South Africa has no civil war but violence is one of the top five causes of death in the country, according to a study published by The Lancet, the Sunday Times reported. According to the report, South Africa was the only country outside the Latin American and Caribbean region to make this claim.

People most at risk of dying because of violence were at the prime of their lives and a group being decimated by HIV. In 2013, almost 200,000 people between the ages of 15 and 49 died of violence, Aids-related illness and road injuries. Suicides surged more than 200 percent last year, compared with 1990, the newspaper reported.

Institute for Security Studies senior research fellow Dr Chandre Goud said violence was one of the most serious challenges facing South Africa.

“High levels of violence undermine investor confidence, drive up costs in the health sector and have a negative impact on… society,” she was quoted as saying.

“Reducing violence is possible, but it requires a comprehensive national plan, adequate resources and partnerships between the government and civil society. South African society also needs to change attitudes and social norms that encourage violence and discrimination.”

According to the study, violence was the leading cause of death in El Salvador, Venezuela and Colombia but for a majority of the 188 countries in the study it did not feature.

In South Africa the leading cause of death in 2013 was HIV/Aids, then lower respiratory infection, tuberculosis was third and diarrhoea was fourth, the Sunday Times reported. Violence was the fifth highest cause of death. SAPA