Community assault--the cost of rough justice.

To the Editor: Violent crime pervades South Africa, with murder, rape and serious assault directly affecting around 1 in 50 people per annum. 1 Approximately 21% of the South African population resides in KwaZulu-Natal province, which has some of the country's highest rates of poverty and violent crime. 2 Law enforcement in such areas is challenging and, as a result, some 40% of households are dissatisfied by the level of policing in their communities. 3 Unpunished criminals and an inadequate justice system have led communities to resort to their own form of retribution. 4 Severe beatings, termed community assault (CA), are administered by members of the local community when alleged criminals are caught. This practice is intended to inflict serious injury rather than to kill, and to serve as punishment upon the alleged perpetrator and as a warning to potential offenders. This alternative to the conventional justice system has been applied in 4-6% of all crimes committed in South Africa. 3 We highlight the inhuman practices that occur as a result of the failing South African criminal justice system, and we further quantify the range of serious injuries that are sustained secondarily to CA and reinforce the importance of early medical intervention. Data were prospectively collected on all CA patients presenting at Ngwelezane Hospital (NGW), a tertiary referral centre for northern KwaZulu-Natal, between October 2006 and January 2007. All patients were managed in accordance with advanced trauma life support (ATLS) principles. Details regarding the mechanism and time of assault were collected. Routine blood investigations, chest radiographs and urinalysis were carried out as standard. Further investigations were performed as clinically indicated. Patient progress and any necessary interventions were noted. The primary end-point of the study was the injuries received. Secondary end-points included time from injury to arrival at NGW and final patient outcome. Results Data on 19 consecutive patients were collected (Fig. 1); 94.7% were males aged 14-48 years (mean 27.1 years); 9 (47.4%) were referrals from rural hospitals, and 10 (52.6%) presented directly to our unit. The average time from injury to presentation at NGW was 4.8 hours (range 0.5-13) for those presenting directly, and 49.1 hours (10-168) for those referred from smaller rural hospitals. Significant morbidity was experienced by 16 (84.2%) patients, with 3 (15.9%) subsequent deaths; 7 (36.8%) developed renal dysfunction secondary to rhabdomyolysis, 3 (42.9%) of these progressed to acute renal failure requiring haemodialysis, with 1 resulting …