43 days of pain as nurses strike leaves 522 dead

For 43 days, Kenya’s public health system was paralysed by a nurses’ strike—a crisis marked by immense pain, suffering and loss of life.

By last evening, some 522 deaths had been recorded. Of these, 63 were women who died while giving birth. Another 69 deaths were babies who died immediately after being born.

The largest number of deaths was recorded among the unborn, with 390 lives terminated in the womb.

The strike lasted about one month and two weeks. And in August 2026 alone, 46 mothers and 36 newborns died in public facilities as the strike continued to bite.

For weeks, Kenyans endured horrific experiences in public hospitals as health workers stayed away, while unions and county governments traded blame instead of finding a solution.

All the while, the voice of reason—the Head of State, who should have stepped in to break the impasse—looked the other way, allowing the suffering of sick Kenyans to continue.

It was only after the President’s intervention that the Council of Governors (CoG) convened a crisis meeting with nurses in a last-ditch effort to resolve the strike and save lives.

The meeting was attended by Council of Governors Health Committee Chairperson Abdulswamad Sharrif Nassir and National Assembly Health Committee Chairperson Dr James Nyikal.

It came just a day after President William Ruto met with the Council of Governors on Tuesday, September 8, as pressure mounted to end the 43-day standoff.

And after several hours of dialogue, the nurses’ unions agreed to call off the strike, intervening on patients suffering and more deaths.

But for the family of Hilary Otieno, this meeting will not bring back their kin.

For Otieno’s family, the nurses’ strike was not a dispute being followed in newspaper headlines or discussed in boardrooms. It was a search for help.

The university student, aged 30, had initially complained of what appeared to be malaria symptoms. He had been walking and going about his life, with no known serious illness, until his condition deteriorated on August 14.

He began vomiting repeatedly and became extremely weak.

His family took him to Coast General Hospital’s Chaani facility, hoping the referral system would lead them to treatment. Instead, they were told health workers were on strike and the facility could not help them.

They moved to Port Reitz, then to a private facility, Chaani Medical Hospital, where tests reportedly showed malaria and dengue fever.

As his condition worsened, a nurse advised the family to take him to the main Coast General Hospital but they were told to wait at the emergency department.

Maurice Akama, Hilary’s relative, said they waited for more than 30 minutes as attendance remained slow. When health workers eventually came to attend to him, the family was told Hilary was already gone.

For Akama, the question that remains is not simply what killed Hilary. It is what might have happened if the health system had been functioning normally when he needed it.

That question now hangs over many Kenya who have also lost their kin as the country wakes up to the end of a 43-day nurses’ strike.

On Wednesday, Kenya National Union of Nurses and Midwives Secretary General Seth Panyako called off the strike and directed nurses to resume duty immediately, and in any case within 24 hours.

The move followed a return-to-work agreement between the union and the Council of Governors.

But even as nurses prepare to return to hospitals, the agreement leaves behind a question that is harder to answer; why did it take 43 days to get here?

The strike, which began on July 29, 2026, was rooted in grievances that were not new.

Nurses were demanding the implementation of a 2017 agreement, the conclusion of the 2017 Collective Bargaining Agreement, career progression guidelines and permanent and pensionable employment for UHC nurses, among other issues.

There was also the unresolved case of 46 nurses dismissed by Kisii County in 2021.

These were not issues that suddenly appeared on July 29, 2026: They had been on the table for years.

And yet, it took nurses withdrawing their services across the country for six weeks before the two sides reached a formula that allowed them to return to work.

The negotiations, however, did not completely stop during the strike.

CoG chair Ahmed Abdullahi said there was a back channel through which the two sides continued talking even as their public positions appeared increasingly confrontational.

Those talks, he said, eventually produced a mutually acceptable agreement that raises the uncomfortable question of what exactly changed after 43 days.

If the conversations were continuing, what made an agreement possible on Wednesday that could not have been reached earlier?

The answer lies partly in the issues that had accumulated over the years and partly in the cost of allowing the dispute to continue but for patients, there was no back channel.

There was only a closed maternity unit, a delayed appointment, a missed clinic or a family moving from one hospital to another looking for care.

Hilary’s family experienced that reality firsthand.

The disruption of services was also felt particularly in maternity and newborn care, where delays can have consequences within minutes.

The CoG acknowledged that a health workers’ strike affects service delivery and it affected services in most public hospitals and that is the uncomfortable part of this dispute.

A nurse negotiating a CBA is thinking about pay, career progression, job security and working conditions.

A county government is thinking about its budget. A union is thinking about how to secure better terms for its members.

But the patient in a hospital bed is thinking about something much simpler; will someone be there when I need help?

That is where the 43 days become more than a labour dispute.

The CoG has argued that the financial demands facing counties cannot be separated from the growth of Kenya’s health workforce.

The number of nurses has risen from about 8,000 in 2013 to roughly 42,000, according to Abdullahi. Counties therefore face a much larger wage bill as health services expand under devolution.

The new agreement attempts to strike that balance. The risk allowance has been increased from Sh3,850 to Sh8,000, while the uniform allowance is to rise from Sh10,000 to Sh15,000.

The parties have also given themselves 45 days to conclude the 2025–2029 CBA.

The Council of Governors is expected to coordinate the development of a model career guideline within the same period, while counties have committed to absorbing UHC staff on permanent and pensionable terms from July 1, 2026, at SRC-approved rates.

The national government will also take responsibility for gratuity accumulated under the two previous UHC contracts.

For now, these are commitments on paper but the real test begins after the nurses return to their stations.

Mombasa Governor Abdullswamad Sherrif Nassir and the chair of Council of Governors Health Committee, acknowledged that the country should not have reached a point where millions of Kenyans were caught in the middle of a health workers’ dispute.

Healthcare cannot be treated like an ordinary industrial sector where a prolonged stoppage is simply an inconvenience to be endured until employers and workers settle their differences.

When nurses leave maternity wards, emergency departments and other critical services, ordinary Kenyans carry the consequences.

That is why Wednesday’s agreement should be judged by more than the fact that the strike has ended.

The 43-day period now provides the government and the union with another opportunity to resolve what has been allowed to drag on for years.

If they succeed, the 43-day strike may become a painful lesson in what happens when negotiations fail and if they do not, the country risks returning to the same cycle of unresolved grievances, escalating rhetoric, court battles, a strike and patients once again caught in the middle.

Question however remains; how the sector got here.

On Wednesday, nurses accused the CoG of being responsible for the stalemate that prolonged their strike.

The Kenya National Union of Nurses and Midwives (KNUNM) chairperson Joseph Ngwasi said counties, through the CoG, failed to forward their negotiated Collective Bargaining Agreement (CBA) to the Salaries and Remuneration Commission (SRC) for advice.

They said this is what blocked its implementation.

“The council should carry blame to the strike. The buck stops at the council," said Ngwasi.

The official said CoG agreed to have the 2017 CBA in place. But immediately, the council wrote a letter withdrawing it.

This is despite CoG having been part of the agreement.

Ten years later, the agreement remains unresolved, with nurses withdrawing work, until their CBA is honoured.

Withdrawal of the agreement by CoG did not ogre well with the union that accused governors of being insincere in their handling of the dispute.

Nurses said Governors blocked efforts to have the dispute solved because health is a devolved function.

But with hundreds of Kenyans dying, more so mothers and babies, the union observed that President Ruto should have picked up the matter for a quick fix.

Ngwasi said president is the Head of State, and could convene a crisis meeting with relevant stakeholders, including the CoG, SRC and National Treasury, and give a direction of solving the strike.

With presidential move, money could have been allocated from the National Treasury, and have SRC give advice, solving the dispute.

The nurses CBA required approximately Sh5.9 billion.

Ngwasi accused the CoG of taking nurses in circles by making offers and withdrawing them.

“We think CoG has been taking us in circles, because giving and taking it at the same time means they did not negotiate with clean hands,” he said.

Nevertheless, the union faulted the President for not being hands-on in resolving the dispute.

“The President has not been hands on. If so, we could not be talking of 44 days of absence of nursing services in the country,” said Ngwasi.

Ngwasi said a crisis meeting bringing together all the key stakeholders was a sure way of ending the strike.

“The President could have called for an early crisis meeting with relevant bodies, so that once an agreement is entered, then it is a matter of executing,” he said.

SRC was expected to give advice on way forward for the CBA, after receiving directive from counties.

"SRC must be moved, and it is CoG to move the SRC. It cannot release a letter out of the blues when they have not released and CBA forwarded from CoG,” he added.

But instead of finding a solution to the strike, governors through CoG threatened striking workers.

During the strike action, patients were forced to pay for the prices of the stalemate.

A spot check by The Standard revealed that operations were limited to emergencies only, including maternity, risking deaths in the community.

For example, last Thursday alone, at least 11 patients at Nakuru Level Five Hospital died as the strike persisted.

The deaths included three newborns, five adults in the medical wards and three children in the paediatric ward.

“Deaths are reported because patients are not being attended to. We could be having more deaths, but admissions have been stopped,” said an official working at the hospital.

The hospital has also combined the post-Caesarean Section and postnatal wards at the Margaret Kenyatta Mother and Baby Wing, as contracted locum nurses struggle with the workload.

In an interview with The Standard, Prof Anyang’ Nyong’o said that inadequate resources and human resource challenges continued to hamper healthcare delivery.

The former Minister for Medical Services, now Kisumu Governor, says counties need more resources to meet health workers’ demands, including promotions, comprehensive medical cover and recruitment.

“The national government knows the amount of money they dispense to counties. They can have this addressed. People cannot go to work without pay,” says Nyong’o.