In a small room with only two delivery beds, a chair, and a table holding a worn register book, basic medical tools sit quietly on a metal tray. A pair of scissors, a sucker, an almost finished pack of cotton gauze, and a clamp are all that remain to assist women during childbirth.
This is Khaabi Primary Health Care Unit, a small government facility serving communities in Western Bahr el Ghazal State near Wau.
First constructed in 2006, the facility once operated under government management, offering basic healthcare services to surrounding villages. But years of conflict and instability left the building abandoned and destroyed.
The war stripped the facility of its equipment, and much of its infrastructure collapsed. With no functioning clinic nearby, residents were forced to travel long distances to other towns for medical treatment.
The situation changed slightly in 2025 when the government, through a project implemented by the International Organization for Migration and funded by the World Bank, reconstructed the facility under the Enhancing Community Resilience Project Phase Two.
The project rebuilt a four-room structure, constructed a pit latrine, installed a water catchment system, and fenced the compound to protect the facility.
However, while the infrastructure has been restored, the clinic still struggles to operate due to a lack of medicine, equipment, and trained staff.
Today, the facility survives largely through community contributions and the dedication of volunteer health workers who receive no incentives.
A Clinic Running on Community Support
Most services at Khaabi Health Care Unit are offered in the afternoon, except for antenatal care, which operates throughout the day.
Even this essential service faces serious challenges due to limited supplies and staff shortages.
Michael Peko recently brought his pregnant wife to the facility after she developed complications. After a brief assessment, the health worker advised that she needed further medical attention.
But the clinic lacked the necessary medicines and equipment.
Peko had no choice but to attempt the difficult journey to Wau, several hours away.
“Sometimes there is no medicine at all, not even paracetamol,” he said.
“If medicine is available, it is very little and does not meet the needs of different age groups.”
In Khaabi, expectant mothers often arrive at the clinic carrying their own delivery supplies.
Some bring gloves and razor blades to cut the umbilical cord after childbirth.
For many families, these small preparations are the only guarantee that a safe delivery will be possible.
Fahdu Rosa Ukello, a traditional birth attendant, plays a critical role in helping women deliver safely in the community.
She assists women both during the day and at night and often becomes the first line of support during emergencies.
“There are many complications here such as eclampsia, abortions, and postpartum hemorrhage that threaten the lives of mothers,” she said.
Since the facility reopened in 2025, Fahdu says she has helped more than 20 women give birth.
Yet she acknowledges that the lack of equipment and medicines continues to put mothers and newborns at risk.
“I conducted most deliveries at home before, but now there is a facility,” she said.
“However, there are no medications or critical equipment to help during complicated deliveries.”
In serious cases, Fahdu and other health workers refer patients to Wau for further treatment.
The journey can take up to three hours by vehicle, and much longer when transportation is unavailable.
Faced with these challenges, residents have taken matters into their own hands.
Community members agreed to contribute money to keep the clinic functioning.
Each household contributes about 2,000 South Sudanese pounds, which is used to purchase basic medicines from local pharmacies.
John Raile Ibrahim, who recently brought his sick daughter to the clinic after several days of fever, says the arrangement has helped the facility continue providing limited services.
“There was no medicine at all,” he explained.
“So the community agreed with a pharmacy to supply drugs at an affordable price.”
While the contributions have made a difference, they are still not enough to meet the needs of the growing population.
Michael Angelo, the acting chief of Khaabi Boma, says the facility has at least reduced the need for long journeys to Wau.
“The distance we used to travel to Wau has reduced,” he said.
“Before, women often gave birth at home or in farms under risky conditions.”
“But even though the community contributes generously, it is still not enough to provide all the necessary medicines and equipment.”
Health Workers Struggling With Limited Resources
Christine James Victor, a health worker at the clinic, says the facility receives patients with serious health complications every day.
On average, more than 15 people visit the clinic daily, most suffering from fever or other illnesses.
“Many people come here with serious conditions,” she said.
“But they often have no money and no means of transportation to reach better facilities.”
She explained that health workers sometimes purchase medicines such as Ciprofloxacin, Quinine, and ulcer treatments using community funds.
Patients are then asked to pay a small fee to help sustain the clinic’s activities.
When medicines run out, many residents choose to return home and rely on traditional remedies rather than travel to Wau because transportation costs are too high.
The situation in Khaabi reflects broader challenges across South Sudan.
Years of conflict, economic hardship, and limited public investment have left the country’s healthcare system severely underfunded.
Government spending on health remains below two percent of the national budget, leaving much of the system dependent on international donor support.
According to the United Nations Population Fund, maternal mortality in South Sudan stands at 1,223 deaths per 100,000 live births.
Under-five mortality is estimated at 99 per 1,000 live births, while infant and neonatal mortality rates are 64 and 40 per 1,000 respectively.
Healthcare access is also limited by workforce shortages.
The country has only about 7.6 health workers and 1.4 health facilities per 10,000 people, leaving large gaps in service delivery.
Despite its struggles, Khaabi Primary Health Care Unit remains an important lifeline.
The facility now serves at least four surrounding communities and travelers passing through the area.
For residents like 55-year-old Paskina Joseph Ayom, the clinic has made a difference.
“When I came here, the facility was able to provide some services,” she said.
“All thanks to the community leaders.”
Local officials say the project implemented by the International Organization for Migration has improved access to services in remote areas.
Across the country, similar initiatives have supported the construction of health facilities, schools, and water points with funding from the World Bank.
Julio Emmanuel Mama, Chief Executive Officer of Wau Municipality, says the goal of such projects is to bring essential services closer to communities.
“Our aim is for people to have access to healthcare, water, and other essential services within reachable distance,” he said.
But in places like Khaabi, the reality remains clear.
Without consistent government support, communities themselves are often forced to keep public clinics running doing what they can to ensure that basic healthcare services remain available, even as the national health system continues to struggle.
