WARRAP STATE, SOUTHERN SUDAN - Aguek Deng is the only doctor at the government hospital in Kuajok, southern Sudan's newest state capital.
The hospital ward, which serves nearly 1 million people, has just 11 beds, none of which has a mattress. The on-site pharmacy boasts mainly acetaminophen and vitamins; Deng says injections for pain relief, pneumonia and malaria run out too quickly.
In the ward, Atong Akol, who says she doesn't know how old she is but who looks to be about 15, sits on the edge of a bed frame. In front of her lies her 10-day-old daughter, Akot, who Deng thinks has "some kind of infection." The odds are stacked against the baby's survival; according to the United Nations, one in six children in southern Sudan dies before turning a year old.
The state of health services in Kuajok is indicative of health services across southern Sudan, an area the size of Texas that is likely to become the world's newest nation next year. On Jan. 9, southern Sudanese will vote in a referendum that will mark the final stage of a 2005 peace agreement that ended 22 years of war between the Sudanese government based in Khartoum, in the mainly Muslim north, and rebels based in the mainly Christian and animist south. Southern Sudanese are widely expected to choose independence, freeing themselves from the rule of President Omar Hassan al-Bashir.
If the vote goes as expected, southern Sudanese will be starting their nationhood under inauspicious circumstances.
"After decades of brutal war, poverty, neglect and the displacement of millions of its people, southern Sudan is one of the poorest and least developed regions of the world," said Louis Belanger of the anti-poverty group Oxfam. "It is being built almost from scratch and needs the support of the rest of the world to help provide development and security."
The United Nations has compiled a set of "Scary Statistics" to illustrate the problem: 90 percent of the south's roughly 10 million people live on less than $1 a day; one in six women dies in pregnancy; and barely one-quarter of girls attend primary school.
But many southerners say they expect that their lives will improve radically after the referendum.
"At the grass-roots level, the belief is that after independence they will have roads, schools and hospitals," said community organizer Druini Jakani.
Counting on oil money
Many believe oil will be their savior.
"After the referendum it will be okay here because we will have our own budget from the oil," said Deng, voicing a common refrain.
"People are expecting very quick development of the south because they believe the problem until now is that the oil wealth has been in the hands of Khartoum," said Edmund Yakini from the pro-democracy group Sunde. "Up to now there is no one who has been engaged in expectations management. It's a huge risk."
Sudan is the third-largest oil-producing country in sub-Saharan Africa, and most of its 490,000 barrels per day come from fields in the south. Under the 2005 peace agreement, southern Sudan was granted semi-autonomy until the 2011 referendum and has its own interim government, headed by former rebel commander Salva Kiir Mayardit.
Since the signing of the agreement, Sudan's oil wealth has been split between Kiir's administration and the Sudanese government, rendering inaccurate the local perception that all the oil revenue is still going to Khartoum. According to the southern government's Ministry of Finance and Economic Planning, 98 percent of the south's budget comes from oil and over the past six years this has amounted to more than $8 billion in revenue.
"The oil money has not been well spent," acknowledged southern Cabinet Affairs Minister Kosti Manibe Ngai. The southern government has been battling widespread corruption, but Ngai said the primary problem has been that southern officials never believed that Bashir's regime wanted to implement the peace agreement, "so there was always in our minds the possibility that we would go back to war." As a result, he said, the south spent a lot of money on security and very little on development projects.
"In the last six years, the government as such has not built a new health facility," southern Health Minister Luka Tombekan-Monoja said at a forum of southern state governors in Juba last month.
The focus on security has also come at the cost of investing in what Ngai says could be the south's ticket to self-sufficiency - agriculture.
At the forum, southern Agriculture Minister Anne Itto pleaded for her government to reduce its oil dependency by investing in development across the south's fertile land.
"We need to diversify, or else when the oil dries up we will also dry up," she said.
In the 2010 budget, her ministry was given $16.8 million, but the military was given $472 million.
President Kiir said he is aware of the development challenges that lie ahead. At his offices in the southern capital, Juba, Kiir laid out the main argument of those who say southern independence will herald the birth of a failed state.
"They say that because they think we don't have the capacity to run a state," he said, explaining the concern that there are not enough educated people in the south. According to U.N. statistics, 85 percent of southern Sudanese cannot read or write.
Kiir argues that there are plenty of educated southerners; the problem is that they have left the region. Millions fled during the war, either to the relative safety of the north or to begin new lives in other countries.
"When we divorce [from the north], we hope the divorce will be peaceful and then these people will come back to us," Kiir said.
But Tombekan-Monoja, the health minister, said he is not counting on emigres to return.
"If they have not come," he said, "for me they don't exist."
The Health Ministry has already seen its hopes dashed in regard to what qualified returnees can contribute. In 2007, they offered financial incentives to attract medical practitioners. But when the bonuses had to be cut after the global financial crisis and a drop in oil prices, most of the returnees left again.
And of those who stayed, many moved from rural centers to Juba, where living conditions are better than in the rest of the south.
In the education sector, the capacity challenge is exacerbated by the southern curriculum, which requires English as the language of instruction. During colonialism, the British enforced English as the lingua franca of the south, which they administered separately from northern Sudan.
But during the post-independence years of war, successive Sudanese governments tried to enforce Arabization (and Islamization) on their southern compatriots, so the return to English is part of an effort to reclaim the south's identity. However, most of those who have enough education to teach received their schooling in the Arabic-speaking north.
"We are trying our level best to get them English training," said Peter Majock Deng, the head teacher at Jul-jok primary school in northernmost Warrap state. He relies on international groups to help his teachers.
Classes at Jul-jok meet outside under the trees; tents donated by UNICEF in 2008 for the school's use have been reduced to tatters by the extreme climate.
"After the referendum, everything will change. Everything will be easy," teacher Myau Deng Adur said. "For sure we will have buildings."