In Gabon, a patient's situation cannot get any bleaker. While health care has been put on the hold and hospital staff are striking for higher pay in an agitation that started on January 12, now even minimal medical service is no longer guaranteed.
"Closed - we're on strike," reads the sign on the door to the gynaecological emergency ward at the central hospital in the capital Libreville, neatly summing up the situation.
"Today, a Gabonese cannot get treatment," said Apollinaire Moukila, communications adviser to Health Minister Idriss Ngari. "People are perhaps going to die for problems which could have been treated."
Libreville hospital is nearly deserted, and the few employees inside prefer not to give their names. "Medical staff are not here," one of them said. "We're not taking any admissions."
In the pediatrics department, the mood is strange. "It's crazy," complained a mother whose son has malaria. "There's a nurse and a doctor here who came out of the goodness of their heart, but my son is not getting normal care."
Over at Jeanne Ebori hospital, minimal service is available, but staff who are present are reluctant to talk. "To do so is risky," one nurse said.
Hospital staff in Gabon - a West African republic of 1.4 million, where the risk of infectious disease is very high and 8.1 percent of adults have HIV-AIDS - want better pay, and better means for treating patients.
Health care in Gabon is peculiar: there is a network of public health hospitals run by the health ministry, and another group of hospitals run by the social security service, whose employees come under the labour ministry.
Both are on strike at the same time, on the heels of a national teachers' strike that dragged on for several months before pay increases were agreed.
"There is not a social security problem and a public health problem," said Serghes Mickala Moundanga of the National Union of Health Workers (SYNAPS). "It is a health problem for all Gabonese."
"The sector has been ignored for many years and staff are badly paid," with the average monthly salary hovering at 150,000 CFA francs (225 euros, 290 dollars) a month.
SYNAPS wants to see a monthly provision for hospital workers of 200,000 CFA francs plus a "motivation" bonus of 60,000 to 80,000 CFA francs.
"The health sector has been allowed to go downhill," said Sylvie Nkogue-Mbot of the Hippocrates union and a doctor at the Owendo pediatrics hospital in Libreville.
"To think that 15 or 20 years ago, we had hospitals famous in Africa. Today, operating theatres are run down. We lack supplies even for the most simple things - no thermometers, no cotton wool for injections."
"If a child comes in convulsing, there are no drugs to treat him. People are dying today because hospitals no longer have the means to care for them."
Mickala Moundanga recalled that, at Libreville hospital, a specialist section dealing with internal matters such as hernias and ulcers has been closed for two years.
"If you have a problem with your foot, you can get it treated," he said. "If you have a visceral issue, you are told: 'Sorry, we cannot'."