With infections passing the 600,000 mark, strikes and walkouts by health care workers have taken place across Africa over the shortage of personal protective equipment (PPE) and a lack of medical resources to combat COVID-19.

Health care systems are buckling due to government underfunding and corruption.

Although the number of coronavirus cases appears comparatively low, the disease is spreading rapidly. The number of infections is now in excess of 663,107, with South Africa recording 324,221 cases and 4,669 deaths, Egypt 84,843 cases and 4,067 deaths, Nigeria 34,259 cases and 760 deaths, Ghana 26,125 cases and 139 deaths, Algeria 21,355 cases and 1,052 deaths, Morocco 16,545 cases and 263 deaths, and Cameroon 15,173 cases and 359 deaths.

From the onset of the pandemic, health care workers sounded the alarm over the lack of staff and beds, as well as ventilators and ICU beds.

Wide swathes of the continent have virtually no public health infrastructure to cope with the pandemic, making it certain that the number of infections is much higher than official reports indicate. Even under “normal” conditions, World Bank figures show that Africa requires 25 percent of global health care spending but has resources comparable to just 1 percent of worldwide health budgets. Although the African Union members committed at the turn of the century to spend 15 percent of their budgets on health care, two decades later hardly any country has made it past 10 percent, and many remain well below this utterly inadequate figure.

There are on average just five hospital beds per 1 million inhabitants in Africa, compared to 4,000 in Europe. Malawi has just 25 intensive care beds for 17 million inhabitants, while Zimbabwe’s main hospital in Harare has none. Even in comparatively well-developed South Africa, there are just 0.9 physicians per 1,000 inhabitants, well below European and American averages.

A total of 10 out of Africa’s 55 countries have no ventilators, while many others have a handful of units. There are just four ventilators in South Sudan (population 11 million), three in the Central African Republic (population 5 million), and six in Liberia (population 5 million).

The absence of effective public health infrastructure, the lack of testing facilities and the terrible social conditions mean that the official COVID-19 figures grossly underestimate the spread of the disease, especially among the working class and poor. The World Health Organisation (WHO) has warned that up to 10 million people will be infected over the next three to six months and 300,000 people will die on the African continent. And that is based on the assumption that the authorities put in place some mitigation measures. If mitigation measures are not taken, the WHO warns deaths could rise into the millions.

With little in the way of health care for any other than the most privileged layers, most African governments moved swiftly to impose lockdowns and curfews, often imposed with brute force by the police and in South Africa by the military. They have caused severe hardship and economic distress, threatening millions with starvation under conditions where there is no social safety net.

According to a weeks-long BBC investigation into hospitals in South Africa, exhausted doctors and nurses have been overwhelmed by COVID-19 patients and the health service is near collapse. Bereft of resources and with many staff themselves sick, nurses are forced to act as cleaners, while surgeons wash their own hospital laundry.

There are reports of nurses at clinics where COVID-19 cases have occurred being forced to continue working while awaiting their test results, potentially infecting hundreds of their colleagues and patients.

It is under these conditions that health care workers across the continent are going on strike or threatening strike action, mounting protests to oppose a non-existent and inadequate health care system, unsafe working conditions and growing inequality.

While strikes have taken place in Kenya, Ghana and Sierra Leone, with protests in Lesotho and Malawi, South Africa has seen by far the largest number of strikes and walkouts, where the government plans to cut nurses’ wages as part of a broader plan to cut the public sector wage bill before turning to the IMF for a loan.

• In March, health care workers at Laetitia Bam Day Hospital in KwaNobuhle, Uitenhage, in the Eastern Cape, went on strike over the appalling state of the hospital after planned refurbishment was suspended. The $240 million refurbishments were to install air-cooling and ventilation systems necessary to stop the spread of disease.
• In Limpopo, nurses demanded the removal of the “incompetent” health minister, citing the shortage of nurses and midwives, dangerous working conditions, and the need to end casual labour.
• Nurses protesting the lack of safety equipment outside the Bongani Regional Hospital in Welkom, Free State, were shot by armed police using rubber bullets and stun grenades, resulting in two nurses being hospitalised.
• At Greys Hospital, Pietermaritzburg, management threatened to fire ambulance workers for refusing to attend a COVID-19 infected patient on March 23 without PPE, then served them with letters informing them of disciplinary hearings.
• In Port Elizabeth, nurses at Veeplaas Clinic stopped work after a colleague tested positive, while at Dora Nginza Hospital in Zwide Township, nurses walked out in protest over the lack of PPE and demanded the hospital be closed and deep cleaned.
• In the Eastern Cape, Glen Grey hospital nurses refused to treat 16 patients because they were not provided with PPE.
• In May, numerous demonstrations and walkouts took place over the lack of PPE and dreadful working conditions, including demonstrations by nurses at the Chris Hani Baragwanath Hospital in Soweto and paramedics in the Emergency Medical Services at Khayelitsha District Hospital in Cape Town, and a walkout by doctors and nurses at the Mpilisweni Hospital in Sterkspruit, Eastern Cape, the second such action over the lack of PPE, with doctors threatening to quit their jobs because they were not being provided with financial assistance for housing as promised.
• In June, in Cape Town, nurses picketed outside the Tygerberg Hospital over unsafe working conditions, community health workers at a hospital in Khayelitsha took action demanding PPE, and health care workers protested outside the city’s False Bay Hospital holding up signs saying, “Protect us so we can protect patients” and “The workload is killing us.” There was a one-day nationwide stoppage by 28,000 community health care workers over the issue.
• In July, health care workers at the Albert Luthuli Central Hospital in Durban demonstrated after more than 100 tested positive for COVID-19, calling for PPE, more staff, a danger allowance, and tests for all, and for a nursing manager to be removed.

Nigeria has seen walkouts by health care workers, including:

• A strike begun at Olabisi Onabanjo University Teaching Hospital in Ogun state by doctors demanding a new minimum wage, hazard allowance and insurance policy that has broadened out into an indefinite strike over government’s failure to fulfil promises on pay arrears and working conditions.
• In Cross River State, doctors went on indefinite strike to oppose the government’s inaction over the coronavirus pandemic.
• In Ekiti State, health care workers went on a three-day warning strike beginning July 6 and July 8 over the failure to implement uniform and hazard allowances.

Zimbabwe has witnessed:

• Strikes by health care workers over the extreme shortage of PPE and the lack of necessary medical equipment to combat the pandemic in public hospitals.
• Demonstrations in March by nurses at Mpilo hospital in Bulawayo over the dreadful working conditions.
• A walkout by the Zimbabwe Hospital Doctors Association over the lack of PPE.
•  wildcat strike by nurses at Beatrice Road Infectious Diseases Hospital over the government’s failure to provide the promised PPE and Z$100-a-day allowance.
•  nationwide and ongoing walkout by doctors and nurses since June over pay, working conditions and the lack of PPE as inflation continued to soar and the currency collapsed against the dollar.
• The arrest of 13 striking workers at the Sally Mugabe Central Hospital in Harare on July 6, as part of the government’s campaign to intimidate nurses, leading to more nurses joining the protests.