Johannesburg, South Africa – “I was looking down to help the patient [when] I saw someone come into the room. I saw the boots, and when I looked up I was staring into a gun.”

It’s a warm October night in Meyerton, south of Johannesburg, and Sonia*, a senior paramedic working for a private ambulance service, is recounting a particularly harrowing day at work in South Africa’s crime-ridden economic capital. She is in her early 40s and does not want to be identified to protect her privacy.

“The guy said to me: “Keep quiet, keep quiet. Go down!” At first Sonia briefly thought he might be a security guard because the emergency call-out was in a wealthy suburban area.

“But then I realised they are busy robbing us and the house. I think they followed us.”

Sonia’s patient, who was suffering from a brain embolism, started screaming. But the gunmen pushed them all to the ground. “I’m thinking ‘What am I going to do?’ Because it’s in me to help a person,” Sonia recounts.

“He had a gun behind me and I’m thinking I must just do what he tells or I’m gonna die,” she continues. Her assailant took her jewellery while screaming threats of: “We’ll shoot you in the stomach! We’ll shoot you in the stomach!”

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Facing the ground, Sonia heard a whistle and then a car engine, before looking up to find the attackers gone. Shaken, she rushed to check on her patient. “The patient’s blood pressure now was extremely high and she started having fits,” Sonia says. “But then the police come and the backup comes and everything was OK afterwards.”

She thought she was fine after that, but days later the trauma hit. “Nine days afterward I get post-traumatic shock. I wake up and I’m screaming to my husband: ‘They’re on the roof, they’re on the roof!’ And then I start crying, and I’m crying the whole night,” she says.

Sonia went for counselling to help her recover and is fully back at work now. “I’ve been in this industry for 20 years. I learned to stay focused. You concentrate on the injuries. You start to become like a machine doing one, two, three, four.”

South Africa has the fifth highest crime rate in the world, according to 2024 statistics from the World Population Review, which notes, in particular, its high levels of assault and violent crime. In recent years, first responders and emergency services have reported a growing number of attacks on their staff and vehicles – some ending in injury and even death.

According to Foster Mohale, spokesperson for the National Department of Health, the number of attacks against emergency medical services (EMS) personnel has increased since 2014. “The annual frequency of attacks has varied, with reported instances ranging from 30 to 109,” Mohale said.

Emergency services and police respond at the scene of an accident [Hamilton Wende/Al Jazeera]

‘False calls’

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In Meyerton, Sonia and her ambulance colleagues gather at the scene of a minor motorbike crash involving a family in an SUV. The motorbike driver’s face is bloody and slightly swollen, but he is otherwise fine. He wasn’t wearing a helmet, so this was his – very – lucky day.

With only minor injuries, Sonia’s services aren’t needed, so she catches up with two other responding paramedics who work for a nonprofit volunteer private ambulance service before heading out on other calls.

This first call of the night is a quiet one for the volunteer paramedics Cecil Parsons, 33, and his partner, Gavin Arrow, 32, who work with the Community Emergency Response Team South Africa (CERT-SA). It was set up to provide multidisciplinary emergency support to the public, free of charge, whether or not the person has medical insurance. Their core focus is emergency medical response but they also attend to fire and animal rescues, and offer trauma support.

It soon gets busy. Parsons’ radio blares. “MVA” (motor vehicle accident), he says. It’s 18:24 on the dashboard clock and the sun is setting. There are seven patients waiting for help after a pick-up truck rolled on the highway: four of them are “P2” – urgent, three of them are less injured. or “P3”.

“Charlie Mike 10 responding,” he says into the walkie-talkie clipped to his shoulder.

It’s a 30-kilometre drive at high speed in Parsons’ Suzuki Fronx and his face is taut with concentration as he weaves his way through the last of the day’s traffic.

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“That gave me goosebumps,” he says after listening to Sonia’s story. “It’s happening more and more to us.”

He peers into the oncoming white headlamps and the twilight on the road rushing by. “We should be safe on this call,” he says. “We probably won’t be the first to arrive on scene.”

Parsons is quiet and professional. Arrow says little as they drive. Parsons has a day job as a sales representative for oncology medicines, and he volunteers on his days off.  Arrow works as a contract facilitator for a steel factory and he decided to start helping Parsons three years ago. He has basic first aid training and his role is mostly as an operational assistant, handling patients, carrying and cleaning equipment and ensuring road safety while they work.

Parsons has been involved in an attempted armed hold-up. He and his partner were called out to the edge of town. “We were given a landmark,” he says. “But it was dark, and no one was around. It felt wrong. We saw two people approach from the front, and then there was a sound at the back. People trying to open the ambulance door. I just put foot on the accelerator, and we heard two shots go off at us as we drove. We were in shock. I called 999 and said: ‘This is a false call’, but they told us ‘No, the patient is still there.’”

There was no time for a police escort, so Parsons and his partner returned. The assailants had left and Parsons and his colleague were able to drive beyond the landmark again to find the patient at his home where he was ill and still waiting for help.

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“It was an opportunistic attempt. They just wanted to steal our phones and the equipment in the car.”

Paramedic Muhammad Varachia attends to a call [Hamilton Wende/Al Jazeera]

‘Impossible to keep track’

Each of South Africa’s nine provinces has a Department of Health with a government ambulance service. In addition, the country has some 200 private ambulance services nationwide.

And the threat to emergency medical workers has been growing, whether they’re with the government or a private service – though hard numbers are difficult to nail down.

“We have seen a serious and very concerning increase in attacks on EMS personnel purely to rob or hijack the ambulance crews,” says Oliver Wright of the South African Private Ambulance & Emergency Services Association (SAPAESA). “With there being so many different private and provincial ambulance services in South Africa it makes it almost impossible to keep track of all of these occurrences.”

On an earlier ride with Medi Response, another private ambulance service in the city, 28-year-old Muhammad Varachia says that it “has definitely gotten worse over the last 10 years”.

In areas that are regarded as dangerous, EMS workers now often insist that the patient’s family or friends bring them to a police station where they park the ambulance safely and can give them vital emergency treatment without being threatened by criminals, and without risking their own lives.

Organisations designate specific areas as “Red Zones”, where EMS personnel cannot go except with a police escort. This is a somewhat haphazard approach to safety. “But there might still be emergency cases in that area,” Varachia says. “So there is the option of a total no-go or you go to the police station, or the patient is brought to a safe zone.”

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Byron La Hoe, the assistant director of communication at the Western Cape Department of Health and Wellness, says there are approximately six attacks on EMS workers each month in the province. But because of a “multifaceted approach to the protection of our EMS workers and their own preparedness and vigilance,” the number of attacks in the Cape has stabilised, he says.

Still, he adds, “this approach is not sustainable and impacts negatively on service delivery”.

To Wright, the attacks on ambulance crews are symptomatic of a “failing, public safety system” and rising crime in South Africa more broadly.

“Until the South African government prioritises crime prevention, our EMS colleagues will never be safe,” he says.

When asked to comment, the South African Police Service (SAPS) did not specifically mention attacks on EMS and first responders, pointing more generally to its recent anticrime initiative, Operation Shanela, which tackles crime through roadblocks, stop and searches, and patrols.

“Through Operation Shanela great strides are being made to arrest criminals involved in all forms of criminality including robbery, murder and rape,” Police spokesperson Brigadier Athlenda Mathe told Al Jazeera in a statement. “To date through this operation which includes heightened police visibility, more than 920,000 suspects have been arrested.”

Paramedics Parsons and Arrow at a scene in Sebokeng, near Johannesburg [Hamilton Wende/Al Jazeera]

‘Sorry, but he’s dead’

On the road in Meyerton, Parsons turns off his siren at 18:45 as the crew arrives at the accident scene.

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Two firetrucks and three ambulances with flashing lights in the growing darkness are already there, but it’s not enough to deal with the injured. One of the ambulance workers rushes up to Parsons: “Will you triage that one?” The worker points to a young man lying in a newly ploughed field. He was travelling in the back of the pick-up when it rolled off the highway and he was thrown out onto the ground. “He’s complaining of a pain in his right side,” the ambulance worker says, and leaves the two paramedics to help him.

Parsons puts on rubber gloves and carefully goes over the young man who is conscious but dizzy with pain.

Someone in the darkness calls out: “There’s another ambulance coming from Midvaal.” Parsons nods, but his attention is on the young man’s pain.

“Don’t move,” he tells the patient. Arrow disappears into the night and comes back with an aluminium stretcher and more EMS workers. One of them holds the patient’s head – they are deeply worried about neck and back injury.

Parsons, Arrow and two others carefully roll the patient onto the stretcher and take him to the ambulance that has just arrived.

Back in the Suzuki, Parsons says: “It’s always bad when you’re the first one to arrive at a mass-casualty incident. Everyone is shouting, they feel like they’re the ones who need help first.”

He pauses. “We always treat the quiet ones first. Those are the most badly injured.”

Cruising through the nighttime city, Parsons recounts another hazardous call.

“We were called out to a gang stabbing and the patient was already dead when we got there. They made us understand, very nicely,” Parsons grimaces, before continuing, “‘If this guy dies, so do you guys.’”

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“We were by ourselves. There were no police there yet. So we had to pretend that we were treating him. Put up a drip, take blood pressure – so we could stay alive. Only when the police arrived we could say ‘Sorry guys, but he’s dead.’”

Almost every paramedic we spoke to has some story of being threatened by criminals.

In September this year, 36-year-old Ronnie Motanyane of ALTOR EMS, a private medical service focused on safety at events, was held up near Soweto, while driving a clearly marked ambulance. His assailants threatened his life while they removed the GPS tracker and forced him to transfer his savings from his bank account using his mobile phone.

They then drove him to a second location where they removed the EMS branding from the vehicle. “I don’t know where they went, but I heard them say ‘Let’s kill this guy.’” But after he transferred all his savings to them, they finally released him.

He insists he still enjoys his job, and accepts that the risks of violent attack now come with it. “It happens to all of the emergency medical service workers,” he says.

Still, he says, he feels angry.

“If I see another car stop in front of me, that anger comes [back].”