As Nigeria’s healthcare bleeds, striking doctors pledge to fight

For months, *Emeka Nwaeze had to shuttle back and forth between his family home in Owerri, the capital of southern Nigeria’s Imo state, and the federal hospital, where his 54-year-old mother suffering from kidney failure was placed on dialysis.

Then one night, her condition worsened. First thing in the morning, Nwaeze rushed her to the hospital but was told that “doctors just started their strike, therefore, she can’t be admitted.”

“Before we could get to any hospital, she went into a coma,” Nwaeze, a beauty salon entrepreneur, told Al Jazeera.

It was too late when she was admitted to a private hospital where the primary school teacher remained unresponsive and eventually died a week later.

Her case is not an isolated one. Many people, including COVID-19 and cancer patients, have been turned away at short-staffed hospitals across Nigeria since August 2, when thousands of resident doctors went on strike over unpaid salaries, poor facilities and insufficient hazard allowances. Others are left to die in hospital beds without being diagnosed or receiving treatment.

The striking doctors say they are worried about the wellbeing of their patients but place the blame on the federal government, saying it repeatedly failed to honour its pledges on improving the healthcare system.

“I have decided to join the strike because the government hasn’t fulfilled any of its promises made before,” said Yahaya Zubaida, a resident doctor at a public hospital in Nigeria’s capital, Abuja.

It is the fourth time that Zubaida and her colleagues have gone on strike since the coronavirus pandemic began last year. This time around, they insist their action would not be suspended until the demands – including pay rise and payment of previous unpaid salaries; an increase of hazard allowance; better facilities and equipment – are met by the government.

The government has responded to the doctors’ strike by invoking the “No Work, No Pay” rule, freezing the wages of the participants. The Minister of Health Osagie Ehanire warned the doctors not “to be used by enemies of the country to cause instability in the health sector”.

Al Jazeera reached out to the health ministry but did not receive a response by the time of publication.

‘Appalling condition’

There are currently about 42,000 doctors in Nigeria, Africa’s most populous country with more than 210 million people. Of the doctors, 16,000 are resident doctors who participate in the strike organised by the National Association of Resident Doctors (NARD).

Those doctors, who are pivotal to the country’s front-line healthcare, have long complained of being ill-equipped, overworked and underfunded. Some of them, even in metropolises such as Lagos and Abuja, have not received their salaries for months.

“There was a time within this year that I was owed three months of salary; some of my colleagues are still being owed some of their salaries,” said *Samihana Mustafa, a doctor in central Nasarawa state.

This year, the government has reportedly allocated just 4 percent of the entire budget for the health ministry, leaving already crumbling public hospitals due to chronic underfunding under a lot of strain.

Mustafa said the system was in an “appalling condition” as people die in the hospitals because of “avoidable causes”.

“I once had to refer a patient that was presented with severe hematemesis (vomiting blood) to another hospital, as the endoscopy machine wasn’t functional. Sadly, the patient died on the way”, Mustafa added.

Zubaida shared the same experiences. “After doing everything you can and the patient passes away, you get so discouraged from saving others knowing if the system was fair, such a patient could have been saved,” Zubaida said.

The ruling elite and wealthy Nigerians travel abroad to seek medical services, spending an estimated $2bn annually on medical tourism.

President Muhammadu Buhari, 78, recently faced criticism as he returned from London following a regular medical checkup while doctors were on strike. Nigerian media reported that Buhari has spent 200 days in total for official medical trips in London since he came to power in May 2015.

“What the ruling elite forget is that they may have medical emergencies and have to depend on the weak health system,” said Dr Ifeanyi Nsofor, Senior New Voices Fellow at the Aspen Institute. “It is in the best interest of everyone – rich or poor, for the system to work.”

‘Love-hate relationship’

Against this background, thousands of Nigerian doctors have moved abroad in recent years for better salaries and working conditions. Last month, in the midst of the latest strike, hundreds of Nigerian doctors participated in a recruitment exercise in an attempt to work in Saudi Arabia – though only seven positions were available.

According to a 2018 survey by Nigeria Health Watch, 88 percent of doctors are actively seeking opportunities abroad. Almost half of the respondents said they have between five to 15 friends and colleagues working in the medical profession who had moved out of the country within the last two years.

Najah Nuhu moved to the United Kingdom in 2019. She said she has had “a love-hate relationship” with the system during her time working as a doctor in Nigeria.

“The love part of it obviously comes from wanting to help out the people of your community because actually the country and the community did invest in you in a lot of ways,” Nuhu said. “The hate part is the failed system in which you always feel like your hands are tied. You want to help but you can’t because somehow the service, the facility is not available.”

Back in Owerri, Nwaeze struggles to move on following the death of his mother.

“If there’s a quality health system in Nigeria … If that strike didn’t happen, my mum would have been alive today. So many ‘ifs’. which obviously won’t still bring back my mum,” he said.

“It’s hurting but there’s nothing I can do, my mum is lying lifeless in the mortuary.”

*Names marked with asterisks have been changed to protect the identity of those who spoke to Al Jazeera on condition of anonymity.