Professor Lorna Martin has done autopsies on more than 12000 bodies in her 23 years as a forensic pathologist. She is used to them. However, the bodies of 548 children who passed through her hands from January to December last year are not likely to slip from her memory. Their small frames, which ended up at the Salt River mortuary in Cape Town where she works, have shone a light on the dark facts of why so many South African children die.Part of a "child death review", details of each case were collected from Salt River with those of 163 children whose bodies ended up at the Phoenix mortuary in Durban North.The review is the first of its kind in South Africa. Initiated by Professor Shanaaz Mathews, of the Children's Institute at the University of Cape Town, it brought together experts from various professions to analyse the circumstances leading to the death of each child who ended up at the morgue, to understand why so many children die.story_article_left1The findings were shocking:A staggering 32% of all the unnatural deaths were cases of homicide;Most of these were cases of child abuse;More than three-quarters of children who died from abuse (78%) were under the age of five; andA further 28% were killed in car accidents - the vast majority of them while walking to or from school.The review came about after a study in 2012 found that three children a day were murdered in South Africa, a rate more than twice the global average.Katie Apleni, a resident of Gugulethu in Cape Town, says the shadow of a child's death hangs over her community."An uncle killed his nephew here last year, and we still feel another murder that happened here four years ago - the murder of three-year-old Lovey."A few streets from her, the burnt-out shell of a house stands like a monument to death.In 2011, Athenkosi "Lovey" Nkone was lured into a shack built behind the house. The tenant, who knew Lovey, slit his throat and stuffed him into a suitcase. When the police arrived, he said he had been told by his father to collect body parts for muti.That was a clear-cut case.full_story_image_hleft1Mathews says there are cases of people literally getting away with murder, slipping through the loopholes between the death of a child and the issuing of a death certificate."A homicide can be masked if you don't look properly. It could be a smothering, for example, but because our under-five mortality rate is high anyway, it is passed off as another natural death. You could also miss a subtle murder. If a child is poisoned, the toxicology report takes so long that by the time it is investigated, it has become a cold case," she said.Martin agrees. "Only unnatural deaths come to us for forensic examination. So we get accidents, suicides and obvious homicides, for example. But the system relies on the goodwill of health practitioners."story_article_right2If the practitioner does not examine a patient properly or is duped in some way, "someone can get away with murder".Having a team from a different sector examine each death strengthens the system ."A child died at home as a result of gastro," says Mathews. "But, during the autopsy and in our review, we noted that she was severely underweight and had never been to a clinic. So we went to find out more about the family."They learnt the mother was an alcoholic, and that two other children in the family had died from neglect. Two children were then removed from her care.Mathews says the review "brought together professionals who ordinarily wouldn't work together" and brought "multiple perspectives to the table".Martin says: "We want to perfect it and follow best international practice by making it a routine system that is used across the country."sub_head_start Naked wires and neglect sub_head_endAn 11-month-old girl was found dead outside the front door of a shack with a live electric wire in her hand. She had crawled outside while her mother was busy with household chores.A boy of nine hanged himself, and it was only through the work of the "death review team" that it came to light he had been raised by a single father who was an "extremely harsh disciplinarian".An eight-year-old boy with cerebral palsy had died at home of "natural causes". The autopsy revealed that he had been severely neglected and weighed only 8kg - and the lack of care had killed him."We were also surprised by the figures on suicide and electrocutions, and the victims of suicide are getting younger and younger," said pathologist Lorna Martin.At two morgues, in Salt River in Cape Town and Phoenix in Durban North, 7% of all the unnatural deaths were suicides and 5% electrocutions.farbert@sundaytimes.co.za nbsp;..