The Life Esidimeni tragedy remains one of the gravest violations of human rights in democratic South Africa. In 2016, the Gauteng Department of Health (GDoH) terminated its contract with Life Esidimeni, a psychiatric care facility, relocating almost 2,000 mental health care users (MHCUs) to unlicensed and unprepared NGOs across the province to save costs and reintegrate MHCUs into the community. This decision resulted in the deaths of over 140 MCHUs, with 44 whose whereabouts are still unknown and inflicted suffering on many more. This conduct by the GDoH is a reflection of the systemic failures in healthcare governance and accountability. The 2017 Health Ombud’s Report into the circumstances surrounding the deaths comprehensively provides detailed findings that form the basis for advocacy on mental health rights and state accountability.

The transfer of MHCUs violated multiple rights enshrined in the Constitution of South Africa, particularly the rights to human dignity and the right to life provided in sections 10 and 11 of the Constitution, respectively. These are not only rights of the Constitution, but are also the founding values of the Bill of Rights, which emphasises their significance of being upheld. Section 27 of the Constitution provides for the right to access to healthcare. Therefore, moving MHCUs into overcrowded, under-resourced NGOs, many of which lacked licenses, trained staff, and basic medical infrastructure, is a clear violation of the above-mentioned rights. The GDoH failed to conduct adequate assessments, ignored warnings from experts, and placed cost-saving above the constitutional obligation to protect vulnerable individuals. Therefore, by doing so, it breached its Constitutional obligation to “…respect, protect, promote, and fulfil the rights in the Bill of Rights.”

The deaths were caused by a combination of negligence, starvation, neglect, and lack of medical care. The Ombud Report highlights how the relocation decisions were made without due diligence or adherence to healthcare standards. The move was framed as deinstitutionalisation aligned with World Health Organisation guidelines, yet in practice, it was a distorted application that stripped patients of safety and dignity. Critical failures included placing patients in unlicensed NGOs, a lack of proper oversight, an absence of consultation with families, and a bureaucratic disregard for medical advice and human rights. This is a tragedy that resulted from the negligence of domestic law and policy that disregarded the framework that ensured human dignity and respect for human rights. Section 8 of the Mental Health Care Act 17 of 2002 mandates treatment and care for MHCUs that aid in improving their well-being and capacity. The relocation of the MHCUs from Life Esidimeni was a premeditated violation of this provision by the GDoH. The National Mental Health Policy Framework 2023 – 2030 substantiates the advocacy for human rights in sections 6.5 and 6.6, hence, this case study is of great significance not only for mental health advocacy but also for the legal study of human rights.

The matter culminated in an arbitration that started in 2017, led by former Deputy Chief Justice Dikgang Moseneke, which found the state liable for the violations. The arbitration award emphasised that the rights to life and dignity had been breached by the government, and ordered the government to compensate the families accordingly. Justice Moseneke’s ruling was not only about financial compensation but also intended to restore the dignity of the affected persons and acknowledge the harm caused. The award included monetary damages, constitutional damages, and a directive that government officials be held to account for the harrowing torture on the MHCUs that some resulted in death. The case sets a significant precedent for state accountability in healthcare, showing that human rights negligence can result in constitutional damages and that vulnerable groups must be protected through judicial oversight when administrative processes fail. This exposes the role of the court that bears critical implications for the mental health care and development in the country.

Justice Teffo’s judgment, which was handed down in 2024, implicated Qedani Mahlangu, the former MEC of health in Gauteng and Dr Makgabo Manamela, the former director of mental health in Gauteng, who can be held criminally liable by the National Prosecuting Authority (NPA). However, a year later, after the inquest judgment was handed down, the NPA has not initiated any prosecution against these government officials. Thus, regardless of the constant pleas by civil society organisations and the aggrieved families of the Life Esidimeni victims to the NPA to prioritise the prosecution of the two individuals. The fact that the prosecution of Ms Mahlangu and Dr Manamela would be the first time senior government officials are held criminally responsible for their conduct in office has been described as monumental “legally, morally, and publicly.” This gives more reason why this prosecution is of great significance.

Between 2016 and 2023, the GDoH has spent approximately R77 million on legal costs on behalf of Qedani Mahlangu and other implicated government officials in this case. These are expenses that were paid to private legal practitioners, whereas the office of the state attorney has a primary function to represent government officials in their legal matters, and they were not utilised. This is one of many injustices that have resulted from the Life Esidimeni tragedy. Similarly, the arbitration awards were not implemented, thus including the building of a memorial to commemorate those who have passed from this tragedy.

The Life Esidimeni tragedy reinstates the urgent need for a human-rights-centred approach to healthcare governance. Especially where the right to life, dignity, and access to adequate health care of people is at stake. Advocacy plays a crucial role in striving for systemic change that will prioritise the importance of mental health. The absence of accountability from the government officials defeats the means of justice, and the inactivity of the NPA is not a reflection of the intention to serve justice as required by the law.

As part of their work, the South African Federation for Mental Health (SAFMH) National Youth Advocacy and Advisory Forum are encouraged to take up advocacy initiatives that are meaningful to them. Senzo Msiza [Gauteng] drafted the above research report as part of his advocacy to recognise Life Esidimeni as a human-rights violation.