sexual orientation violence against LGBTI persons. A National Task Team (NTT) was set up in 2011 by the Department to explore appropriate interventions, and to develop a national intervention strategy to combat crimes perpetrated against the LGBTI persons, in response to increasing media reports about incidences of sexual violence perpetrated against black lesbians by heterosexual men, who thought they could ‘correct’ the sexual orientation of lesbians. This was a crime socially termed as ‘corrective rape’.

South Africa, as one of the pioneers in the world to constitutionally-protect sexual orientation, had progressively demonstrated its dedication towards guaranteeing protection to same-sex couples. Several pieces of legislation provided protection of same-sex couples, including the Domestic Violence Act of 1998, which endorses the right to legal protection by classifying the same sex relationship as a domestic relationship. In 2000, the Promotion of Equality and Prevention of Unfair Discrimination Act (PEPUDA) was promulgated, giving effect to section 9 of the Constitution that prohibits discrimination on the ground of sexual orientation. Other pieces of legislation had since been passed.

She stated that it was within this progressive legislative and constitutional development that the NTT was mandated to ensure protection of the LGBTI group. The NTT had held approximately seven meetings from the date of its establishment, with the latest taking place in June 2012. However, it had made little progress up to early 2013, for a variety of reasons, including conflicting definitions between the different roleplayers, tensions between actors and role players. However, the DOJ&CD acknowledged that all the roleplayers had learned from the challenges, and had realised the need to unite to forge a way forward.

The NTT had established a working sub-group mandated to review the terms of reference and operations of the NTT, with a view to making recommendations on its effectiveness. The working group comprised representatives of the DOJ&CD, South African Police Services (SAPS), Departments of Social Development (DSD), Correctional Services (DSC), National Prosecution Authority (NPA), South African Human Rights Commission (SAHRC), Commission for Gender Equality (CGE), and other nominated members of the civil society organisations of the NTT.  The Working Group had already met on four occasions, twice in June 2013, and on 2 August and 9 September 2013.

The meetings of the NTT Working Group addressed a number of issues. It had revised the terms of reference for the NTT in an effort to address its operations and compositions. It had developed a strategic work plan for 2013/14 on strategic areas of public education and communication, development of training materials, civil society alliance building and case flow management for outstanding and pending LGBTI cases relating to gender and sexual orientation-based violence, in the criminal justice system.  A national intervention strategy on Gender and Sexual Orientation-based violence perpetrated against LGBTI persons was at the final stages of development.

The NTT Working Group had identified a number of activities to  protect LGBTI persons. The Team would do an environmental scan to identify relevant parallel structures with whom the NTT could coordinate or align its activities. Regional workshops would be conducted in all the provinces to create awareness. It would develop training manuals, since hate crimes were not specifically covered in the statute books, thus providing guideline and assistance to roleplayers in the criminal justice system to screen the crimes. The core work of the NTT would be to monitor LGBTI cases in the criminal justice system. It had already developed a case tracking system and established a multi-sectoral rapid response team.

Ms Sewpaul also explained that the DOJ&CD was developing a Bill based on the draft policy framework, which recommended that hate crimes be treated as a distinct category of crime. This Bill would be ready for tabling in 2014. The draft policy would shortly be sent to Cabinet for approval, and public participation processes would follow after that.

The DOJ & CD concluded by re-echoing its commitment to promoting and protecting rights of LGBTI persons. A further report would be presented to the Committee on the outcome of the next NTT workshop on  18-19 September 2013.

The Chairperson asked if the Triangle Project wanted to make its presentation.

Ms Ingrid Lynch, Research, Advocacy and Policy Coordinator, Triangle Project, said that she would not make a formal presentation, as the Committee had not seen it in advance of the meeting, but offered her assistance in answering any questions.

Mr Worth wanted to know why NTT had held only one meeting in 2012 and one in 2013, although seven were held in 2011.

Mr Mokgoro asked why the NTT had made such little progress from its establishment to date and wondered what mechanisms had been put in place to increase its output.

Ms Sewpaul acknowledged that a number issues had stalled progress, including budgetary challenges, composition and representation, and lack of clear definition of roles. Some civil society organisations withdrew from the task team and the Department had also failed to attend. Attempts to address this included the transfer of LGBTI issues to the Constitutional Development division, strengthening of capacity, and other initiatives, including review of all LGBTI cases, which had already led to two arrests in Western Cape and Gauteng.

Mr Worth also asked where the R3.87 million for the Update Intervention Plan of July 2013 to March 2014 would be sourced, which Department would reflect the spending, and whether it was budgeted.

Ms Sewpaul said that the money would come from the baseline budget.

The Chairperson asked why the copy of the Baseline Report had not been circulated.

Ms Sewpaul responded that the report, together with the situational analysis and the intervention strategy, would be submitted after obtaining the Minister’s approval.

The Chairperson wanted to know the reasons for the difference in the budget figures for the Imbizo and regional workshop, and their justification.

Ms Sewpaul explained that these budget figures were only estimates and would likely change after they had been submitted to the National Committee in the next week.

The Chairperson noted that the presentation did not specifically cover the proposed Hate Crimes Bill, and asked if this would create a new substantive offence and when it was to be tabled in Parliament.

Ms Sewpaul said that although the Bill would only be introduced into the new Parliament, the public participation process would be started as soon as possible. The Bill would provide for special categories of Hate Crimes and distinct offences would also be created. It would also tackle issues around sentencing.

Mr Mokgoro expressed concern that some of the reports submitted to the Committee did not always reflect what happened on the ground, sometimes showing a rosy picture, although there was often little progress to implementation.

The Chairperson said she would expect the baseline report from the Department by end of October, so that the Committee could then consider whether it wanted to accept it, or see a revised report. The Committee was still not happy with the presentation.

Ms Sewpaul assured the Committee that its reports did attempt to correctly reflect the real situation on the ground.

The meeting was adjourned.

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