Have you ever thought about what would happen to your body if you were murdered? Turns out, it’s a bit like what you see on TV – you’d be sent to a mortuary and the evidence collected from the autopsy would be used in court to help put your killer behind bars.

But in South Africa, it’s a little more complicated in practice – mostly because there is a dire shortage of forensic pathologists, the experts who carry out autopsies.

Ideally, a country needs 6 forensic pathologists per million people, says specialist forensic pathologist and author Prof Ryan Blumenthal. Instead of the 330 South Africa should have, there were only about 50 working in the public sector last year.

Despite the number of pathologists entering the profession being relatively stagnant, murders in South Africa have increased by 36% since 2017. This means there’s even more work for forensic pathologists to do.

Swamped

Gauteng, which has a population of more than 15-million, has just 16 forensic pathologists in public service, according to the provincial department of health. And the caseload faced by these 16 experts? In 2023, almost 22,000 bodies – about 60 a day – were admitted for autopsies in Gauteng, a 45% increase from 2006, which is as far back as the data goes.

If they were to have performed all the necessary autopsies in 2023, Gauteng’s forensic pathologists would have had to assess 1,367 bodies each. Given that it takes about 3 hours per body (longer in more gruesome or complicated cases), each forensic pathologist would have had to work 12-hour shifts for 7 days a week to get their jobs done.

Busted guidelines

There are 11 medico-legal laboratories (better known as mortuaries or morgues) in Gauteng, with some carrying heavier loads than others. The Department of Health says 40% of all the bodies admitted for autopsies in Gauteng last year were assessed at two morgues, Germiston and Joburg.

In the US, official guidelines recommend that forensic pathologists perform no more than 250 autopsies a year. If forensic pathologists exceed that number, the office loses accreditation.

South Africa does not have similar standards in place. If it did, most medico-legal laboratories would be at risk of losing their accreditation.

It gets worse

As of 29 February 2024, there were 776 unidentified bodies in Gauteng’s mortuaries, according to the provincial department of health.

Although Gauteng and the Western Cape have 16 forensic pathologists each, most of South Africa’s other provinces only have 1 or 2, according to official figures. KwaZulu-Natal, South Africa’s second-most populous province, has just 2 forensic pathologists, whereas Limpopo and the Free State have 7 each.

Dead end

The shortage of forensic pathologists means court cases are often delayed, ultimately causing setbacks in legal proceedings, says Blumenthal.

‘Examinations may be rushed due to increased workload [which] might mean evidence might not be as reliable, affecting trial outcomes,’ he says. ‘Solving crimes will become tougher without enough forensic experts to analyse the evidence.’

The heavy caseloads, harsh working conditions and pay that’s below international salary scales paint a grim picture for forensic pathology in SA.

Many of the issues, including the shortage of posts, are as a result of a lack of state support and funding. As Blumenthal says in his book Autopsy: Life in the Trenches with a Forensic Pathologist in Africa, forensic pathology is ‘always going to come last because our patients are already dead’.

Blumenthal says many of his colleagues have emigrated and are working in places such as Australia and Canada.

Notebook