BY RITA OYIBOKA
It began with a faint feeling of unease.
Dr Femi Rotifa, a young resident doctor at the Rivers State University Teaching Hospital (RSUTH), had just finished his regular shift when fatigue began to set in. He told his superior that he wasn’t feeling well and needed to rest. But that simple request fell on deaf ears.
The hospital was short-staffed, just like many, if not most, other hospitals in the country, and there was no one else to take over. So, Femi stayed. He worked until his body could no longer take it. Hours later, he collapsed in the call room. By the time his colleagues tried to rush him to the Intensive Care Unit, he was gone. He reportedly collapsed and died after a gruelling 72-hour call duty.
It was there that he slumped and later died, despite efforts to resuscitate him in the Intensive Care Unit.
The 28-year-old’s death was not from an accident or a violent attack. It was from something far quieter but deadlier, exhaustion.
Medical experts later suggested that malaria and extreme fatigue played a role, but among doctors, the verdict was unanimous: the system killed him. His friends, colleagues, and former classmates from the University of Port Harcourt Medical School mourned him online. Many said they were not surprised. They’d seen this happen before.
Across Nigeria, these tragic stories have become alarmingly frequent: doctors collapsing on duty, dying quietly in hospital call rooms, or breaking down mentally under impossible pressure. The problem isn’t isolated; it is systemic, pervasive, and worsening.
A System on the Brink
Nigeria’s health system is on its knees, and its doctors are paying the price.
The Nigerian Association of Resident Doctors (NARD), which represents over 10,000 resident doctors nationwide, recently released a damning statistic: as of early October 2025, the doctor-to-patient ratio in Nigeria has deteriorated to one doctor for every 9,083 patients. The World Health Organisation recommends one doctor for every 600 patients. By that standard, Nigeria is not merely below the mark; it is in a crisis of catastrophic proportions.
This shortage is driven by a mass exodus of health professionals seeking greener pastures abroad. Every week, at least 50 doctors leave the country, citing poor pay, insecurity, and crushing workloads. Those left behind face impossible odds, covering shifts meant for five people, performing surgeries back-to-back without sleep, and attending to over 70 patients in a single day.
Hospitals that should have teams of specialists now operate with skeletal staff. A single doctor might manage an entire ward, attend to multiple emergency cases, and remain on call throughout the night. In some cases, doctors are not just overworked; they are exploited, compelled by senior consultants to keep working through exhaustion because “patients must be attended to.”
A 2024 study of Nigerian resident doctors showed that they work an average of 106.5 hours per week, more than double the European Union limit of 48 hours. Surgical residents work even longer, averaging 122 hours weekly. The result? Burnout, errors, depression, and deaths.
It is little wonder, then, that the FCT chapter of the NARD raised the alarm in August, warning that many of their members, like countless others across the country, are now physically broken and mentally fraying under the strain.
Some, they revealed, have resorted to antidepressants and anxiety medication just to make it through another day in the hospital. Think about that: the very people entrusted with preserving life now rely on pills to stay sane, to stay functional, to stay alive. It has become normalised madness, a health sector so stretched that doctors must harm themselves to keep saving others.
NARD Sounds the Alarm
In recent months, the Nigerian Association of Resident Doctors has been relentless in calling out the Federal Government’s neglect of the medical sector.
From strikes to ultimatums, the association has made it clear: doctors are not slaves.
In a statement on October 3, 2025, NARD President, Dr Mohammed Suleiman, declared, “Enough is enough, doctors are not slaves. Overwork is killing us, and the system is breaking.” He warned that continued neglect would push the health sector into complete collapse.
By October 7, he reiterated that “tired doctors make mistakes,” emphasising that the burnout was real and the workload unbearable. NARD instructed its members to stop continuous calls beyond 24 hours, an attempt to protect them from fatal exhaustion. But enforcing that directive in hospitals already crippled by shortages is nearly impossible.
In another statement posted on X on October 20, NARD lamented: “In our hospitals, just two doctors now attend to nearly 70 patients in a single clinic. This isn’t sustainable. Our members remain overworked.”
These warnings are not new. For over a decade, NARD has battled the same cycle of broken promises: unpaid salaries, unimplemented agreements, and deteriorating working conditions. But the crisis has deepened in 2025, driven by economic hardship, insecurity, and the mass emigration of healthcare workers.
As of now, NARD’s 30-day ultimatum to the Federal Government, issued in late September, expires today, October 25, and tensions are high. The doctors have made 19 demands, including enforcing 24-hour call limits, paying salary arrears, and replacing emigrating doctors on a one-for-one basis. Yet, government response has been tepid, filled with “ongoing process” excuses that translate to inaction.
The Voices of the Overworked
Beyond official statements, the human side of the crisis is told through stories, real, raw, and painful.
Speaking with The Pointer, the Vice President of the Association of Resident Doctors (ARD) at the Asaba Specialist Hospital (ASH), Dr Harrison Ubini, painted a grim picture of the realities facing Nigerian doctors.
According to him, the situation has deteriorated rapidly due to the rising wave of brain drain in the health sector. “Doctors are leaving the country daily. If you check statistics of how many medical professionals migrate every day, it’s shocking. From my graduating class alone, nearly half have already left the country, and many of those still here are only waiting for employment opportunities abroad. This massive exodus puts an unbearable strain on those of us left behind,” he explained.
“Not everyone wants to leave, to be fair. Some of us genuinely want to remain in Nigeria, complete our residency, become consultants, and contribute meaningfully to society. But the workload is crushing, and the pay does not match the effort. When you consider the level of stress and compare it with the monthly salary, it’s nothing to write home about. Even Physician Assistants abroad are better off financially,” he added.
Dr Ubini described the irony of being a “Chief” resident doctor, a title that carries weight but little reward. “Here, a resident doctor doing specialist training is called ‘Chief’ and expected to perform miracles, yet takes home a pittance,” he said.
At the teaching hospital where he works, the burden is even heavier. “We’re a referral centre. Many rural health centres have no doctors, some are manned only by midwives. So, when complications arise or cases are mismanaged, the patients are referred to us, often after travelling two hours or more. Most of the mortality cases we record in my centre are referred patients, not those initially managed by us. Many of these deaths could have been avoided if doctors were available at the primary or general hospitals to perform basic procedures like a simple caesarean section.”
He compared the situation to the old saying, “A hungry man is an angry man,” noting that the same could be said of an overworked doctor. “Personally, I work Monday to Friday, closing around 4 p.m. Twice a week, I also do 24-hour calls. So, if I start a shift on Monday morning, I don’t close until Tuesday evening. In developed societies, after such a 24-hour call, doctors get the next day off. But here, I’m expected to resume work again by 8 a.m. on Wednesday,” he explained.
As a resident doctor in Obstetrics and Gynaecology, Dr Ubini said his department bears one of the heaviest workloads, particularly due to Delta State’s free maternal care policy. “During call duty, there’s no rest, you’re constantly attending to patients in labour, monitoring them, handling emergencies, performing surgeries, and more. On weekends, it’s even worse. I sometimes start a shift on Saturday morning at 8 a.m. and close on Monday evening at 4 p.m. That’s nearly 57 hours of non-stop work, after which I still resume on Tuesday morning.
“On clinic days, we attend to no fewer than 100 patients. There’s simply no time to engage patients properly or discuss their conditions in detail. You just go straight to the point to save time, energy, and stress. Consequently, the patients don’t always receive optimal care, not out of negligence, but because the few doctors available are completely stretched thin. The workload drains you mentally and physically.
“If, at least, the pay were fair, it might compensate for the stress, but it isn’t. The average rent for a doctor in this area is between ₦1.2 million and ₦1.5 million per year, which amounts to about four or five months’ salary. That’s why I said earlier, ‘a hungry man is an angry man.’ A doctor who’s exhausted and financially strained can’t possibly remain cheerful or give their best. Meanwhile, as residents, we still have to study and prepare for our exams. Residency is both training and academics, you’re learning and reading simultaneously. But when you’re this drained, you can hardly concentrate or give your best.”
According to Dr Ubini, government response to these long-standing concerns has been largely dismissive. “Honestly, from experience, the government hardly ever takes such warnings seriously. Some people in leadership positions even trivialise our struggles. I recall a senior government official once saying we should be ‘grateful’ to have as many doctors as we do, implying we’re privileged to even be working.
“It’s a disturbing mindset. Many of these leaders endured similar conditions in their time, so they think it’s normal. They glorify the suffering rather than fix it. Unless the government genuinely engages with us and meets our basic demands, like improved salaries, allowances, and welfare, a strike is inevitable. We had a warning strike about two months ago, but nothing meaningful has changed. NARD is determined this time. If the government refuses to meet our needs, we may have no choice but to down tools again.”
Dr Ubini clarified that Nigerian doctors are not seeking luxury but fairness and dignity. “The truth is, doctors are not asking for luxury, we’re asking for fairness and dignity. Look at the UK or other countries, they pay doctors well because their governments prioritise healthcare. If Nigeria did the same, many of us would gladly stay. We love our country, but love doesn’t pay bills. If Nigeria treated health workers properly, people wouldn’t migrate. In some countries, doctors are given staff quarters, reducing the burden of rent. Here, we’re left to struggle on our own. Even the so-called ‘Medical Training Fund’ that’s meant to support us isn’t enough to cover the cost of travel, accommodation, and course fees. The system simply isn’t ready for us yet.
“That said, we’re open to dialogue. If the government genuinely listens and acts, we’ll call off the strike. But as it stands, we’re meeting tomorrow with NARD’s National Executive Council to decide the next steps, and the mood among members suggests industrial action is likely.”
According to a resident doctor of Uyo Teaching Hospital, who only identified as Dr Ebinne, “Doctors in hospitals are overworked because most people don’t want to do residency. People don’t want to do a residency because they don’t want to be overworked. It’s a vicious cycle, and every time something happens, we address the complications of it rather than the root cause.”
He continued, “Not wanting to be overworked is just the tip of the iceberg. What sits pretty beneath that tip is the desire for a better life, better pay, and job satisfaction, and that’s what drives the exodus we have now. The ripple effect is what we’re experiencing in tertiary facilities.”
For him, the solution lies in overhauling the system completely, starting from the medical schools. “Doctors doing residency shouldn’t be overworked simply because fewer people are residents. They should employ medical officers who can work at par or open the roles for locum staff. That’s the right way things should be done. We need an overhaul of the whole system. Even from medical school, the foundation is faulty and needs fixing. People don’t want to do residency here in Nigeria because they’re overworked and grossly underpaid. One would think since there are fewer people in residency, the pay would be higher, but Nigeria is a hellish country with demonic leaders.”
He added, “If that department had enough registrars, it’d be easy to take time off. But in a department with four registrars, everyone is tired and poorly remunerated. There’s no hope. We’re in a loop that only proper planning and increased remuneration can break.”
Similarly, Dr Kennedy. I, a public health practitioner in Ibadan, shared my recent experience visiting a private hospital. “The owner of the facility complained bitterly about being overworked due to a lack of available medical doctors. According to him, he’s losing about three doctors every month to japa,” he said.
He noted that the situation cuts across both private and government hospitals. “This is a specialist hospital that pays more than a government one. My advice to Nigerians to take their health seriously, don’t douse your innards with concoction, do annual physicals, don’t cross the road like a stunt man because we have no more doctors in Nigeria,” he said.
Also speaking, a doctor who preferred to remain anonymous, who described a worsening situation in his hospital. “My hospital has unfilled junior doctor shifts that they’ve given to a Physician Assistant (PA). This is the same shift I am on call for, so instead of splitting the workload, over 70 patients, between two doctors, it will now be between the PA and me.”
He explained that the new arrangement not only increases his workload but also puts his medical license at risk. “This is only going to increase the workload for me because I will have to prescribe for them, and I cannot trust their assessment blindly because it’s my license on the line. The hospital is using this to push back any resistance to the unfilled shifts by saying, ‘Well, you have a PA to help.’ But I’ll still bear the brunt of having to double-check everything they do.”
Frustrated, he added, “This is literally the definition of replacing doctors with PAs, because the hospital won’t escalate locum rates to find a doctor to fill the shift. During this shift, the PA should be going to the consultant with any questions or prescriptions, but I know it will ultimately fall to me. I don’t want to be seen as causing problems if I refuse to do their jobs for them. It’s become completely hopeless — I, the doctor, will be acting as their assistant, with the responsibility for their actions ultimately lying with me if I choose to follow their advice without seeing the patient myself.”
Why Nigeria’s Health Sector Keeps Failing Its Doctors
To understand how things got this bad, one must look at the foundations.
Nigeria allocates just 4–5 per cent of its national budget to health, far below the 15 per cent target set by the 2001 Abuja Declaration. This chronic underfunding means hospitals lack staff, equipment, and incentives. In many facilities, doctors must buy their own basic tools or rely on outdated machines that break mid-surgery.
An entry-level doctor in a government hospital earns the equivalent of $300 to $400 a month, barely enough to survive, let alone support a family. In contrast, the same doctor could earn over $7,000 monthly in the UK or $10,000 in Canada. The result is a continuous “Japa” wave, the migration of skilled professionals seeking survival abroad.
As one NARD executive put it, “The government trains us, but other countries harvest the benefits. Nigeria is funding foreign healthcare systems by driving its own doctors away.”
The ripple effect is devastating. With fewer doctors available, those remaining are stretched beyond human limits. Patient waiting times skyrocket. Surgical backlogs grow. Mothers die during childbirth due to a lack of specialists. Nigeria already accounts for 10 per cent of global under-five deaths despite representing just 2.4 per cent of the world’s population. It’s not because diseases here are deadlier; it’s because care is simply unavailable.
The vicious cycle is self-perpetuating: underfunding leads to overwork, overwork leads to burnout and mistakes, mistakes lead to emigration, and emigration worsens the shortage. The system devours itself.
The World Works Less, But Earns More
Globally, regulations limit how long doctors can work to ensure both patient safety and practitioner health.
In the United States, medical residents are capped at 80 hours per week, averaged over four weeks. In the European Union, the cap is even stricter, 48 hours a week. Any hospital that violates this faces penalties. In contrast, Nigerian doctors regularly cross 100-hour weeks without rest, without penalty, and without extra pay.
Physician density tells the same story.
While countries like Germany boast 42 doctors per 10,000 people, and the United States maintains 26, Nigeria struggles with 3.9 per 10,000. That’s about one doctor for 9,083 Nigerians, a number that keeps worsening as more doctors emigrate. In comparison, even low-middle-income countries like India and Brazil fare better.
Burnout rates also paint a grim picture. Globally, about 40–50 per cent of doctors report some form of burnout. In Nigeria, the rate is over 80 per cent among resident doctors. Half report poor sleep quality, and a significant number develop chronic illnesses related to stress and fatigue.
The difference isn’t just in numbers, it’s in values. Other nations protect their doctors with enforceable labour laws and welfare systems. Nigeria leaves her to die on the job.
The NARD Ultimatum: “Enough is Enough”
The ongoing face-off between NARD and the Federal Government epitomises the crisis. The doctors’ demands are not unreasonable; they are, in fact, basic. They want regular payment of salaries, prompt replacement of emigrating staff, hazard allowances, fair promotion, and recognition of postgraduate medical qualifications.
But even these modest requests have become battlefronts.
In September 2025, NARD staged a five-day warning strike after months of unfulfilled promises. Hospitals across the country were crippled. The strike was later suspended after partial concessions, but the doctors returned to work without any real change.
By late September, at its Annual General Meeting in Katsina, NARD issued a 30-day ultimatum listing 19 unresolved issues. Among them were the need for the enforcement of 24-hour call limits, restoration of downgraded salaries, and immediate replacement of doctors lost to the “Japa” syndrome.
The tone of the ultimatum was unmistakable: “Doctors are not slaves.”
With that deadline terminating today, tension hangs thick in the air. The government has yet to meet most of the demands. NARD leaders have hinted at another nationwide strike, a move that could paralyse the health system completely. Yet, for the doctors, it’s not about disruption; it’s about survival.
Possible Way Out: What Can Be Done
Experts argue that Nigeria’s healthcare crisis is reversible, but only with political will and decisive action.
First, recruitment and replacement must be made immediately and automatically. Each time a doctor resigns or leaves the country, another should be hired without bureaucratic delay. This “one-for-one replacement policy” is one of NARD’s strongest demands.
Second, working hours must be regulated. A 24-hour call limit, as NARD proposes, would align Nigeria with international best practices and reduce the risk of fatigue-related deaths.
Third, the health budget must increase. The Abuja Declaration target of 15 per cent of the national budget for health must be revived and implemented, not merely mentioned in political speeches. Without adequate funding, hospitals will remain empty shells.
Fourth, incentives for retention, like housing, hazard allowances, and tax waivers, should be introduced. Doctors need to see reasons to stay. Countries like South Africa and India have implemented retention bonuses and rural posting benefits with measurable success.
Finally, the government must restore trust. Many doctors no longer believe in promises. What they need are actions, visible, consistent, and fair.
For now, the health system limps on, hollowed out and exhausted. The few who still show up every morning do so out of a sense of duty, not because the system deserves their sacrifice.
A society that watches its healers die from exhaustion is a society in decline. It is immoral to expect compassion from people who are constantly drained, underpaid, and ignored. Nigeria’s doctors have given their all, some, literally, their lives.
It is time the country gives something back.
Because if the doctors all collapse, who will be left to save the rest of us?
