Thousands killed in violent SA despite no civil war
Although South Africa faces no civil war, violence is now among the top five causes of death, making it the only country outside the Latin American and Caribbean region able to make this unenviable claim.
Those most at risk of dying because of violence are in the prime of their lives, a group also being decimated by HIV.
Last year, almost 200000 people between the ages of 15 and 49 died either of Aids-related illness or violence, and road injuries and suicides surged more than 200% in 2013 compared with 1990.
The findings are from a global study published by The Lancet this month, which was undertaken by a consortium of international researchers at the University of Washington in Seattle, in the US, and which analysed data from 188 countries.
"Violence is one of the most serious challenges facing South Africa," said Institute for Security Studies senior research fellow Dr Chandre Gould. "High levels of violence undermine investor confidence, drive up costs in the health sector and have a negative impact on ... society."
Gould said there were multiple and complex reasons for high rates of violence and that these could not be addressed only by the police or the criminal justice sector. "Reducing violence is possible, but it requires a comprehensive national plan, adequate resources, and partnerships between the government and civil society. South African society also needs to change attitudes and social norms that encourage violence and discrimination."
Elizabeth Apleni, whose brother was murdered, said it was not unusual in her community to have had a family member murdered. "Many of us have something like that."
In El Salvador, Venezuela, and Colombia, violence was the leading cause of death. But for a majority of the study's 188 countries, it did not feature at all.
The leading cause of death in South Africa in 2013 across all age groups, according to the study, was HIV/Aids. Second was lower respiratory infection, third tuberculosis and fourth diarrhoea, which was also the highest killer among children under five last year, claiming 6510 toddlers.
A variety of factors worked together against such children, said Dr Costa Gazi, a public health specialist. "Children who are poorly nourished are often also the ones living ... where water supply and toilet facilities are erratic if not entirely absent, and that is the perfect combination for bacteria and viruses that attack the digestive system to thrive and spread."
Another shocking statistic, but one that masks a story of success, is that of life expectancy. The study showed that in 2013, average life expectancy was 63 for women and 57.7 for men - compared with 68.9 and 60.5 respectively in 1990.
But, said Dr Bongani Mayosi, professor of medicine at the University of Cape Town, "we must remember that between 1990 and 2005, there was a nearly 20-year drop in life expectancy". He said that from 2006, when antiretrovirals were introduced, the chance of a longer life was improved. So, "while we have not reached the 1990 level, we are on an upward trajectory".