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Riots and looting have prevented medical care and cut supply chains of food, medicines, and COVID-19 vaccines. Munyaradzi Makoni reports from Cape Town. Health care in South Africa has been thrown into jeopardy by riots, looting, and ransacking of warehouses. The unrest, concentrated in KwaZulu-Natal and Gauteng, grew out of protests triggered on July 8, 2021, by former president Jacob Zuma's 15-month imprisonment for contempt of court. “While the instigators intended to cripple South Africa's economy and undermine its social fabric, the health sector has also been a major casualty of the unrests”, Jerome Amir Singh, director of the Scientific Advisory Group on Emergencies, part of the Academy of Science of South Africa, told The Lancet. Throughout July 12–16, unrest prevented the provision of essential health-care delivery by blocking patients, medical staff, and critical supplies from reaching facilities, says Sean Christie, spokesperson for Médecins Sans Frontières (MSF) in South Africa. The disruptions occurred in every district of KwaZulu-Natal province, where staff could not work because of public transport stoppages, road closures, and the suspension of ambulance services. “Certain hospitals in Gauteng and KwaZulu-Natal and their emergency departments, already stretched by a surge in COVID-19 cases, were overwhelmed due to staff shortages and an influx of trauma cases linked to the violence”, Christie says.

lic transport stoppages, road closures, and the suspension of ambulance services. “Certain hospitals in Gauteng and KwaZulu-Natal and their emergency departments, already stretched by a surge in COVID-19 cases, were overwhelmed due to staff shortages and an influx of trauma cases linked to the violence”, Christie says. Many KwaZulu-Natal hospitals ran short of food for patients because catering supply trucks were looted. Staff in many hospitals are working irregular hours because they must spend several hours a day queueing for food for themselves and their families, he says. “It is obviously quite worrying that patient care would be compromised through not only disruption of health-care services but through other impacts as well”, Atiya Mosam, public health medicine specialist in Johannesburg, told The Lancet. For example, disruptions in public transport, lack of food to take medication, or even patient fear about venturing out into public, she says. There will be increased trauma from the looting and violence, decline in the nutrition status of children without appropriate food, and possible spread of SARS-CoV-2 due to lack of physical distancing or people being displaced from their homes, Mosam says. The unrest could contribute to the spread of SARS-CoV-2 because of the number of people involved, most of whom seemingly did not wear masks, says Mosam.

atus of children without appropriate food, and possible spread of SARS-CoV-2 due to lack of physical distancing or people being displaced from their homes, Mosam says. The unrest could contribute to the spread of SARS-CoV-2 because of the number of people involved, most of whom seemingly did not wear masks, says Mosam. eThekwini Mayor Mxolisi Kaunda in KwaZulu-Natal told reporters that more than 15 billion rand (about US$1 billion) worth of property and equipment had been damaged, affecting 40 000 businesses. The economy will take years to recover, says Singh. The death toll from the unrest has reached 212, with more than 2550 people arrested, and 161 malls extensively damaged during the protests. “Our vaccination programme has been severely disrupted just as it is gaining momentum”, said South Africa's President Cyril Ramaphosa. “This will have lasting effects on our ability to consolidate some of the progress we were already witnessing in our economic recovery.” Only a small proportion of South Africans have been vaccinated against COVID-19, Mosam says. “We cannot afford to delay vaccinations.” Medical supply chains were severely affected by the looting of pharmacies, depots, and the destruction of a major pharmaceuticals' factory. “South Africa has 6 months' worth of antiretroviral drugs buffer stock and so the significant impacts of the disruptions will be lagged in regard to HIV care, but medicine and personal protective equipment stockouts are anticipated in the short term”, Christie told The Lancet.

ction of a major pharmaceuticals' factory. “South Africa has 6 months' worth of antiretroviral drugs buffer stock and so the significant impacts of the disruptions will be lagged in regard to HIV care, but medicine and personal protective equipment stockouts are anticipated in the short term”, Christie told The Lancet. Several clinics in eThekwini remain shut, severely disrupting the collection of prescriptions for patients with chronic conditions, and COVID-19 vaccination sites have been closed. Because of looting, MSF has stayed away from Ngwelezana Tertiary Hospital near Empangeni where it supports the COVID-19 response. In KwaZulu-Natal's Eshowe, where MSF runs HIV and tuberculosis programmes, all medical and community-based activities are suspended. For health institutions to resume normal functioning, improvements in infrastructure are needed, health-care workers who might have been incapacitated or died in the unrest need replacing, and “we will need leadership, funding, and active citizenship”, Mosam says. Security is essential, says Christie, adding that broad-based advocacy and health promotion are needed to promote the sanctity of health care at all levels of society. “If the insurrectionists thought they would succeed in undermining South Africa's vibrant democracy and fraying our unity, they were wrong”, says Singh. © 2021 Alet Pretorius/Gallo Images/Getty Images2021