‘The infrastructure can’t cope’: South African healthcare workers struggle to deal with third wave
Dr Angelique Coetzee is a GP in the South African capital Pretoria, where she has run a family clinic for the past 33 years.
But she has never known anything like COVID-19.
She said: “If you have never been in such a situation, you can’t imagine what it is like. We’ve been dealing with 30 or 40 positive cases every day. The pressure is extreme.
“If you look at a country like Australia where they have a few cases, well I would see their national caseload in a couple of days. Can you imagine?”
When we first spoke in June, Dr Coetzee seemed on the verge of tears.
She said: “If I speak to you now, that means someone with COVID will not been seen – and there is no point trying to message. I don’t have time to answer.”
Dr Angelique Coetzee is a GP in the South African capital Pretoria
South Africa has found itself in the grips of a Delta variant-driven “third wave” of infection.
The caseload has been brutal, outstripping the first two waves by a factor of three.
The country’s acting health minister says this surge has now peaked in the province of Gauteng, where the cities of Pretoria and Johannesburg are situated but Dr Coetzee says her personal and professional burden has barely changed.
She said: “We have been seeing fewer patients on a daily basis this week but the weather is colder and COVID-19 patients are turning up with pneumonia so we are seeing sicker patients than we have been during the last three or four weeks.”
South Africa’s beleaguered public-run health system has struggled to cope with wave after wave of the virus.
Lacking sufficient beds and qualified staff, city hospitals used casualty departments as holding centres where patients wait for space to free up – sometimes for days.
South Africa’s healthcare system has been struggling with staff shortages during the pandemic
“This is the third wave we have experienced, comes less than six months (after the second) and the infrastructure can’t cope,” said Dr Coetzee.
“Most patients need oxygen and I try to admit them to hospital but because of (capacity) problems I have had to treat them at home. We have been waiting for 24 to 48 hours before we could get them cylinders, dealing with the stress of trying to manage patients without oxygen with the knowledge that if we don’t make a plan they are going to die. All this while the surgery is full, full, full. It is so very stressful.”
The extreme working patterns and the mental pressures that come with it have been felt in unexpected ways.
“I have had colleagues who have had motor vehicle accidents. One was so tired after work that he drove his car into a tree,” she said.
“The second one was hit at a crossroads – and a lady doctor reversed into a garage door because she had forgotten to open it. The most bizarre things that happen in a short space of time but it shows you the pressure they are under.”
Community groups have been running ad-hoc clinics in South Africa during the pandemic
Dr Coetzee has been operating on the very edge within a healthcare system that was been put under severe strain.
There are no support workers or home visits or specialist consultations for most people in South Africa.
Instead, GP’s like Dr Coetzee try to do it all.
“You become distant after a while but you try to carry on and on. I think that is the only way to survive it,” she said.
Yanga Booi is a 32-year-old nurse working at the intensive care unit at Thelle Mogoerane Regional Hospital in Vosloorus, on the outskirts of Johannesburg.
He says the hospital is poorly equipped and the staff have been insufficiently prepared during the pandemic.
He said: “The health system in South Africa did a complete spin when the pandemic hit our shores. We were put in the spotlight and given this false sense of heroism, but it wasn’t the right sort of attention because when we went to work, the hospital was in a worse state that than it was before.
“We were ill-prepared from the beginning, and we are still not prepared.”
The third wave has come as rioting and looting has taken place across the country
The hospital in Vosloorus provides beds and treatment but Booi says COVID testing at the facility is not reliable and patients are not properly isolated.
“We cannot be sure who has COVID because we get so many false negatives. It’s like we wait for people to get sick or drop dead, then look into the COVID thing,” he said.
“I remember admitting a patient who was negative on admission and so we didn’t isolate him. A few days later he died and we found out that he was positive.
“It’s a sad situation because the hospital does not have an isolated ICU ward for COVID patients. It’s a general ICU with isolation rooms and we admit COVID patients to it – some people have it and others don’t. We cannot be sure.”
Mr Booi says dozens of his colleagues have paid a terrible price over the course of three separate waves of infection in South Africa.
He said: “It is unfortunate that we have had to watch our colleagues dying from this… countless members of staff have gone, it’s not just nurses, it’s the doctors, it’s the clerks, it’s the porters.”
The 32-year old, who took up the profession when he was offered a government bursary, says he was “deeply afraid” when the pandemic arrived.
Yet 17 months later he has noticed a change in himself and others.
Yanga Booi said the country was ill-prepared for the pandemic
He said: “The loss of life has caused us to grow a thick skin, just like when we came into the profession. Our first experiences with death were terrifying but then we got accustomed to people dying and that is what has happened with COVID.
“We are used to the virus we know it is here to stay and we must find ways to keep going.”
Dr Shabir Mahdi is dean of the faculty of health sciences at Witwatersrand University in Johannesburg and is a source of expertise and fearless criticism in a country that has struggled in all aspects of its pandemic response.
Dr Mahdi says the ferocity of South Africa’s third wave of infection came as a “huge surprise”.
He said: “The current resurgence far exceeds what we have experienced either in the first or second wave in the number of documented cases. In fact, the numbers of new cases diagnosed on a daily basis is three times what it was at the time of the peak of the first and second wave.”
Dr Shabir Mahdi said the third wave in the country came as a ‘huge surprise’
However, this eminent viriologist is unsparing in his criticism of the government’s response.
While the magnitude of the Delta-fuelled third instalment could not have been predicted, he says health officials knew another wave was coming at the beginning of South Africa’s winter season.
He said: “In a province like Gauteng where 25% of the population live, our hospitals are completely overwhelmed but at the same time, we have beds that are literally vacant in the same hospitals and we can’t actually use those beds because some official in some government department forgot that you actually need to have health care workers available to actually staff those beds.”
Blindfolded and under armed guard, a captured ISIS fighter is brought before us.
When the blindfold is removed, he doesn’t look surprised to see a camera crew and several counterterrorism officers, one of whom interrogated him when he was first caught.
The 24-year-old militant is on death row in Somalia awaiting execution by firing squad, having been accused of being an ISIS commander, as well as a sniper and a member of a two-man bomb squad.
We’ve been given extremely rare access to speak to him and another ISIS recruit in a secure location in Puntland, the semi-autonomous region of northern Somalia where the terror group has been seizing territory and ruling over terrified communities.
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Watch the documentary – Hunting for ISIS: A warning from Africa
US and Somali commanders say ISIS is running its global headquarters in Puntland’s caves, financing its activities worldwide.
Muthar Hamid Qaayid is from Yemen and came to Somalia via a sea route where we’ve witnessed how challenging it is to halt the flow of militant travellers.
He insists he wasn’t an active participant in the two-man bomb squad – and seems entirely unbothered about the situation he now finds himself in.
“I didn’t press the button,” he says. “I just looked. The other man made the bomb and set it off. I didn’t come here to kill Muslims.”
His partner blew himself up as he was planting the bomb in Bosaso city centre and realised he had been discovered.
Officers believe he detonated it prematurely.
The man in front of us was injured, and we are told he had incriminating bomb-making equipment with him.
I ask him if he has regrets about his involvement and joining the militant group.
“I don’t regret anything,” he says, smiling. “Even if you take me out of the room now and execute me, I don’t regret anything.” Again, another smile.
“If they shoot me or hang me, I don’t mind. In the end, I don’t care.”
Tellingly, he says his family does not like ISIS. “If they found me here, they’d be upset,” he says.
Despite persistent questions, he doesn’t shift much. “I’m not thinking,” he insists. “There’s nothing. I’m just waiting for death.”
The ISIS militant speaks to Sky’s Alex Crawford
I ask if he’d heard of people being killed by the bombs he’s accused of planting.
“Yes, but they don’t kill all people,” he insists.
But what about killing anyone, I suggest, slightly puzzled.
“They don’t kill everyone,” he continues. There’s a pause. “Only infidels”.
Infidels is a term many recruits use to describe those who simply don’t agree with their strict interpretation of Sharia – that can include Muslims as well as other religions.
Officials show us multiple foreign passports recovered from ISIS cave hideouts in Puntland and from those they’ve captured or killed.
Passports seized from ISIS hideouts and fighters
There are passports for whole families from South Africa, including children, as well as ones from Germany, Saudi Arabia, Venezuela, and Bahrain.
There are also handfuls of IDs which show European faces.
Since a Puntland army offensive was launched last December, just five of the 600 ISIS fighters killed have been Somalis, says Mohamed Abdirahman Dhabancad, Puntland’s political affairs representative.
‘The main target was to rule the world’
The second prisoner brought before us is from Morocco and is much more talkative.
Usman Bukukar Bin Fuad insists he was duped by ISIS and says he only travelled to Somalia because he’d heard he could make money.
Usman Bukukar Bin Fuad claims he only dug caves for ISIS
“Instead, I ended up digging caves,” he says. “It was difficult to escape but when they told me to put on a suicide vest to kill Puntland forces, I said this is not what you told me I would be doing – and I escaped.”
He says he was given a weapon but never used it – a claim not believed by his captors.
“I never joined any fight,” he insists. “I had my weapon [AK47] but I just did normal duties taking supplies from location to location and following orders.”
He says he met the ISIS leader in Somalia, Abdul Qadir Mumin, several times.
“He used to visit all the ISIS camps and encourage them to fight.”
“And he’d reassure us all about going to heaven,” he adds.
It seems to lend credence to the belief that Mumin is still alive and operating – up until a few months ago anyway.
He says he was given training in sniping (which he didn’t finish) and map reading, which was interrupted when the Puntland military offensive began.
He says he travelled over from Ethiopia with six Moroccans, before meeting an Algerian recruit.
Fellow militants in the ISIS mountain stronghold were from countries including Tunisia, Libya, Tanzania, Kenya, Turkey, Argentina, Bangladesh, Sweden, and Iraq.
“The main target or focus was to rule the world,” he says. “Starting with this region as one of the gates to the world, then Ethiopia and the rest of the world.
“I heard so much talk about sending ISIS fighters to Bosaso, Ethiopia or Yemen. Sending people to other parts of the world and ruling the world was all part of the plan.”
The captives’ information has added to the belief that Puntland and Somalia is just the tip of a huge ISIS problem which is spreading and is able to cause terror in a range of ways.
Alex Crawford reports from Somalia with specialist producer Chris Cunningham and Richie Mockler. Photography by Chris Cunningham
Israel has said it has begun the first stages of its takeover of Gaza City – as the UK condemned the approval of plans for a new West Bank settlement.
Brigadier General Effie Defrin, Israel’s military spokesperson, said on Wednesday that “IDF forces are holding the outskirts of Gaza City” after preliminary operations to take the entire area.
An estimated 60,000 reserve soldiers have also been called up to help seize Gaza’s biggest urban centre, but will not report for duty until September, according to a military official.
Israeli troops are already operating in the Zeitoun neighbourhood of Gaza City, and the Jabaliya refugee camp in northern Gaza.
Prime Minister Benjamin Netanyahu’s war cabinet approved the plans last month, which include an eventual full security takeover of all of Gaza, despite growing international criticism that it will likely lead to the displacement of many more Palestinians.
He is said to have sped up the timeline for taking control of Hamas strongholds after both sides clashed near Khan Younis, south of Gaza City, on Wednesday.
Israel claims it will help any civilians evacuate before any assault begins.
Smoke rises in Gaza City after Israeli strikes. Pic: Reuters
Pic: Reuters
Ceasefire proposal being considered
Israeli officials said they are also considering a new ceasefire proposal put forward by Qatar and Egypt.
The deal, which involves a 60-day ceasefire and the release of some of the remaining Israeli hostages and Palestinian prisoners, has already been accepted by Hamas.
Thousands of Israeli civilians have called for the government to accept a ceasefire and reverse its decision to take over Gaza City, but Mr Netanyahu is thought to be under pressure from some far-right members of his coalition to reject the deal and continue to pursue the annexation of the territory.
Relatives and supporters of hostages held by Hamas protest in Israel. Pic: AP
West Bank settlement plan approved
One of those is Bezalel Smotrich, Israel’s finance minister, who announced on Wednesday that a controversial plan for a settlement project in the occupied West Bank had been approved after they received the final go-ahead from Israel’s higher planning committee.
Mr Smotrich, an ultranationalist in the ruling right-wing coalition, said in a statement that the government was delivering with the settlement what it had promised for years: “The Palestinian state is being erased from the table, not with slogans but with actions.”
He said last week that the settlement would “finally bury the idea of a Palestinian state, because there is nothing to recognise and no one to recognise”.
Israeli Finance Minister Bezalel Smotrich shows the planned settlement on a map. Pic: Reuters/Ronen Zvulun
‘A stake through the heart of two-state solution’
British Foreign Secretary David Lammy condemned the plan, saying it “would divide a Palestinian state in two”.
In a post on the X social media platform, Mr Lammy called the settlement in the West Bank “a flagrant breach of international law”, which “critically undermines the two-state solution”, and urged the Israeli government to reverse the decision.
The UN also condemned the decision, with spokesperson Stephane Dujarric saying that it “will drive a stake through the heart of the two-state solution”.
Read more:
Inside the conflict forcing Palestinians from their homes
The city where what was law now has no place in reality
David Lammy called the new West Bank settlement “a flagrant breach of international law”. File pic: Reuters
Where is the settlement?
The settlement is set to be built in E1, an open tract of land east of Jerusalem, and includes around 3,500 apartments to expand the existing settlement of Maale Adumim.
E1 has been eyed for Israeli development for more than two decades, but plans were halted due to pressure from the US during previous administrations.
A two-state solution to the decades-old Israeli-Palestinian conflict would see a Palestinian state in East Jerusalem, the West Bank and Gaza existing side by side with Israel.
A view of part of the Israeli settlement of Maale Adumim. Pic: Reuters/Ronen Zvulun
Today, an estimated 700,000 Israeli settlers live in the West Bank and East Jerusalem. There is also a growing movement of Israelis wanting to build settlements in Gaza.
Settlers make up around 5% of Israel’s population and 15% of the West Bank’s population, according to data from Peace Now.
Settlements are illegal under international law and have been condemned by the UN. They are, however, authorised by the Israeli government.
The family of a father who disappeared with his three children nearly four years ago in New Zealand have broken their silence to appeal for him to return home.
In December 2021, Tom Phillips vanished into the wilderness with his two daughters and son – but his family have said they still remain hopeful “today will be the day you all come home”.
Phillips, along with Jayda, now aged 12, Maverick, 10, and Ember, nine, were last believed to have been seen in a “credible sighting” last October hiking through a bush area near Marokopa on the country’s North Island.
For the first time, his family have directly appealed to Phillips in the hope that “just maybe, he’s going to see this” and “that we are here for him”.
In an interview with New Zealand journalist Paddy Gower, his sister Rozzi Phillips said she missed being part of her brother’s life, adding “I really want to see you” and “you’re very special to me”.
She also read out a handwritten message from Phillips’ mother, Julia, which came from her “heart, just to her son”.
“Tom, I feel really sad that you thought you had to do this, not considering how much we love you and could support you,” she said.
“It hurts every time I see photos of the children and of you and see some of your stuff that is still here, thinking what could have been if you’d not gone away.”
Tom Phillips. Pic: New Zealand Police
According to New Zealand news site, Stuff, the letter ended with a message for the three children.
“We love you so much and really miss being part of your lives,” it read.
“Every day we wake up and hope that today will be the day you all come home.”
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Ms Phillips said her brother is a skilled builder and would have constructed a shelter.
Police believe his actions could be linked to a custody battle.
There have been numerous reported sightings since December 2021.
The most recent last October was said to be from a distance when the group were seen wearing camouflage gear and carrying large camping backpacks.
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