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The conjoined twins born at the Dr Malizo Mpehle hospital at Tsolo, near Mthatha, last week have died.
The twin girls were transferred to the Red Cross Children's hospital in Cape Town where they died late on Monday.
They had a combined weight of four kilogrammes and shared a heart and liver.
A Red Cross hospital spokeswoman told AlgoaFM news that the twins simply stopped breathing before any attempts at surgery could be done.
They were the 5th pair of conjoined twins born in the Transkei in the past two years.