Traditional male circumcision is still widely practised in the Xhosa population throughout South Africa. It is a rite of passage from boyhood to manhood. Unfortunately, botched circumcisions are a public health hazard and lead to tragic mutilations and deaths.The present study was undertaken to assess the extent of circumcision-related complications and fatalities in the Eastern Cape. Health care data were provided by the Eastern Cape Department of Health. Hospital admissions, amputations and deaths per circumcision season were recorded as well as causes of death and the number of legal and illegal initiation schools, respectively. The aim was to establish if the Application of Health Standards in Traditional Circumcision Act of 2001 has been successful in reducing the health risks of the ritual.The findings show that the incidence of circumcision related complications and fatalities has remained virtually unchanged in the observation period 2001 - 2006. Unqualified surgeons, negligent nurses, irresponsible parents and youths medically unfit for the hardships of initiation continue to contribute to tragic outcomes. One of the main problems is the perception that government interference in the ritual is undesirable, and the fact that a stigma is attached to non-completion of the procedure.Progress is only possible if all the relevant stakeholders--traditional surgeons, traditional nurses, traditional leaders, traditional healers, representatives of the Department of Health, medical officers, police, parents, initiates and the communities concerned--can be made aware of the problem and rendered willing to work together in preserving a cultural tradition in the spirit of the Constitution, that is, without violating fundamental human rights.