Empty halls buzz with flies. Rats scamper through the wards at night. The emergency room is empty except for four shackled prisoners, watched over by relatives and missionaries rather than medical personnel.

The Hospital of the State University of Haiti, the largest and most important public medical facility in this troubled country, is at the epicenter of the most punishing strike by Haitian medical workers in memory.

"We've been left to rot," said Alme Cesar, one of the shackled prisoners, who was brought to the hospital months ago for treatment that has yet to materialize. "I would have died here without my wife coming to care for me."

Young doctors and interns walked off the job in March to protest chronic shortages of basic medical supplies, dismal pay and working conditions so unsafe that relatives of patients routinely threaten them, even storming into operating rooms with handguns.

Nurses and support staff soon joined the walkout. Then waves of strikes spread to 12 other government-run hospitals across Haiti, crippling a severely under-resourced health system that struggles to cope during the best of times.

Health Ministry authorities say four state hospitals are closed and others hit by strikes are functioning at diminished capacity.

They claim hospitals are gradually reopening.

But Associated Press journalists visited one hospital identified as open in the capital's Delmas district and found it barely scraping along. While a couple of specialists did scheduled consultations, the hospital was nearly empty and support staff sitting at the entrance turned away people seeking treatment.

"I heard this hospital was open. But they just told us to go somewhere else," Macula Josephe said as she and her sister helped her grandfather into a pickup truck in the hospital's parking lot.

The government-run hospitals that cater to Haiti's poorest citizens frequently lack basic supplies like surgical gloves, gauze, antiseptics and sometimes even water. Power outages force night-shift doctors to use light from their cellphones to finish operations.

The director general of the Health Ministry, Dr. Gabriel Thimothe, said public hospitals have been badly underfinanced for many years. The Haitian government devotes 4.7 percent of its budget to health care and has called for increasing the share to nearly 10 percent next year under a proposed budget.

Thimothe said many of the striking resident doctors are "radicals" who trained in Cuba.

"We're open to negotiations. But we can't give everything they demand due to the economic situation of the country," he said.

Since 1996, resident doctors in Haiti have been paid $120 a month, a paltry salary that has been eroded further by the rising cost of living.

After initially demanding $500 a month, striking residents now say they will accept $360. They recently rejected a government offer of roughly $200 monthly to return to work.

Dr. Vanessa Mehu, a third-year anesthesiology resident, said the strike would not stop until all their demands were met. While salaries are a major sticking point, she said doctors need systemic changes to a public health system that has long been unable to give adequate care to many.

"People were dying for nothing. People were dying because they didn't have money to buy gloves. People were dying because they didn't have money to buy some serum, syringes," Mehu said.

Thimothe said at least three deaths, including a pregnant woman who died outside the State University hospital's gates, have been attributed to the strike.

Haiti's longest health walkout comes as a political impasse between feuding factions shows no sign of ending, leaving the poorest citizens suffering most amid Haiti's latest leadership drift.

Interim President Jocelerme Privert, whose term ended last month but remains in office as divided lawmakers delay a vote on his fate, has threatened to strip hospital residents of their medical licenses. The threat has inflamed tensions.

"He's just trying to intimidate the residents," said Dr. Joseph Herold, a third-year resident in obstetrics and gynecology.

Recently, specialist physicians tried to report to work at the State University hospital but they were driven away by striking residents.

A hospital strike is the last thing Haiti needs.

Life expectancy has long been the shortest in the Western Hemisphere. Mosquito-borne diseases, measles, meningitis and other scourges are common. Malnutrition and stunted growth are widespread. Cholera has killed at least 10,000 people since 2010, when it was introduced into the country, likely by U.N. peacekeeping troops.

Few patients can afford prescription medicines, and private care is out of reach for many. Those with means seek treatment in Miami or the neighboring Dominican Republic.

About 50 percent of total health care expenditure in Haiti is provided by NGOs, according to the World Bank. Clinics and hospitals run by foreign NGOs such as Doctors Without Borders have been swamped with patients amid the strike.

On a recent afternoon, dozens of poor people trying to get on waiting lists camped outside the Mirebalais public-private hospital created by Boston-based Partners in Health. The well-equipped hospital opened in 2013.

Asania Sineus was in her sixth day outside the teaching hospital's doors as she waited for her mother to get treated for injuries from a motorbike crash. She first took her mom to a public hospital in Gonaives but it was closed.

"Having to travel here is not good for us. But what else can we do?" the 20-year-old student said from her camp of piled blankets.

At Port-au-Prince's State University hospital, which was supposed to be rebuilt by now with $83 million from international donors, Penina Pierre sat alone in a dermatology ward. Visiting missionaries are keeping her fed since she has no family.

"Maybe someday the doctors will come back," said Pierre, the skin around her bandaged foot discolored and inflamed.

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David McFadden on Twitter: www.twitter.com/dmcfadd