MINGKAMAN, South Sudan – In a country with one of the highest maternal mortality rates in the world, a small reproductive health clinic serving more than 200,000 people is on the brink of closure. The concerned looking mothers know all too well what can happen.
“If the hospital closes, we will die more because we are poor,” said one mother-to-be who only mentioned her name as Chuti. She attended a monthly checkup at Mingkaman’s reproductive health clinic in this White Nile town, and it could well be her last.
The United Nations has said it plans to end operations at the clinic by December due to a lack of funding from European and other supporters. It is just one of many casualties in developing countries as humanitarian donors have been stretched through crisis after crisis, from COVID-19 to the Russian invasion of Ukraine. The UN won’t say how much it costs to run the clinic.
A loss like the clinic is critical for people in places like Mingkaman, which, along with the rest of South Sudan, is struggling to cope with the aftermath of a five-year civil war, climate shocks such as widespread flooding and ongoing insecurity, including shocking rates of sexual assault.
The UN Commission on Human Rights in South Sudan has said the war in Ukraine has dramatically cut funding for emergency medical care for people who have been sexually abused. “It’s not like sexual violence ebbs and flows, it goes on all the time, largely unseen,” said Commissioner Barney Afako. The commission has also alleged that the government has failed to invest in basic services such as health care.
This reproductive health clinic in the capital of central South Sudan’s Awerial province serves a community largely made up of people displaced by the civil war and floods. Women who once gave birth at home now come here to give birth to their children. It is also where women who are attacked come for care.
According to the World Health Organization, the maternal mortality rate in South Sudan in 2019 was 789 deaths per 100,000 live births. That’s more than double the rate in its more developed neighbor Kenya, according to UN data, while the U.S. rate was 23 deaths per 100,000 live births in 2020, according to the Centers for Disease Control and Prevention.
Every month, at least 250 women give birth at the Mingkaman clinic, said Teresa Achuei, the site manager at the IMA World Health organization, which runs the clinic. She said she only knew three women who died in childbirth in the community, all outside the clinic.
Now, she said, hundreds of women are at risk. “Our goal, our mission, is to reduce maternal mortality. Every woman should give birth safely. If the facility closes, there will be many deaths in the community,” she told The UK Time News in mid-October.
The clinic was founded in 2014, the year after the civil war in South Sudan started. Set up in tents as a temporary way to serve people displaced by combat, it remains improvised but works around the clock.
It is a hub of activity in Mingkaman, a community on one of South Sudan’s muddy main roads without reliable electricity and running water. The military is there to respond to outbreaks of violence. Many women support their families by collecting firewood from the nearby forest to sell or to work in modest local hotels.
Several women expressed concern about the clinic’s impending closure.
“It will get worse for us because it helped us,” said Akuany Bol, who gave birth to her three children there. She looked miserable as she waited for a midwife to examine her child.
Andrew Kuol, a clinical officer, said the facility receives an average of 70 to 80 patients per day. It often allows 20 patients a day, or twice the number of beds.
Some women need to be treated on the floor.
Kuol said the clinic is facing a shortage of drugs, including antimalarial drugs, post-rape drugs, prenatal drugs and others, again due to dwindling support from donors.
The nearest hospital is in the town of Bor in neighboring Jonglei state, where the clinic’s more complicated cases are sent. It’s also complicated to get there. Without a bridge between the states, it can take an hour for a boat to cross the Nile.
As in much of South Sudan, traveling is a challenge. And due to the current circumstances, few people can easily move here for health care or anything else.
“These[displaced people]are not going anywhere because there is still insecurity and also the flooding,” said James Manyiel Agup, the health director of Awerial County, Lakes State. He urged UN partners to continue supporting the facility to save lives.
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