South Africa: The cost of a bullet

30 June 2010

This article focuses on South Africa and draws on a recent study published in the South African Medical Journal which states that 127,000 individuals are treated at South African state hospitals each year for non-fatal firearms injuries. The majority are young men.

As we know, gun violence devastates lives and also imposes major economic costs on societies around the world, some of which spend more than 4% of their Gross Domestic Product (GDP) on dealing with violence-related injuries according to the World Health Organisation.

The approach taken by the study authors and the breakdown of the economic costs of gun violence could be a useful strategy for your own work on the issue especially in advocacy aimed at the financial and health sectors of government.

Cost of a bullet in South Africa

Friday, June 25, 2010:

Sleeping with a gun under your pillow in South Africa is not that uncommon. Given the soaring crime rates, people live in a constant state of fear and understandably many have taken precautionary measures to try and protect themselves and their loved ones.

Sometimes this heightened state of anxiety and terror can result in tragedy – as witnessed last week, when a Sandton man mistakenly shot and killed his domestic worker’s 12-year-old son whom he mistook for an intruder.

A few years ago, a former Springbok rugby player shot and killed his own daughter, after mistaking her for a car thief.

According to the International Action Network on Small Arms (IANSA), a global movement against gun violence, South Africa has the fourth highest gun homicide rate in the world. The organisation is calling for a Gun-Free 2010 World Cup in South Africa, following the shooting of an ANC councillor and member of the World Cup local organising committee earlier this year.

Cost of a bullet

But firearm injuries are not just disabling to the individuals and communities they affect, studies show they also place a huge burden on state hospitals.

A recent study published in the South African Medical Journal* states that 127 000 individuals are treated at South African state hospitals each year for non-fatal firearm injuries.

The study estimates the average minimum cost for treating a gunshot injury at a tertiary hospital in South Africa in December 2006 was R15 722 ($US 2230).

Based on extrapolated results from the study, the treatment of gunshot injuries at Tygerberg Hospital in 2006 cost the state a whopping R7 825 500 ($US 1 110 000). The study included all patients with firearm-related injuries who were seriously injured and required admission for more than 12 hours.

Gunshot trends - study findings

  • Young male adults made up the majority of gunshot victims (87%) with an average age of 28 years.
  • Most of them were unmarried (89%).
  • Most patients sought medical care between 7pm and 7am and mostly over weekends.
  • The distribution of bullet entry wounds shows that most of gunshot injuries were in the legs, chest area and head.
  • The average length of stay was 5.8 days at an average cost of R2 714 ($US 385) per day.
  • Most patients (95%) underwent diagnostic imaging and 38% required surgical procedures in theatre.
  • Blood products were given to 16%.

According to the study, the greatest costs were: admission and duration of hospital stay, including ambulance transport and haemodialysis (64%), followed by diagnostic imaging (14%), surgical procedures (12%), and blood products (11%).**

Researchers recommend that “a national costing initiative, utilising a standardised costing system, is urgently required to efficiently determine the real costs of trauma to South Africa’s already under-resourced health system”.

The Firearms Control Act

In South Africa, the Firearms Control Act (2000) replaced the Arms and Ammunition Act (1969). The new Act introduces more rigorous firearm control processes and procedures in South Africa, according to the Institute for Security Studies (ISS).

The Firearm Control Act has forced licensed gun owners to re-apply for their firearm licenses, with more stringent testing and background checks applied.

However, in June the Pretoria High Court ruled that licences obtained under the 1969 firearms legislation will be deemed valid for now. This means that millions of gun owners who have not yet renewed their firearm licences in terms of the new Firearms Control Act have been granted temporary relief.

According to the ISS website, many firearm control civil society groups, as well as many individuals have identified the establishment of the Firearms Control Act in South Africa, as a constructive attempt by government to decrease the number of firearms in circulation, as well as to stop small arms-related deaths.

However, concerns over the security of the impounded firearms have also been raised. In response to a question in parliament earlier this year, the Ministry of Safety and Security acknowledged that some 8,286 firearms, which had been recovered by the SAPS, had subsequently been lost, stolen or otherwise misplaced, said the ISS website.

Gun-Free 2010 World Cup

Joseph Dube, IANSA Africa Coordinator said the 2010 World Cup was an opportunity to rid South Africa of the tyranny of gun violence forever.

Writing for The Times online, Dube said every football stadium in SA should be declared in gun-free zone in accordance with the Firearms Control Act of 2000. He also called for an immediate moratorium on the carrying of guns and that no new gun licences should be issued until the end of the tournament.

"2010 is not only a chance for South Africa to showcase its beauty and thriving businesses to the world, but a chance for the government to show that it is tough on gun crime," he said on the IANSA website.


* Data was collected from Tygerberg tertiary teaching public hospital in Cape Town, 128 out of 203 gunshot victims were admitted for more than 12 hours

** These figures exclude the costs of staff salaries and laboratory and pharmacy costs.

*** The costs in the study were published in US dollars, these were converted to South African rands, using mid-market rates from 31 December 2006 – when study occurred).


Norberg, J, Nilsson, T, Eriksson, A, Hardcastle T, “The costs of a bullet – inpatient costs of firearm injuries in South Africa, South African Medical Journal, June 2009, Vol.99, No.6, pp 442-444.
Times Online,
International Action Network on Small Arms (IANSA),
Institute for Security Studies,

Originally published online at:,51602.asp