Spokesperson for the provincial health department Sizwe Kupelo said a minibus transporting the schoolchildren, all of them under ten years old, reportedly collided with a truck 18km from the town on the road to Ugie.
Four children died in the impact, and seven were taken to hospital in Elliot.
Of the seven, five were in a critical condition, and two of the five were "very critical".
Those two might be flown to hospital in East London, he said.
He was waiting for reports on the condition of the drivers of the vehicles.
A helicopter, four ambulances and a rescue vehicle were sent to the scene when the accident was reported, he said.
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