Third Generation Gangs Strategic Note No. 38: Cape Town Extortion Gangs Target Paramedics
John P. Sullivan and Robert J. Bunker
Paramedics in Cape Town (Western Cape), South Africa are allegedly victims of extortion gangs that seek ‘protection’ money to allow them to provide emergency medical care. This incidence of extortion is exacerbated by a recent upswing in violent attacks against Emergency Medical Service (EMS) staff and the influence of Covid-19 lockdowns on public [in]security.
Western Cape Metro EMS Rescue. Source: Bob Adams, CC BY-SA 2.0.
Key Information: Murphy Nganga, “Alleged extortion of paramedics being investigated.” IOL (Independent Online). 26 May 2021, https://www.iol.co.za/weekend-argus/news/alleged-extortion-of-paramedics-being-investigated-e99a224c-d68a-4e72-95a1-584660402a83:
Following the mass shooting that killed 13 people in Khayelitsha last week, extortionists are allegedly now threatening to attack paramedics who are servicing the community.
Deanna Bessick, communications officer for EMS and the forensic pathology service in the province, said that they are investigating the claims of extortion syndicates targeting paramedics.
According to Bessick, there have been 27 attacks during 2021 on Western Cape Government Health's Emergency Medical Services officials.
Key Information: Siskone Mlamla, “Cape Town paramedics allegedly forced to pay protection money to extortion rings.” IOL (Independent Online). 26 May 2021, https://www.iol.co.za/capeargus/news/cape-town-paramedics-allegedly-forced-to-pay-protection-money-to-extortion-rings-04c13b76-0dd3-48b1-9979-8b1fce28d22a:
Emergency Medical Services (EMS) staff working in Cape Town’s townships have called for more policing as they are now allegedly forced to pay extortion syndicates for protection.
Community Safety MEC Albert Fritz said they had noted with concern the way in which the issue of extortion now extended to the EMS workers and health services…
…ANC provincial spokesperson for community safety, Mesuli Kama, said crime in the Cape Flats and townships has been slowly escalating to an uncontrollable level.
Kama said they had heard of allegations that more government services - including Eskom [electric utility], EMS personnel and municipal workers - have to pay protection fees to work safely in communities.
Kama said the extortion rackets were getting out of hand, the gangs were organised and well resourced. He said at that point, the police and other crime-fighting stakeholders needed more resources to be deployed to hot-spot areas for stabilisation purposes.
Key Information: “Cape Town extortionists demanding ‘protection fees’ from off-duty paramedics.” Cape Talk (567AM). 26 May 2021, https://www.capetalk.co.za/articles/417359/cape-town-extortionists-demanding-protection-fees-from-off-duty-paramedics:
Extortion syndicates operating in Cape Town, particularly in the Khayelitsha area, have been targeting small businesses, street vendors, and even households in recent months.
It’s alleged that these syndicates are now casting their net even wider and targeting off-duty medics.
eNCA reporter Monique Mortlock says EMS staffers are being forced to pay protection fees when they are off-duty in their local communities.
Key Information: Monique Mortlock, “EXCLUSIVE: Paramedics forced to pay for ‘protection’.” eNCA. 25 May 2021, https://www.enca.com/videos/exclusive-paramedics-forced-pay-protection:
Paramedics in parts of Cape Town, tell eNCA they’re being forced to pay extortion syndicates for protection.
The syndicates usually demand cash for protection from shop owners, and fruit and vegetable traders but now, they're casting a wider net and targeting off-duty medics.
Paramedics forced to pay for ‘protection.’ @eNCA, 24 May 2021,
Key Information: Peter Gastrow, Lifting the Veil on Extortion in Cape Town. Geneva: Global Initiative Against Transnational Organized Crime. April 2021, https://globalinitiative.net/wp-content/uploads/2021/04/Lifting-the-veil-on-extortion-in-Cape-Town-GITOC.pdf:
In the past, public discussion about extortion in South Africa was limited and media coverage sporadic. Reports focused mainly on isolated instances of extortion in the entertainment and nightclub areas of central Cape Town. Extortion-linked murders of foreign nationals running shops also received only occasional coverage. But the silence around extortion changed significantly during 2020. From about August and September 2020, the media began to increasingly report on a significant expansion of extortion rackets in central Cape Town.
The phenomenon, reportedly, was no longer confined to the night-time entertainment industry but increasingly affected small day-time businesses, including restaurants and coffee bars. This is likely to have been linked to the effect of the COVID-19 lockdown restrictions, which affected the night-time entertainment industry. More alarmingly, reports appeared of a surge in extortion incidents in township areas on the periphery the city. In places such as Khayelitsha, Gugulethu and Philippi, South African residents were being targeted by extortion gangs.
Key Information: Richard Chelin and Willem Els, “South Africa’s deadly mix of explosives, extortion and organised crime,” Institute for Security Studies (ISS). 18 February 2021, https://issafrica.org/iss-today/south-africas-deadly-mix-of-explosives-extortion-and-organised-crime:
On 30 January, armed robbers in Cape Town hijacked two members of a maintenance team loading automated teller machines (ATMs). They strapped a makeshift explosive device to one of the victims and forced him to open various ATMs in order to steal the cash. The victim was later released next to a highway…
…In South Africa, tying an explosive device to the body of a victim is a new modus operandi. This shows that organised crime syndicates are willing to go to extreme levels by using stolen explosives to reach their goals. And it highlights the dangers that smuggled explosives play in the arsenal of organised criminals who are constantly adapting to responses by the police, the banking sector and the private security industry…
…A senior organised crime investigator who requested anonymity expressed his concern that explosives were now being used by syndicates as a tool of extortion. This tactic mirrors those used by suspected terrorist cells in KwaZulu-Natal province in recent years.
Third Generation Gangs Analysis
The recent attention to extortion against Emergency Medical Service (EMS) personnel in the Western Cape comes in the aftermath of a series of mass shootings in Khayelitsha that claimed the lives of 13 people. The shootings are related to competition between rival extortion gangs. Eleven suspects were arrested in relation to the attacks.
Extortion is a longstanding problem in South Africa, and the Western Cape. The issue is directly linked to ‘gangsterism’ and corruption. Traditional targets include small businesses, informal businesses, and taxi companies. According to Minister of Police Bheki Cele, who is spearheading a crackdown on extortion:
“What has also become even more worrying is the targeting of the poor and ordinary people in the townships by these ruthless criminals. Flat owners and backyard landlords who are trying to make ends meet are not spared,” he said, explaining that they were forced to pay over portions of rental income.
Attacks Against Health Care
The rise in extortion follows a rise in attacks against paramedics. Indeed, there are several ‘red-zones’ where EMS crews receive police escorts from the South African Police Service (SAPS) in order to operate in the high-risk zones. In 2020, attacks against pre-hospital care providers increased three-fold. Attacks against other health care facilities are also a concern. For example, on 7 May 2021, armed robbers stormed a clinic. The clinic had two security guards on duty. Both patients and staff were robbed. According to a community safety representative, there were nearly 20 security incident so far this year (up to the beginning of May) compared to over 40 attacks last year.
Extortion by gangs and criminal armed groups (CAGs), as seen in Cape Town, is not uncommon in gang challenged regions. For example, extortion is a significant issue in Central America and Brazil. Attacks against healthcare personnel are also a global concern. These attacks have become more prevalent due to the Covid-19 pandemic.
Influence of the Covid-19 Pandemic?
The influence of the Covid-19 pandemic and related lockdowns on the criminal economy is a potential driver of both the rise in violence and the uptick in extortion by criminal gangs. While the Covid-19 pandemic’s influence on violent attacks demands further examination:
“The attacks have been increasing drastically and affect the most vulnerable in communities where the EMS is most required. Since the national lockdown was instated, we saw an increase in attacks. The impact is that service delivery to vulnerable communities is affected,” said Bessick.
According to Dr. Simon Howell, a research associate the University of Cape Town, Centre of Criminology, “Extortion gangs have grown quite significantly since the end of the last lockdown because the lockdown affected everyone, including criminal elements...people are trying to recoup their financial basis.”
Extortion of paramedics and health care personnel is a significant indicator of the erosion of social safeguards protecting public goods. Corruption is also closely related to this erosion of social norms.
Gang activity and extortion are also linked with broader issues of corruption. In the Western Cape, recent arrests link corrupt police to extortion rackets. Perhaps the greatest challenge, however, is the rise of violent engagements in pursuit of illicit economic goals. This ‘criminal insurgent’ potential could further diminish public trust in the police while eroding perceptions of state legitimacy. Such violent potentials are seen in the rise of explosive means of gang attacks and attacks.
“Cape Town extortionists demanding 'protection fees' from off-duty paramedics.” Cape Talk (567AM). 26 May 2021, https://www.capetalk.co.za/articles/417359/cape-town-extortionists-demanding-protection-fees-from-off-duty-paramedics.
Richard Chelin and Willem Els, “South Africa’s deadly mix of explosives, extortion and organised crime,” Institute for Security Studies (ISS). 18 February 2021, https://issafrica.org/iss-today/south-africas-deadly-mix-of-explosives-extortion-and-organised-crime.
Peter Gastrow, Lifting the Veil on Extortion in Cape Town. Geneva: Global Initiative Against Transnational Organized Crime. April 2021, https://globalinitiative.net/wp-content/uploads/2021/04/Lifting-the-veil-on-extortion-in-Cape-Town-GITOC.pdf.
Siskone Mlamla, “Cape Town paramedics allegedly forced to pay protection money to extortion rings.” IOL (Independent Online). 26 May 2021, https://www.iol.co.za/capeargus/news/cape-town-paramedics-allegedly-forced-to-pay-protection-money-to-extortion-rings-04c13b76-0dd3-48b1-9979-8b1fce28d22a.
Murphy Nganga, “Alleged extortion of paramedics being investigated.” IOL (Independent Online). 26 May 2021, https://www.iol.co.za/weekend-argus/news/alleged-extortion-of-paramedics-being-investigated-e99a224c-d68a-4e72-95a1-584660402a83.
 Athandile Siyo, “‘It boggles mind that Khayelitsha mass shooting suspects were arrested at hotel’.” IOL (Independent Online). 17 May 2021, https://www.iol.co.za/capetimes/news/it-boggles-mind-that-khayelitsha-mass-shooting-suspects-were-arrested-at-hotel-a373c3dd-2bc0-4feb-abf8-48d774dbd63d.
 See Caryn Dolley, “Tackling Cape Town’s deep-rooted extortion problem means tackling the city’s gangs too.” Daily Maverick. 17 April 2021, https://www.dailymaverick.co.za/article/2021-04-17-tackling-cape-towns-deep-rooted-extortion-problem-means-tackling-the-citys-gangs-too/.
 Nathan Adams, “Attacks on paramedics have more than tripled.” IOL (Independent Online). 13 December 2020, https://www.iol.co.za/weekend-argus/news/attacks-on-paramedics-have-more-than-tripled-2f274464-9949-4599-b80b-5aa3a546aabb.
 Over 50 attacks against EMS were registered in 2020, See Adrian Kriesch, “Crime hits paramedics in Cape Town [Video].” DW (Deutsche Welle). 19 November 2020, https://www.dw.com/en/crime-hits-paramedics-in-cape-town/av-55667532.
 “COCT [City of Cape Town] Raises Concerns Following Latest Attacks on Healthcare Staff, Patients.” EWN (Eyewitness News). 6 May 2021, https://ewn.co.za/2021/05/08/coct-raises-concerns-following-lates-attacks-on-healthcar-staff-patients.
 On Central America, see the Extortion in Central America project, Global Initiative Against Transnational Organized Crime, https://globalinitiative.net/initiatives/extortion-in-central-america/. On Brazil, see, for example, John P. Sullivan, José de Arimatéia da Cruz, and Robert J. Bunker, “Third Generation Gangs Strategic Note No. 36: Rio de Janeiro Gang and Militia Extortion and Control of Telecommunications Towers.” Small Wars Journal. 28 May 2021, https://smallwarsjournal.com/jrnl/art/third-generation-gangs-strategic-note-no-36-rio-de-janeiro-gang-and-militia-extortion-and.
 “Health-care providers, patients suffer thousands of attacks on health-care services over the past five years, ICRC data show.” ICRC News Release (International Committee of the Red Cross). 3 May 2021, https://www.icrc.org/en/document/health-care-providers-patients-suffer-thousands-attacks-health-care-services-past-5-years.
 See Sharmila Devi, “COVID-19 exacerbates violence against health workers.” The Lancet. Vol. 396, Issue 10252, p. 658. 5 September 2020, https://doi.org/10.1016/S0140-6736(20)31858-4 and Howard Larkin, “Navigating Attacks Against Health Care Workers in the COVID-19 Era.” JAMA (Journal of the American Medical Association. Vol. 325, no. 18, pp. 1822-1824. 21 April 2021, https://jamanetwork.com/journals/jama/fullarticle/2779310.
 See John P. Sullivan and Robert J. Bunker, "Third Generation Gangs Strategic Note No. 24: COVID-19, Gangs and Lockdown in Cape Town.” Small Wars Journal. 18 May 2020, https://smallwarsjournal.com/jrnl/art/third-generation-gangs-strategic-note-no-24-covid-19-gangs-and-lockdown-cape-town for an early look at the situation. Also see John P. Sullivan and Robert J. Bunker, Eds. Covid-19, Gangs, and Conflict. (A Small Wars Journal–El Centro Reader.) Bloomington: Xlibris, 2020.
 For a timely discussion of extortion in Cape Town, see Peter Gastrow, Lifting the Veil on Extortion in Cape Town. Geneva: Global Initiative Against Transnational Organized Crime. April 2021, https://globalinitiative.net/wp-content/uploads/2021/04/Lifting-the-veil-on-extortion-in-Cape-Town-GITOC.pdf.
 Deanna Bessick, a PIO for the Western Cape EMS and Forensic Pathology Service commenting on the effects of the Covid-19 pandemic on community violence at Murphy Nganga, “Alleged extortion of paramedics being investigated.” IOL (Independent Online). 26 May 2021, https://www.iol.co.za/weekend-argus/news/alleged-extortion-of-paramedics-being-investigated-e99a224c-d68a-4e72-95a1-584660402a83.
 Dr. Simon Howell quoted in “Khayelitsha shooting: ‘Hard work ahead for SAPS to bring down extortion gangs’.” Cape Talk (567AM). 18 May 2021, https://www.capetalk.co.za/articles/416647/khayelitsha-mass-shooting-hard-work-ahead-for-saps-to-bring-down-extortion-gangs.
 See Marvin Charles, “Deputy minister’s protector, 2 cops arrested for alleged extortion in Western Cape.” News 24. 8 April 2021, https://www.news24.com/news24/southafrica/news/just-in-deputy-ministers-protector-2-cops-arrested-for-alleged-extortion-in-western-cape-20210408.
 Police corruption is an endemic issue in South Africa. See, for example, “Hundreds of crooked cops in South Africa under investigation for corruption.” BusinessTech. 4 November 2020, https://businesstech.co.za/news/government/445728/hundreds-of-crooked-cops-in-south-africa-under-investigation-for-corruption/.
For Additional Reading
Peter Gastrow, Lifting the Veil on Extortion in Cape Town. Geneva: Global Initiative Against Transnational Organized Crime. April 2021.
Deborah Bonello, Tuesday Reitano, and Mark Shaw, A Handbook for Community Response to Countering Extortion. Geneva: Global Initiative Against Transnational Organized Crime. March 2021.
John P. Sullivan, “Gangs, Criminal Empires and Military Intervention in Cape Town’s Crime Wars.” Small Wars Journal. 11 February 2020.
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