AGOK, RAJAF and JUBA, South Sudan — Most of southern Sudan is still celebrating its overwhelming vote for independence, but doctors and statistics describe the territory's desperate need for improved healthcare.
After 20 years of civil war, in which an estimated 2 million people died, and years of underdevelopment, South Sudan has one of the world's worst rates of infant mortality and of maternal death in childbirth.
“The situation is a consequence of the last several decades of fighting, and the development of the country has been minimal,” said Emmanuel Roussier, head of mission for Medecins Sans Frontieres in southern Sudan. “Healthcare is either non-existent or very poor, there are almost no doctors, nurses or midwives.”
An inventory of suffering has been compiled by United Nations agencies and dubbed the "scary statistics" by aid workers in the region: more than 90 percent of South Sudan's 9 million people live on less than a dollar a day; one in six women who get pregnant will die during pregnancy or childbirth; only 10 percent of pregnant women have any trained medical help at birth; one in every six children born will die before their first birthday.
The list of South Sudan's health dangers goes on: more than half the population does not have access to clean drinking water. Only 13 percent of children are vaccinated, which is the lowest immunization coverage anywhere in the world. Although malaria is “hyper-endemic” only 12 percent of homes have the insecticide-treated bed nets that can prevent infection.
“Southern Sudan is one of the least developed regions in the world,” said Alun McDonald, a regional spokesman for the charity Oxfam International. “Most people don’t have access to clean water, sanitation, health care, schools — you name it. The statistics and the indicators on the humanitarian situation, whether we’re talking about the number of women dying in childbirth or the number of children in school, are some of the worst in the world.”
Much of what little health care that can be found in southern Sudan is provided not by the government but by international aid agencies such as MSF which runs a hospital in Agok, a little town where you can stand with one foot in the South and the other in the North. The little brick hospital has 14 maternity beds and they are regularly oversubscribed.
In May 2008 when the disputed town of Abyei — a couple of hours slow drive north on a rough road — was razed by fighting the population fled southward to Agok, a tiny town that had a makeshift hospital. With one eye on the chance of further fighting over Abyei, MSF has built a new operating room in its Agok hospital, a clean, freshly painted and well-equipped oasis.
The village of Rajaf, south of Juba, have no such facilities and is more typical of southern Sudan’s needs. Here most mothers give birth on the floor of their mud and straw huts, without any medical care, assisted by a relative and ignored by husbands for whom involvement in childbirth is culturally taboo.
Susan Poni silently sweated through eight hours of labor before giving birth to her sixth child, a little girl named Doki. Mother and child both survived and are now healthy. Statistics show many others are less fortunate, making southern Sudan the most dangerous place on earth to be pregnant or a new mother.
In the village of Rajaf, south of Juba, there is one health clinic run by Sudanaid, a local organization supported by Catholic charity CAFOD, and it struggles to serve more than 1,000 households.
“We lack the manpower to run maternal health programs,” explained Felix Lodiyong who, as a trained medical assistant, is the most senior staff member.
Vincent Bolt, CAFOD’s Sudan manager, said: “The majority of deaths around childbirth are entirely preventable. The Southern Sudan authorities must prioritize women, and get skilled health workers present at births.”
If complications are spotted then Lodiyong can only refer mothers to Juba hospital which is equipped with eight maternity ward beds and two delivery rooms that have birthing chairs with stirrups.
“Five years ago this hospital was just buildings with dirty, smelly wards,” said Dr. Mergani Abdallah, the consultant in charge of obstetrics and gynecology at Juba hospital. “We have 68 obs and gyne beds now and our own emergency operating theater [room]. Our main problem is lack of midwives.”
There are only 100 trained midwives in the whole of southern Sudan, a country the size of Texas.
Suzy Mohamud, 26, was one of the few lucky enough to be attended by a trained midwife. She was lying on one of five beds in a post-natal ward at Juba hospital where there are nurses and trained staff for the 15 mothers who give birth there every day.
Ceiling fans stirred the hot air, there was no breeze blowing through the open windows. Mohamud watched contentedly as her 12-hour-old son, as yet unnamed, slept peacefully.