At least 35 young men have died since the beginning of the winter initiation season in Eastern Cape, South Africa, due to circumcision malpractice.
Circumcision is practiced by members of the Xhosa tribe, which consider the genital mutilation as a rite of passage - commonly referred to as 'Ukwaluka' or 'going to the mountain' - from childhood to manhood.
"Over 180 boys have been admitted to hospital and 35 have died so far since the initiation season started," health department spokesman Sizwe Kupelo said.
"We have observed issues that we believe are circumstances and contributing factors, including criminal elements, lack of discipline [and] improper conduct."
The initiation season, which started in December, was expected to end when the schools reopened in July, Kupelo added.
According to the ritual, Xhosa boys aged between 15 and 17 are covered with white mud and taken to an 'esuthwini', or initiation school, where they are circumcised by an 'incgibi', a surgeon.
After the circumcision, the initiates live together into a hut where their families cook specific foods for them.
At the end of the initiation period, the boys cover their bodies with red mud, to symbolise their new life as men.
Human rights activists have often called for the end of the practice as many boys who undergo the surgery die shortly after.
Over 500 boys died in the past 8 years during the initiation process.
The lack of surgical education of the surgeons is one of the main causes of death.
According to a 2008 study that analysed 192 boys after being circumcised, even some of the surgeons who had gone through training failed to perform safe circumcision procedures.
Xhosa males who are not initiated are often ridiculed by the other members of the tribe and are not considered as real men. For this reason, hundreds of boys undergo surgery every year, despite growing concern over the many deaths.