An unprecedented surge in gun violence is placing increasing strain on health services in the Western Cape, as alcohol and gangsterism take a deadly toll, new research shows.

The rate of gun-related murders doubled between 2010 and 2016, rising from 17 per 100,000 to 35 per 100,000 population, according to the 2019 Western Cape burden of disease report, released on Tuesday.

The increase was most marked in the Cape Town metropolitan area, with a fourfold increase in gun-related homicide in Klipfontein. The murder rate was nine times higher among men than women.

“We have seen an exponential increase in male homicide in the past four years, and there is no sign of it tailing off,” said Prof Johan Dempers, head of forensic pathology at Tygerberg Hospital. Alcohol and gangsterism were the key drivers of this trend, he said.

Half of all homicide victims had been drinking alcohol, and 45% had a blood-alcohol level above the legal driving limit of 0.05g per 100ml.

Despite the development of an integrated violence prevention policy, there has been no progress on the two potential quick wins —  alcohol and firearm control — said the report. The fast-tracking of firearm licences at national level had seen weapons percolate into the illegal market through theft and loss, amplifying the effects of weak provincial gun control. Alcohol was more widely available in the formal retail sector than ever before, said the report.

Western Cape head of health Beth Engelbrecht said all sectors of society needed to work together to combat violence and take the burden off the health system.

“We need a social movement for health. We can’t do this on our own,” she said, alluding to the knock-on effects of violence and other social determinants of health such as poor sanitation.

The Western Cape health department has previously said violence has affected the response times of its emergency response vehicles, as ambulance crews have to wait for police escorts to go into dangerous neighbourhoods. The high number of gunshot victims also means less urgent cases have to be delayed.