Kenya’s public healthcare system is once again buckling under the weight of prolonged industrial action, as clinical officers in Nairobi mark 65 days on strike.

This is the strike action of their counterparts in Marsabit, entered 115th day.

What began as a dispute over unfulfilled return-to-work agreements, promotions, and medical cover has now spiralled into what health unions describe as a full-blown humanitarian crisis.

Across the two counties, millions of residents are grappling with shuttered facilities, skeletal services, and mounting uncertainty over where to seek care.

“It is very unfortunate that we have two counties where for the past three to four months the health services have collapsed but all we can say from the people who are concerned being the Governor of Nairobi and the Governor of Marsabit, they are more concerned with the politics of the day and where to align themselves,” said Peterson Wachira National Chair of the Kenya Union of Clinical Officers and Chair of the Health Union Caucus.

In Marsabit County, the numbers tell a story of collapse.

At Marsabit County Referral Hospital, outpatient services have plummeted by 94.4 per cent from about 9,000 patients monthly to just 500.

Inpatient admissions have fallen by 83.3 per cent, from 600 to 100 patients. Theatre cases have dropped by 42.3 per cent, sustained only by three nurse anaesthetists.

Overall, service provision at the facility has reduced by more than 93 per cent.

The situation is equally dire at Moyale Sub-County Referral Hospital, where inpatient admissions have declined by 91 per cent and theatre services have come to a complete halt due to the absence of clinical officer anaesthetists.

Laisamis Sub-County Referral Hospital has recorded an 85 per cent drop in outpatient visits and an 81.8 per cent reduction in theatre cases, with only one nurse anaesthetist holding fort.

Combined, unions estimate that over 15,000 patients are being turned away from outpatient departments monthly across Marsabit, nearly 700 patients are denied admission, and at least 133 surgical procedures are not performed every month.

Overall service delivery across major facilities has collapsed by nearly 90 per cent.

“This is not just a strike. This is a humanitarian crisis unfolding in Marsabit County,” said Wachira,

Wachira, flanked by officials from the Kenya National Union of Nurses, Kenya Environmental and Public Health Officers Union, Kenya National Union of Medical Laboratory Officers, and other health sector unions, accused county leadership in both Nairobi and Marsabit of ignoring signed agreements and opting for intimidation instead of dialogue.

In Nairobi, the standoff has paralysed most public health facilities. Apart from doctors who resumed work following a court directive, clinical officers, nurses, laboratory officers, nutritionists, and pharmaceutical technologists remain on strike.

According to Stephen Muthama, Chair of the Clinical Officers Union in Nairobi, the strike, now in its 65th day for clinical officers and over 40 days for other cadres, stems from agreements signed in July last year that were never implemented.

“We are not ready to sign fresh agreements when previous ones have not been honoured,” Muthama said. “We have tried to engage the county leadership, but meetings have either been postponed or reduced to casual conversations with no tangible outcomes.”

Union leaders allege that instead of resolving disputes, the county has resorted to intimidation. They claim offices at Mama Lucy Kibaki Hospital were broken into and converted into makeshift wards, and that interns and students were deployed to fill gaps left by striking staff, a move they say puts patients at risk.

Governor Johnson Sakaja has been accused by union officials of being unreachable despite repeated requests for dialogue. “We are asking the governor to take responsibility as the CEO of this county,” Muthama said. “Nairobians are suffering, and so are we, because we also depend on these facilities.”

Eunice Ritindi, Chair of the Nurses Union Nairobi branch, said health workers had engaged management throughout the year in a bid to avert a strike.

“We signed several agreements and tried to follow up on implementation, but the employer kept running away from the table,” she said. “As we speak, facilities are barely functioning. Where are these citizens going for care?”

Public health officials warn that the shutdown carries grave risks beyond routine services.

In Marsabit, the crisis is compounded by delayed salaries and a lack of medical cover for health workers. According to union leaders, some staff have gone for three months without pay. Promotions pending for years remain unaddressed despite budget allocations.

Nicholas Odipo, National Chair of the Medical Laboratory Officers Union, said the pattern of unimplemented agreements has become routine.

“Workers cannot continue operating without promotions, without medical cover, and without conducive working conditions,” he said. “If county governments cannot meet these obligations, they must take responsibility.”

The ripple effects are already visible. Union officials report a sharp drop in immunisation coverage and facility-based deliveries in both counties. In Nairobi — often branded as East Africa’s premier capital — mothers are reportedly delivering at home due to inaccessible services.

Health experts warn that prolonged service disruption could reverse gains made in maternal and child health, infectious disease control, and emergency care. Urban informal settlements in Nairobi, which rely heavily on public facilities, are particularly vulnerable.

Meanwhile, residents in remote parts of Marsabit face the harsh reality of travelling hundreds of kilometres in search of care, an option many cannot afford.