The annual tribal “initiation ceremony” where teenage males in South Africa undergo painful circumcision has begun – despite it ending in 93 horrific deaths last year.

Gruesome injuries also led to a further 11 penis amputations after unskilled traditional “surgeons” used old spears and razor blades to perform eye-watering rituals.

Hundreds more ended up in hospital after being whisked off to the secret camps where the “snip” marks the end of three weeks transitioning from a boy to full manhood.

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Without undergoing the ceremony known as Ulwaluko, the teenagers are not allowed to sit in on tribal meetings or take part in many social activities or consider marriage.

The rituals have been held for centuries in secret in specially built huts away from the villages where nobody except the tribal elders and the young initiates can enter.

But a report commissioned by the South African government recorded a shocking 322 deaths of young boys between 2021 and 2024 and thousands more hospitalizations.

It lays the blame at the door of criminal gangs who have set up unscrupulous illegal initiation schools that use untrained surgeons and "nurses" who botch surgeries.

They ignore the law that anyone aged under 16 cannot undergo the ritual and charge high prices to families to carry out Ulwaluko often with fatal or horrific end results.

Gangrene, sepsis and severe dehydration are the main cause of death even though it has been reported unwilling boys had also been stabbed, drowned or beaten to death.

There are hundreds of reports a year of illegal schools kidnapping boys as young as 12 and carrying out the surgery then forcing parents to pay to get their sons back.

The Customary Initiation Act has now been introduced to make it illegal for unregistered initiation schools to be set up and force all traditional surgeons to be trained and qualified.

Police now have the power to shut down the illegal schools and arrest the principals. Every year, tens of thousands of boys undergo the transition from boy to manhood, which is a sacred ceremony dating back hundreds of years, despite the very high death rate.

But so far this year, since the initiation season began on May 30 for non-schoolboys and last Friday for schoolboys, there has been only one reported death, but more are feared.

The Minister for the Department of Governance & Traditional Affairs had set a target of zero deaths in registered schools while police shut down the illegal schools.

According to a tribal chief Sipho Mahlangu, Deputy Chair of the National House of Traditional Leaders, 80% of initiates who die are the victims of botching by illegal schools.

Although boys have a choice as to whether they undertake the initiation, there is huge peer pressure, and those who refuse are called Inkwenkwe or “boy” – a harsh insult.

Traditional surgeons charge parents to take the boys away for up to three weeks to teach them survival skills and how to behave as a man, then perform the dreaded “snip."

Scotty Dawka, 19, went to an initiation school despite having seen a TV programme on penile amputations and told a local reporter: “I was of course very scared of going. In my community many boys went through the initiation before me and I wanted to be the same as them. I wanted to be looked up to as a man in my village by the elders."

“It was very painful to go through and I fell ill but I was treated and survived” he said.

Anne Kumalo had her 16-year-old son kidnapped when he went to a local store along with 22 other boys and taken to an illegal initiation school 20 miles away in Soweto.

She said: “I was charged R1000 (£43) to get him back or warned he would be killed and when police found the school the boys had been badly treated, whipped and beaten."

Former South African President Nelson Mandela wrote about the spiritual meaning of his own circumcision as a teenager before becoming accepted as a freedom fighter.

Those who have undergone the sacred ritual are sworn to secrecy and considered tribal outcasts and severely beaten or killed if they tell anyone what the process entails.

The worst of the injuries occur from botched circumcisions carried out by tribal “nurses” who may use the same spear for many boys, which causes mass infection.

The wounds are tightly wrapped with bandages that cut off the blood supply to the area, and within 10 hours, the genitals can become gangrenous and need amputation.

Many initiates do not seek medical treatment when clearly needed for up to 10 days having been told that if it “falls off” that it will grow back but then die from sepsis.