By DAVID McFADDEN

Associated Press

PORT-AU-PRINCE, Haiti – Haiti’s longest and most punishing strike by medical professionals officially came to an end Thursday with young doctors returning to their jobs at the nation’s biggest hospital after a nearly five month walkout.

Residents at Port-au- Prince’s Hospital of the State University of Haiti first walked off the job in March. Nurses and support staff followed. Waves of strikes spread to 12 other government-run hospitals.

They were protesting chronic shortages of even the most basic medical supplies, dismal pay and unsafe working conditions. They called for systemic changes to a severely under-resourced public hospital system that serves Haiti’s poor majority.

Dr. Clerfort Michel, an anesthesiology resident, said all the striking doctors and other staff were back at work Thursday after the government agreed earlier in the week to satisfy pay demands and improve conditions.

“The strike is over today. We never expected it would last so long,” Michel told The Associated Press at the State University hospital.

A new agreement calls for a gradual pay adjustment for residents, who were making some $120 a month when the strike began. Later this year, they expect to get as much as $460 per month. Michel said the interim government was already replacing beds and funding other improvements.

At least three deaths, in- cluding a pregnant woman who died outside the State University hospital’s gates, have been attributed to the strike. But authorities acknowledge there have almost certainly been others.

A medical staff strike was the last thing Haiti needed. Malnutrition and numerous diseases are widespread. Cholera has killed roughly 10,000 people since 2010, when it was introduced into the country. And Haiti recently had its first case of Zika-related microcephaly, a severe birth defect.

Dr. Vanessa Mehu, a third- year anesthesiology resident, said some exasperated residents have migrated out of Haiti during the lengthy strike.

The State University hospital was packed with people on Thursday.

The return of the staff was a huge relief for Alme Cesar, one of four shackled prisoners who were chained to beds for months during the strike. They were kept alive by visiting relatives and missionaries.

“I still haven’t seen a doc- tor yet but at least now there’s hope,” said Cesar, a blind inmate who was dropped off at the emergency room five months ago.

Jean-Bernard Fortune, a primary school teacher who was waiting in a lengthy line to see a specialist, said the fact that Haitian public hospitals were paralyzed for months was infuriating.

“In other countries a strike like this will last one, maybe two days. That a strike can go on and on here shows that our government does not care about the population,” he said.

The government devotes 4.7 percent of its budget to health care and the health ministry’s director general has called for increasing the share to nearly 10 percent next year.