LAGOS, Nigeria (AP) — Dr. Olaniyi Olaoye and the other resident doctors at the Ekiti State University Teaching Hospital in Nigeria haven't been paid at all for five months.

Since the pandemic began, there have been many months when they've only received 60% of their salaries, bringing at least six of them to resign.

Now Olaoye and some 19,000 other doctors across Africa's most populous nation are on strike for the fourth time since the pandemic began, leaving government-run hospitals and COVID-19 treatment centers short-staffed.

The latest work stoppage comes as Nigeria confronts an avalanche of new COVID-19 cases blamed on the delta variant first detected here in early July.

Doctors who are lucky have wives who work and are depending on their income, he said. "Life is difficult for those who are not," he said.

Already Nigerian media outlets are reporting that patients — some with COVID-19 symptoms — are being turned away at short-staffed hospitals. Other patients have been discharged into the streets or left to languish in hospital beds without being diagnosed or receiving treatment.

At the Lagos University Teaching Hospital, The Associated Press witnessed two patients turned away shortly after they arrived at the emergency room last week.

“We cannot admit — resident doctors are on strike," a doctor on duty was overheard telling one of the patients. "When they call off the strike, you come back.”

Uyilawa Okhuaihesuyi, president of the National Association of Resident Doctors, said the federal health ministry has sent him a letter warning that the country's 19,000 medical residents don't have the right to strike.

“Imagine a doctor not paid for 16 months in some states,” Okhuaihesuyi told The Associated Press. "How does he even provide food for his family?”

Nigerian Health Minister Dr. Osagie Ehanire and the Federal Ministry of Health both declined to comment and said a briefing would be held at a later date.

The strike is the fourth work stoppage by medical residents since the pandemic began, the longest of which lasted 10 days.

While the current work stoppage does not affect specialist doctors or nurses, medical residents make up the bulk of health care workers at government hospitals throughout Nigeria, and they also staff most of the government-run treatment facilities for COVID-19.

The striking doctors worry about their patients but place the blame on the federal government, saying it failed to honor an earlier agreement reached after the last strike in April.

“We don’t get paid enough for what we do; we have a diminished workforce, a lot of people are overworked," said Egbekun Ethel, a resident doctor at the Lagos Orthopedic hospital where patients were discharged into the streets to wait for the strike's end. “And it is not only the resident doctors who are disgruntled — the entire health sector is.”

For her, it has been a “vicious cycle" of always returning to work with “little or no rest" and a meager salary.

Some resident doctors say they have not started to receive the reviewed monthly minimum wage of N30,000 ($73) for doctors, according to the association that represents them.

Nigeria's health minister has said that he is "committed' to getting the resident doctors back to work, though he has said that most of their demands are issues to be solved by state governments, not his ministry.

Nigeria's public health sector has not been sufficiently funded for years despite the country having one of Africa's biggest economies, budget documents show.

In 2021, funding for the Federal Ministry of Health was only 4% of the entire budget, or 549.8 billion naira ($1.34 billion). An additional 70.2 billion naira ($171.6 million) was provided because of the pandemic but that allocation remains a fraction of the African Union's recommendation that governments spend an additional 15% for healthcare during the pandemic.

Critics, meanwhile, point to the vast disparity between the government hospitals treating most Nigerians and the medical care abroad that is available to the country's elite. Nigeria’s President Muhammadu Buhari has had at least 200 days of medical care in the United Kingdom since he was elected president in 2015.

“You cannot go to any hospital in the country that has all the basic infrastructure and adequate manpower to treat patients,” said Okhuaihesuyi. “That is why most people that are in government that have money do not want to receive treatment in Nigeria.”

Dr. Agwu Nnanna at the Federal Medical Center in Nigeria's Kogi state said his colleagues are trapped in “a very unfortunate situation.”

“A doctor needs to take care of himself adequately to be able to cater to his patients as well,” he said.

Copyright 2021 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed without permission.