The town of Leeu-Gamka owes its existence to the route chosen by Prime Minister John Molteno for the Cape Government Railways's western main line, from Cape Town towards the diamond fields at Kimberley.

[2] The railway line reached the meeting-point of the Leeu and Gamka rivers in 1879, and on 11 August of that year a station was opened on that location.

[4][5] A small town grew around this station, with a church and school opening in 1896, and a hotel in 1898.

The town lies at an elevation of 552 m, in the southern Karoo; to the north are the Nuweveld Mountains, and to the south the Swartberge.

Leeu-Gamka established a new emergency medical services station in conjunction with the Western Cape Provincial Health Department to render support services to accident victims on the N1 en route to Cape Town and Johannesburg.