As doctors, nurses and pharmacists flee for their lives from brutal violence unleashed by Islamist Boko Haram militants, healthcare services have collapsed in the northern part of Nigeria's Borno state.
Medical professionals say health services in the region have largely shut down, with mortality rates and vaccination programmes severely hit and pressure heaped on the skeleton staff that remain.
Advertisement"The whole healthcare system in northern Borno has collapsed and healthcare delivery is nil," said Musa Babakura, a surgeon at the University of Maiduguri Teaching Hospital (UMTH).
Babakura said the situation was a "growing health crisis", with the sick forced to trek vasts distances to receive medical attention and vaccination programmes for children compromised.
Violence by Boko Haram militants has raged since 2009, but has been particularly ferocious in recent weeks, with some 500 people killed in suspected Islamist attacks since the start of the year.
Worst hit by militant attacks are villages in remote, rural areas near Borno's border with Cameroon, despite an increased military presence in the state.
Hospitals and clinics have not escaped raids, even after Nigeria's government imposed emergency rule on Borno and two other northeastern states in May last year.
Medical personnel have been kidnapped, either for ransom or to treat wounded fighters in Boko Haram's ranks, while pharmacies -- mostly run by Christians -- have faced armed robberies and looting.
- Vaccination programmes attacked -
The insecurity has forced local people to cross into neighbouring Cameroon in search of treatment, with pregnant women and the infirm using donkeys and auto-rickshaws to negotiate the difficult terrain.
The gruelling trek takes its toll, said Modu Faltaye, a local chief in Wulgo, on the shores of Lake Chad.
"By the time the sick reach the hospital (in Cameroon), they are in a worse state, which is why we lose a lot of our sick," he said.
"Naturally, the rate of maternal and infant mortality is bound to rise in the area as a result of complications arising from poor transportation facilities to hospital," added Babakura.
Nigeria is one of only three countries in the world -- along with Afghanistan and Pakistan -- where polio is endemic but violence against immunisation workers have affected programmes.
At least nine people were killed in February last year, when gunmen stormed two vaccination clinics in the northern city of Kano, hampering efforts to inoculate children against the virus.
In 2013, there were 53 recorded cases of polio in Nigeria, the Global Polio Eradication Initiative said.
Just over half were in Borno and neighbouring Yobe, which is also under emergency rule and suffering from Boko Haram attacks.
One Borno immunisation official said childhood jabs were now only given in the state capital, Maiduguri, because vaccinators were afraid to travel to many parts of the state.
In Baga, a fishing village near Lake Chad, a suspected cerebral fever has killed scores of people since December last year but residents have been unable to seek treatment.
"People are dying like fowls," said local man Husseini Goni.
- Pressure on staff -
Difficulties in delivering drugs to violence-affected areas and the closure of pharmacies have increased costs of medication by as much as 35 percent, local people say.
Hospital treatment in Cameroon is also more expensive than in Nigeria, according to doctors and nurses.
But the closure of healthcare facilities in rural areas has added pressure on those who remain, with hospitals in Maiduguri having to take the strain, despite staff shortages.
Two of the hospital's three orthopaedic surgeons have quit, said doctor Kabiru Ibrahim.
A number of senior specialists are either on leave of absence or sabbatical pending an end to the violence, he added.
"Patients with special ailments like HIV, diabetic and hypertensive patients need to access drugs at regular intervals and those drugs can only be found in Maiduguri," said Ibrahim.
"But these types of patients are sometimes denied the chance to come and take their drugs due to Boko Haram carrying out highway attacks."
Babakura said hospitals such as the UMTH were now forced to provide treatment that would ordinarily be given at primary care level.
"(Closures have) substantially increased the patient burden on us, which makes us work longer hours that could compromise efficiency," he added.