Twenty South African boys have died following botched circumcisions in the Eastern Cape Province.
"The deaths occurred over the past 12 days, with nine of them occurring over the past 24 hours," said a provincial health spokesperson.
Some 60 boys have been rescued from 11 initiation schools which have since been closed.
Circumcision is seen as a rite of passage into manhood in some South African communities.
The practice is common among the Xhosa and Ndebele communities.
However, Zulu King Goodwill Zwelithini wants it reintroduced among the Zulu people because of reports that medical circumcision can reduce the chances of getting HIV.
The rescued boys have been taken to the Nelson Mandela Academic Hospital in Mthatha.
"All 60 of them have septic wounds and are dehydrated," said Eastern Cape health spokesperson Sizwe Kupelo, reports Sapa news agency.
"Four of the boys even need their genitals removed completely, as it could result in death if it's not. We are just waiting for consent from their parents to perform the procedures."
Illegal initiation schools have become common in the Eastern Cape, especially in rural areas.
Unregistered surgeons often set them up as a way of making money, says the BBC's Pumza Fihlani in Johannesburg.
Earlier this week, seven under-aged initiates were rescued from an illegal initiation school run by a 55-year-old unregistered traditional surgeon who had been arrested several times for the offence.
"He was recently given a three-year suspended sentence but he continued doing the same thing. In the past five years, close to 20 initiates died in his schools and 15 had their penises amputated," said the Eastern Cape health department.
Health department officials are meeting the police, members of the justice department and prosecutors to discuss the prosecution of those contravening the Traditional Circumcision Act, which regulates the custom in the province, according to Sapa.
"The major problem is that parents are reluctant to prosecute illegal traditional surgeons who sometimes force their children into circumcision at a very young age," Mr Kupelo said.
"We identify the perpetrators, but if parents are not willing to open cases against them, they are freed and continue illegally circumcising and killing these boys."
Most initiations are either done in June-July or November-December.
Last year, 91 initiates died and hundreds were hospitalised in the province.