ABUJA (AL JAZEERA) - In March, hundreds of Nigerian doctors gathered at a hotel in Abuja, the capital, and another in Lagos, the country's commercial centre, to take a test conducted by the Saudi Arabian health ministry.
In a symbol of the Nigerian medical "brain drain", those yet to migrate must complete foreign exams in order to get work placements abroad.
Weeks before the attempt by Saudi Arabia to lure Nigeria's greatest medical talents, dozens had sat the regular Professional Linguistic Assessments Board (PLAB) exams at the British Council. Once they pass, it will enable them to work in the UK.
According to some estimates, about 2,000 doctors have left Nigeria over the past few years.
Doctors have blamed the mass exit on poor working conditions - only four percent of Nigeria's budget is allocated to health.
While the annual healthcare threshold per person in the US is $10,000, in Nigeria it is just $6.
"More than half of those seeking visas to [India] are going for medical care that is not available here in Nigeria. Indigent Nigerians would be at the mercy of the dilapidated health infrastructure," Onwufor Uche, consultant and director of the Gynae Care Research and Cancer Foundation in Abuja, told Al Jazeera.
"It has become worse; a doctor [in Nigeria] earns N200,000 monthly ($560), necessitating moving to countries where they can be better paid for their services … This ultimately means that eight of 10 Nigerians are presently receiving substandard or no medical care at all."
Middle-class and wealthy Nigerians often travel for healthcare. Even the septuagenarian Nigerian president, Muhammadu Buhari, seeks medical care in London.
British, American, South African, Emirati and Saudi Arabian agencies operate in Nigeria to recruit the best doctors.
Nigeria's polling agency, NOI Polls, in partnership with Nigerian Health Watch in 2017, found that most doctors seek work abroad.
"The trend of doctors emigrating to other countries is at an all-time high," Chike Nwangwu, head of NOIPolls, told Al Jazeera in Abuja. "Our survey … showed that 88 percent of doctors are considering work opportunities abroad."
Reasons for emigrating include better facilities and work environment, higher salaries, career progression and an improved quality of life.
One doctor in 5,000
Medical schools and residencies are subsidised by government funds, an investment that is now benefiting other countries.
With an estimated population of over 180 million, there is one doctor per 5,000 people in Nigeria, according to Isaac Folorunso Adewole, the health minister, compared with the World Health Organization (WHO) recommendation of one per 600 people.
There are 72,000 doctors registered with the Medical and Dental Council of Nigeria (MDCN); over half practise outside the country.
"Nine in every 10 doctors are considering work opportunities outside Nigeria. And it is projected to keep rising as doctors continue to face systemic challenges," said NOIPolls' Nwangwu. "I actually think [Nigeria] is already at the state of emergency with the availability of medical doctors."
The country's worsening health sector also grapples with strikes by health workers.
The government is often in conflict with the Nigerian Medical Association, an umbrella union of doctors, over working conditions. The union argues that government officials fail to stick to agreements, leading to industrial action.
When asked last year why Nigerian doctors had to wait a long time to get residency training, Adewole appeared to make light of the issue, saying: "It might sound selfish, but we can't all be specialists; we can't. Some will be farmers; some will be politicians … The man who sews my gown is a doctor. He makes the best gown. And some will be specialists, some will be GPs, some will be farmers."
As well as angering some doctors, the apparent failure to act seriously also affects patients.
"The government needs to urgently start addressing the issues and concerns of the medical workers and especially the doctors. The truth is, most of these doctors leave for better working conditions and you can't blame them," said Mariam Abdullahi, a 38-year-old patient at a hospital in Abuja.
"I am being referred to strange faces and different doctors almost at each of my bi-monthly visits and I'm always told the last doctor left the country. As a patient I feel heartbroken anytime my doctors leave, but what can I do when the system treats them poorly?"