South Africa’s emergency services are on the brink
South Africa is facing a severe shortage of ambulances and urgent care beds at hospitals, resulting in emergency medical services buckling under the pressure.
According to law firm DSC Attorneys, this is leading to dire consequences for patients in the country, with lives lost or severe injury as a result of delayed action.
Health minister Aaron Motsoaledi recently confirmed that the country has a shortage of about 2,000 ambulances.
Meanwhile, Professor Fathima Paruk, head of the Department of Critical Care Services and Emergency Medicine at the University of Pretoria, noted that the country is short about 10,000 hospital intensive care unit beds.
DSC said that it has seen an increase in the number of cases it deals with related to ambulance delays, where a suitably-equipped EMS could have prevented severe injury or death.
It noted that national EMS standards recommend one ambulance per 10,000 people, yet in many provinces—including the Eastern Cape, North West, and parts of KwaZulu-Natal this target is nowhere near being met.
Reports point to patients waiting hours for help or receiving none at all, and those in need of aid suffer the consequences.
However, even if patients are able to get to hospitals, they may find themselves without the proper care facilities, especially in the public sector.
According to Professor Paruk, while private hospitals can build and create space for critical care as needed, the public sector is restricted by the infrastructure it has.
“In the private sector, you can literally create an ICU bed. In the public sector, you have x number of beds and that’s it,” she said.
This is also reflected in disparate levels of care geographically, where patients in one province, like the Western Cape, can expect greater access and higher quality care than those in Limpopo.
Skills crisis making matters worse
Professor Paruk added that the availablitly of beds and services is just one side of the problem, the other being a severe lack of skills needed to run these units.
“You can’t run an ICU bed without nurses and doctors who are trained in critical care, and we are extremely short on them in both the public and private sectors,” she said.
Across the country, only 25% of ICU nurses are trained in critical care, she added. Things get more troubling when further specialisation is required.
The professor noted that a critically ill patient in South Africa requires a specialist who has had additional training in critical care, known as an intensivist or critical-care subspecialist.
There are fewer than 100 of these specialists in the country, she said.
As a result, many ICU patients, especially in the private sector, are managed by general specialists. She attributes these shortages mainly to a lack of training posts.
According to DSC, these shortages risk putting the state in a precarious position, as, legally, there must be liability for the consequences of failing to provide these critical services.
The law firm said that liability could lie anywhere along the chain. In cases of EMS failure, liability may fall on:
- The provincial Department of Health, if the failure stems from systemic under-resourcing or poor management.
- EMS providers, if they act negligently or breach their contractual duties.
- Hospitals, if delays in coordinating ambulance responses lead to injury or death.
“Legal claims could fall under medical malpractice, personal injury, or even constitutional claims for the violation of the right to healthcare,” the firm said.
Medico-legal claims are already a massive burden on the National Health Department’s budget.
In 2024, the department said it was hit hard by “an explosion of litigation” in medical claims since 2015, amounting to over R100 billion.
However, not all of these claims are above board, with R33 billion of the claims being under SIU investigation for possible fraud.
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