When 22-year-old Lamkelo Mtyho left home for an initiation school in South Africa’s Eastern Cape, his family believed he was taking a proud, time-honoured step into manhood. He was healthy, enrolled at a registered school, and wrapped in the ochre-smeared blankets that signal a boy’s transition to adulthood.

He never came back.

Weeks after he disappeared into the hills with other initiates, his grandmother, Nozinzile, was told he had collapsed on his way to bathe. By the time help arrived, it was too late. “Initiation is not an easy thing,” she said, “but the thought of him dying never crossed my mind.”

Mtyho is one of at least 48 boys and young men who died during the most recent circumcision season, a period that recurs twice a year in several provinces. The deaths are part of a grim pattern that has persisted despite years of public outcry and government pledges to intervene.

Former health minister Zwelini Mkhize told parliament that 476 young people died over a five-year span during traditional initiation, calling them “deaths that are unacceptable.” Behind the numbers are preventable causes: dehydration, blood loss, septic wounds, and infections spread by unsterilised instruments.

Many initiation schools are set up in remote bush camps, far from clinics or ambulances. Poorly trained practitioners may bind wounds too tightly, fail to monitor for infection, or deny initiates water and food as part of harsh disciplinary regimes. By the time a boy’s condition is recognised as critical, the journey to medical care can be fatal.

Traditional leaders insist the practice itself is not the problem. Morena Mpembe, a senior figure in one community, describes initiation as “a culture left to us by our elders,” arguing that when properly regulated it instils discipline, respect, and identity. But regulation is patchy, and illegal schools flourish where registered ones are too expensive or too far away.

In one municipality, lawmakers discovered more illegal than legal schools operating. Police and provincial authorities have arrested traditional surgeons and parents accused of falsifying boys’ ages to secure their admission. Sixteen practitioners were recently detained in a single sweep.

For many families, the fear now rivals the pride. A mother whose two sons have undergone initiation says she wants the state to step in more forcefully. “Young people are losing their lives,” she said. “We cannot keep sacrificing our children in the name of culture.”