Health Minister Dr Zweli Mkhize has called on traditional leaders in the Eastern Cape to "act in restraint" to save the lives of initiates.Mkhize was speaking after the number of initiates who died at initiation schools in the province rose to 23 on Wednesday.He said the deaths have raised concerns and action should be taken against all those who could have played a role in them.Mkhize added some of the initiates had died from dehydration.READ: 21 boys undergoing initiation ceremonies confirmed dead in Eastern Cape Speaking to eNCA, he said the deaths were preventable and unfortunate."We really have to indicate our disdain because the number of deaths is going to rise… The bulk of those who died are as a result of dehydration because some believe initiates should not be given water."Some end up with mental disturbances and hallucinations. This is a problem, and some complaints indicate renal diseases or acute renal failure. [Others] died from pre-existing diseases like diabetes."Mkhize said one initiate died of a known, previously diagnosed congenital heart disease after someone close to the initiates colluded to get him into an initiation centre where he should not have been.The department has been visiting the area in an attempt to resolve the problem.Health Minister Dr Zweli Mkhize, EC Premier Lubabalo Oscar Mabuyane MEC for Health Sindiswa Gomba arriving at All Saints Hospital on a visit to initiation schools in Komani & Ngcobo.@MYANC @omabuyane@LulamaNgcuka@gomba_sindiswa@DrZweliMkhize @Bulelanilali1 @AndyDontsa pic.twitter.com/a1iqibiq4A— @healthecmec (@healthecmec) December 17, 2019 Mkhize said many cases that have been opened against the ingcibi (traditional surgeon), or inkankhatha, ended up being closed due to a lack of participation from witnesses."As a result, [the] police can't take investigations further because no one comes forth with evidence. Once initiates are healed, they don't want to come back and deal with these issues in court because what happened in the bush stays in the bush."Mkhize accused some people of using loopholes in the legislation to build up a legal defence for themselves, making it difficult to implement the legislation as it stands."We have agreed to … review the legislation, to tighten it up and look at regulations where we make proclamations to force those around initiates to participate in explaining what their roles are."We have agreed with traditional leaders that the issue of [withholding] water to initiates must stop. We will send a team of doctors to rescue those who are at initiation schools.Pre-initiation screening"We do pre-initiation screening to ensure a person is fit for initiation; once there is a complication, we get [them] to co-operate and bring people for medical attention. We are [trying to] ensure that the initiation takes place in winter, particularly in hot areas so that temperatures don't compromise the lives of people."Mkhize said some communities are not keen to participate in male medical circumcision. Instead, they will take someone who has undergone male medical circumcision to an initiation school, resulting in a number of penis mutilations and excessive skin removal."Every family looks after their own, there is no standardised way of treating [injuries] and when something goes wrong, we need to intervene."All initiation centres must be centralised under a traditional leader and all ingcibi and inkankhatha should be registered with the courts, traditional leaders and the health department." Mkhize said this would ensure the department could intervene immediately and ensure that no initiation school was far away from an accessible area.Community interventionHe called on communities to inspect initiation schools and intervene if there was a need to do so.The minister also called for action to be taken against those found to be at fault."Many inquest cases are closed because no one comes [forward] with evidence. We need to make sure that there are few examples made of those who end up causing the damage."In this case, we have seen terrible things. I been to many wards and it is distressing when you see the level of penis amputations and some complications. We are going to increase supervision and act [against] those who don't co-operate," he said.Eastern Cape Cooperative Governance and Traditional Affairs spokesperson Mankeli Ngam said the department was dealing with the matter.Ngam said MEC Xolile Nqatha had observed some traditional leaders were not pulling their weight to ensure that there were no deaths registered."It has mooted an idea that there must be consequences for leaders where there have been deaths or boys have been injured or mutilated. They must account and tell us what action they have taken that our kids are safe."We have launched campaigns and support from non-governmental organisations to ensure it is safe and free. Unfortunately, we continue to see the rise in a culture that is not supposed to be killing or maiming anybody."Initiation season movedThe Eastern Cape chairperson of the House of Traditional Leaders, Chief Mwelo Nonkonyana, agreed with Mkhize that some areas in the province should be prevented from having an initiation season in the summer.Nonkonyana said it was safer to practice the customs in mountainous areas in the province and not in coastal areas where it was humid and hot in summer.He added areas like the Chris Hani region have registered zero deaths in three consecutive seasons during the winter season."The deaths are of course against our customs. Some post-mortem results have revealed that initiates died from dehydration. Clearly dehydration can be avoided because we have said that initiates must be provided with water."[The] government must empower our traditional courts to deal speedily with those contravening the tradition. [The] government must also establish special courts. There are some cases which are pending far back as 2016, and some have been struck off the court [roll]," Nonkonyana said.