The 500-bed Juba Teaching Hospital is the biggest hospital in South Sudan, but it's struggling.
Hospital General Director Wani Lolik Lado recently took a reporter through a male ward where patients lined up in beds in an open room were being treated under rotating ceiling fans.
“We don't have sophisticated equipment; we are dealing within our capabilities,” he says. “Compare it to your hospitals.”
Most of the medications and supplies, he said, are provided by nongovernmental organizations. Donations, he said, “come here and there.”
In fact, according to the World Health Organization, NGOs provide 80 percent of all health care services across the country.
The South Sudanese government announced big plans to begin providing services for its own people after the country won independence in 2011, but the current conflict has changed all that.
In December last year, a political dispute between President Salva Kiir and his former deputy Riek Machar descended into violence, leaving at least 10,000 people dead and displacing more than 1.5 million more.
As a result, development in the country has been, more or less, put on hold.
Shift in priorities
In his introduction to the new budget in August, Finance Minister Aggrey Tisa Sabuni said the crisis has “forced us to refocus our immediate priorities away from development, towards security and emergency relief.”
Funding for security and law enforcement increased by $290 million this year compared with last, and represents about 50 percent of the total $3.75 billion budget. Another $88 million has been set aside for an emergency contingency fund.
In comparison, 5 percent goes to education and 4 percent to health.
National Assembly Finance Committee Chairman Goc Makuac said the budget makes clear that achieving peace is the first priority.
“The government will work very hard to see that peace is achieved. If peace is achieved, then there will be stability, and if stability is there, then the economy will prosper,” Makuac said.
Much of the fighting has centered around oil-producing areas of South Sudan, threatening the industry that provides the vast majority of the country's revenue. So securing oil fields is crucial to protecting the economic interests of the country.
But the crisis is also shifting priorities for donors. Many blame the government for creating or prolonging the crisis. As a result, international grants to the government have fallen dramatically.
“We do have to accept that this is a man-made crisis, and it was important to continue our commitment to the people of South Sudan without necessarily working through the central government,” said Teresa McGhie, the U.S. Agency for International Development's South Sudan mission director.
One area in which the U.S. is still providing direct assistance, she said, is helping the South Sudanese government manage its oil resources.
Like other foreign donors, USAID has increased its humanitarian assistance, most recently granting $180 million in additional funding in August to relieve the food crisis.
Rama Anthony, development program director for the British aid group Oxfam in South Sudan, said his group has had to suspend some development work, including a food security initiative.
“The money isn't there,” he said, “because the donors clearly aren't funding any development projects anymore.”
Anthony said the majority of aid agencies working in South Sudan have suspended development work in order to tackle the humanitarian crisis.
And the emergency needs are immense. NGOs say they, too, have had to suspend or delay long-term projects in agriculture, water, health care and education to focus on lifesaving efforts. The groups warn that without support, more than a million people could face severe hunger by early next year.