The hospital where Warren George worked as a nurse in Zimbabwe was so short of basic supplies, like plaster, that he could not make casts to treat people with broken bones. He soon sought to join the exodus of more than 4,000 nurses who have fled the southern African nation in the past two years.
But the government has refused to give him and many others the documents they would need to work in, say, Britain or Canada. He says that he now earns only about $500 a month as a traveling nurse and has to pick up extra shifts on his days off to ensure his family has enough to eat.
Zimbabweans are scheduled to go to the polls on Wednesday in only the second election since Robert Mugabe, the liberation leader turned strongman president, was ousted in a coup.
The vote amounts to a referendum on President Emmerson Mnangagwa, who is seeking a second term after, critics say, failing to steady the economy or stop the flight of workers, including a crippling “brain drain” of educated professionals. The departure of nurses and doctors has increased since the Covid pandemic, contributing to a widespread shortage of health workers on the African continent.
Triple-digit inflation has become the norm — it spiked to 176 percent in June. The country is $18 billion in debt and cannot get international loans because of political instability. Jobs are sparse, with economists estimating that 90 percent of work is informal.
“Everyone you meet in the streets, they are desperate to leave the country,” said Dr. Norman Matara, head of the Zimbabwe Association of Doctors for Human Rights, an advocacy organization.
“Some of our colleagues have gone outside — you see them doing well in South Africa, in the U.K., in Canada,” he added. “You get the motivation to also leave because, honestly, we are just wasting our time.”
This election, like past ones, is taking place in a jittery environment with fears of violence and of vote-rigging in favor of ZANU-PF, the party of Mr. Mnangagwa, which has governed Zimbabwe since independence in 1980.
Mr. Mnangagwa came to power through a coup in 2017 that unseated Mr. Mugabe, who became increasingly autocratic during his nearly four decades in power. In the 2018 election, Mr. Mnangagwa eked out a victory, winning 50.8 percent of the vote over his closest rival, Nelson Chamisa, who is now president of the main opposition party, the Citizens Coalition for Change.
This election is a rematch, and while polls suggest a tight race, many international and domestic observers doubt that the election will be free and fair.
“It’s history repeating itself, except that ZANU-PF has perfected the system of rigging,” said Ibbo Mandaza, a political analyst in Harare, Zimbabwe’s capital, who runs an independent social-science think tank.
The police have shut down dozens of rallies of the Citizens Coalition for Change and arrested dozens of its supporters. A new law that could result in the death penalty for Zimbabweans deemed to have betrayed the national interest has made many fearful to share their views.
Even so, in surveys, Zimbabweans overwhelmingly say that they are dissatisfied with the direction of the country and the economy under Mr. Mnangagwa. If he prevails, political analysts say, there could be a surge in mass migration of Zimbabweans, straining other countries in the region — especially South Africa, where a struggling economy of its own has fueled violence against immigrants.
Many African countries are short on health workers, more than any other region. The continent produces about 150,000 trained medical workers a year, but one in three cannot get jobs because there is not enough money to fund positions, according to James Avoka Asamani, who leads the World Health Organization’s work force team for Africa.
The W.H.O. has identified 55 nations with critical shortages of health workers and suggests that foreign countries should not recruit from them. Thirty-seven of those nations are in Africa, including Zimbabwe, added this year, where the government estimates that the country will need at least an additional 69,000 medical workers by 2030.
When Angela Khulu, an 84-year-old grandmother, was hit by a car recently and stumbled into a hospital in Bulawayo, in Zimbabwe’s south, most of the administrative nurses and hospital clerks were already ending their day shifts. She waited in a long line while the few medical workers on duty bounced between patients.
After two hours, with pain radiating down her left side, she was seen by a doctor, who recommended checking for internal bleeding. But the hospital, Mpilo Central, did not have enough radiographers — or X-ray films — so, despite her serious symptoms, she was sent home and told to come back the following day.
Dr. Tawanda Mapfumo, who works at Mpilo Central, says he has become accustomed to the chaos at the hospital, where about three dozen patients cram onto wooden benches in the corridors and waiting rooms. He says he cannot shake the guilt of seeing patients die because there are no resources to treat them.
Those trying conditions have created an opening for Britain, in particular, to lure away Zimbabwean health workers. Nearly 22,000 Zimbabweans have received health care work visas from Britain over the past three years (though not everyone who receives one actually moves).
Britain’s recruitment has drawn the ire of Zimbabwe’s government. In April, the vice president, Constantino Chiwenga, who is also the health minister, suggested introducing a law to criminalize the recruitment of Zimbabwean health workers by foreign countries. No law has been formally introduced yet.
But within the past two years, health workers in Zimbabwe said, the Health Ministry has made it more difficult for them to get the letters of good standing they need to be hired abroad.
A 31-year-old doctor, who requested anonymity to avoid trouble with the Zimbabwean government, said that in 2020, when he applied for his letter to move to Namibia to practice, he paid $40 and received the letter the same day.
But when he sought another letter from the Zimbabwean authorities in early 2021 to move from Namibia to South Africa for more training, he was confronted with a fee of $150 and a five-page form with questions he considered intrusive. He filled out the form and paid but has still not received his letter.
Nonetheless, he said he was fortunate because he still works in Namibia, where his $3,000 monthly salary is roughly 10 times what he made in Zimbabwe.
“It’s not worth your time or dignity,” he said, referring to the poor pay in Zimbabwe.
The Zimbabwean Health Ministry did not respond to requests for comment. Christopher Mutsvangwa, spokesman for ZANU-PF, said that the government was not opposed to citizens going abroad for jobs but that it needed to control the flow to ensure that some skilled workers remained.
Despite the government’s barriers, Zimbabweans are still finding ways to flee.
Wynter Banda swapped her life as a hairdresser in Harare to become a nursing home aide in Britain. She and her husband, Godwill, a teacher, sold their car and borrowed from friends to come up with the $5,000 she needed for the visa fee and other moving expenses.
Her husband eventually joined her and works as a science teacher. Things are tight, she said, because of debt and high rent. Still, she said they had made the right decision.
“Even though it’s not easy and the working hours are very long and stressful, I can’t imagine going back to Zimbabwe,” she said. “We suffered there.”
Jeffrey Moyo contributed reporting from Harare, Zimbabwe, and Lynsey Chutel from Johannesburg.