The cruelest detail of this disaster is who died and where. Tambo Memorial Hospital stood almost beside the bridge, and the people inside it had no warning that mattered. Eight hospital staff, seven nurses and a driver, were killed in the carpark. At least one of them died trying to move her own car away from the burning tanker. Inside, twenty-four patients and thirteen more staff in the emergency unit were caught by the blast, suffered severe burns, and had to be carried out to other hospitals. The ceiling of the emergency unit partly collapsed, forcing every patient to be moved to the theatre complex at the back. A hospital that should have been the first to help the injured was instead, for those terrible hours, unable to take anyone in at all.

Of the dead, 23 were members of the public and 11 were health workers from the damaged hospital. Eight died immediately or before paramedics could reach them; the rest succumbed later in hospital beds. Two more people who had been near the blast were still listed as missing days afterward, their families left without even the certainty of a body. Among those killed were residents who had come into the area to help, neighbors drawn toward danger by the instinct to do something. These were not abstractions. They were Boksburg's nurses and its neighbors, people who on any other Christmas Eve would have been finishing shifts and heading home, and a single illegal turn down the wrong street ended their lives within minutes of each other.

Help came first from the people closest at hand: local security companies, the community policing forum, and volunteer groups. Investigators later found that early calls to emergency services went unanswered before the fire department finally picked up, and that police did not reach the scene until after the last explosion. Once mobilized, though, the response was enormous. Disaster-relief organizations including Gift of the Givers and Muslim Aid arrived through the day. The Gauteng Emergency Medical Services coordinated a frantic evacuation of critical patients from the wrecked hospital, using thirty state and private ambulances and several air-ambulance helicopters over a three-hour window. The blast had also destroyed the railway bridge itself, severing the Germiston-to-Springs line and adding a city's broken infrastructure to its grief.

The driver survived with only minor injuries. He was arrested the next day on charges including culpable homicide, but the deputy provincial police commissioner soon declared the arrest unlawful, since South African law required an investigation into intent before any arrest. The charges were dropped for lack of evidence, and six months on he remained uncharged. An external audit commissioned by the trucking company cleared it of wrongdoing, yet no comprehensive technical investigation was ever made public. The Citizen reported, from Google Street View imagery, that the height-restriction sign on the bridge had been illegible. As of late 2024, two years after that Christmas Eve, no one had been held legally responsible for the 41 deaths. For the families, the absence of accountability became its own lasting wound, a question that the bridge, now rebuilt, still cannot answer.