Mass circumcision ceremonies in South Africa have left more than 43 boys dead and dozens more mutilated. 

The rituals – known in the country as ‘Ulwaluko’ – are carried out twice a year with the intention of preparing young men for adulthood. 

When the youngsters arrive at the ceremony, they are taken away from their families and smothered in white clay. 

They then spend three weeks transitioning from boys to men before being returned home. 

As part of the ceremony, the initiates are meant to be circumcised by traditional surgeons who have years of experience.

But many circumcisions are instead carried out by unskilled people working at illegal initiation schools who use old spears, scissors or razor blades to perform horrific surgery.

Ulwaluko can be deadly. In 2024, the combined deaths of both winter and summer rituals was 93 boys with 11 total penis amputations – with some rogue ‘surgeons’ found to perform the operation without anaesthetic.

A report commissioned by the South African government recorded 322 deaths of young boys between 2021 and 2024, as well as thousands of hospitalisations and amputations.

It laid the blame at the door of criminal gangs who have set up unscrupulous illegal initiation schools who use untrained ‘surgeons’ and ‘nurses’ who botch the circumcisions.

Twice a year, the ceremonies – known in the country as ‘Ulwaluko’ – are carried out with the intention of preparing young men across the nation for manhood

Many circumcisions are carried out by unskilled people working at illegal initiation schools who use old spears, scissors or razor blades

The main causes of death are gangrene, sepsis and severe dehydration – though some unwilling boys have been stabbed, drowned or beaten to death. 

There are hundreds of reports a year of illegal schools kidnapping boys as young as 12 and carrying out the surgery then forcing parents to pay to have their sons returned home safe.   

The Customary Initiation Act has been passed to make it illegal for unregistered initiation schools to be set up and force all traditional surgeons to be fully trained and qualified by the state.

Police now have the powers to shut down the illegal schools and arrest the principals.

South African police clamping down on unregistered initiation schools have shut down 42 of them, making 40 arrests and rescuing 180 boys. 

But the ceremonies are still hugely important to many across the country. Unless the youths undergo the rite they are not allowed to sit in on tribal meetings or take part in many social activities or consider getting married.

The rituals have been held for centuries in secret in specially built huts away from the villages where nobody except tribal elders, a ‘surgeon’, and the initiates can enter.

Every year tens of thousands of boys undergo the transition to manhood through a sacred ceremony dating back hundreds of years despite the shocking annual death rate.

South Africa’s Minister of Traditional Affairs Velenkosini Hlabisa said after the 43 teenage deaths: ‘These figures are deeply concerning to us and we send our condolences to all the families.

‘They serve as a stark reminder that much more must be done collectively to eliminate preventable deaths, injuries and criminal activities associated with customary initiation.

‘I condemn the continued operation of illegal initiation schools which are responsible for many of the deaths, injuries, kidnappings and abuses that are reported each year.

‘Individuals who establish, facilitate or participate in the illegal initiation schools must also understand they are committing criminal offences and must face the full might of the law.

‘Respect for tradition must go hand in hand with respect for the law and every initiate’s constitutional right to life, dignity and safety as we pledge to work towards zero deaths.

‘Every initiate deserves to return home safely and with their dignity intact and this requires all of us, parents, traditional leaders and communities to all play our full part,’ he said.

Although the boys have a choice as to whether they undertake the initiation there is huge peer pressure and those who refuse are called Inkwenkwe or ‘boy’ – a harsh insult.

Boys under 16 are not allowed by law to enter the initiation schools but boys as young as ten are often operated on in the illegal initiation schools.

Traditional surgeons charge parents to take the boys away for up to three weeks to teach them survival skills and tribal history and how to behave as a man then perform the dreaded ‘snip’.

Teenager Scotty Dawka, 19, went to an initiation school despite having seen a TV programme on penile amputations and told a local reporter: ‘I was of course very scared of going.

‘In my community many boys went through the initiation before me and I wanted to be the same as them. I wanted to be looked up to as a man in my village by the elders,’ he said.

‘It was very painful to go through and I fell ill but I was treated and survived.’

Anne Kumalo’s 16-year-old son was kidnapped when he went to a local store along with 22 other boys and taken to an illegal initiation school 20 miles away in Soweto.

She said: ‘I was charged 1000 Rand (£45) to get him back or warned he would be killed and when police found the school the boys had been badly treated, whipped and beaten.’

Last year Siyamthanda Siymthanda, 13, from Witbank, Mpumalanga Province, died while at initiation school and his family claim he was abducted against his and their will.

Former South African President Nelson Mandela wrote about the spiritual meaning of his own circumcision as a teenager before becoming accepted as a freedom fighter.

Those who have undergone the sacred ritual are sworn to secrecy and considered tribal outcasts and severely beaten or killed if they tell anyone what the process entails.

The worst of the injuries occur from botched circumcisions carried out by tribal ‘nurses’ who may use the same rusty spear for many boys which causes mass infection.

The wounds are tightly wrapped with bandages that cuts off the blood supply to the area and within ten hours the genitals can become gangrenous and need amputating.

Many die of severe dehydration as after surgery they are denied water to stop them urinating on the grounds it will cause further injury to their grievous wounds.

Many superstitious initiates do not seek medical treatment when clearly needed having been told if it ‘falls off’ that it will ‘grow back’ – but then die from sepsis.

The winter initiation season runs from mid-May to mid-July with the official figure of 43 deaths now having been collated and the summer season from November to January.