Defiant nurses in Zimbabwe have vowed to continue a nationwide strike, despite the government saying that they have all been sacked. The striking staff continued for a fifth day on Thursday, their labour action demanding better pay and improved working conditions.The walkout is seen as the biggest mass action facing Zimbabwe's President Emmerson Mnangagwa since he took power after an army-led operation overthrew veteran ruler President Robert Mugabe in November 2017.On Tuesday, Vice President Constantino Chiwenga issued a directive ordering the immediate dismissal of more than 16,000 striking staff, accusing them of "politically motivated" actions.Chiwenga, a former army general who led the anti-Mugabe military operation, said the sacked staff would be replaced by trained nurses and retirees.But the Zimbabwe Nurses Association (ZiNA) said they were undeterred.In a statement issued on Wednesday evening, the union said its members had not received any letters terminating their services by the Health Services Board (HSB), the medical employer.It also said that it would take legal action if the HSB failed to confirm by Thursday at 4pm (14:00 GMT) that it would not act on Chiwenga's mass dismissal order ."[W]e shall approach the High Court on an urgent basis to protect our rights," the statement said.* Sign up to News24's top Africa news in your inbox: SUBSCRIBE TO THE HELLO AFRICA NEWSLETTERFOLLOW News24 Africa on Twitter and FacebookSimangaliso Mafa, president of ZiNA, told Al Jazeera that the government had acted in "bad faith" and their action was not procedural."We only heard about the firing on the television; the pronouncement was not communicated formally so we are currently engaging our stakeholders and we are following our procedures so we can interrogate the decision and act," he said in a telephone interview.Negotiations to pay outstanding allowances that date back to 2010 were under way and the Treasury had taken steps to release $17.1m for payment of arrears.However, ZiNA said the backdated allowances had nothing to do with the current dispute."Our grievances which relate to poor and dangerous working conditions which threaten our health and affects the discharge of our duties remain unaddressed," ZiNA said in a statement.Many of Zimbabwe's nurses work in poorly-equipped government institutions where patients are required to supply basics such as gloves, cotton wool and methylated spirit.One of the early major successes of Mugabe's era was to offer free primary healthcare in the 1980s. However, the consistent underfunding of the health sector saw the collapse of the scheme in the late 1990s when the economy began to decline.In a bid to revive the benefits of the past, Mnangagwa has followed suit by extending the provision to the elderly. However, health centres are inadequately funded and its workers poorly paid.The lowest paid nurses currently earn less than $300 a month, before allowances.They reportedly demand a raise on their night duty allowances from $0.70 to $70 an hour, and a review of their on-call allowances from $1,50 to $7,50 an hour.Enduring the worstThe crisis has left patients, who have withstood bouts of labour action for months, feeling worried.Freshly discharged from Mpilo Hospital, Zimbabwe's second largest health centre in Bulawayo, Siphiwe Mkhwananzi, 37, told Al Jazeera that she had been badly affected by the series of strikes by Zimbabwe's health workers.Diagnosed with cervical cancer, Mkhwananzi has been in and out of the city's public hospitals since March, but to no avail."When I first came here, I was sent to UBH (United Bulawayo Hospitals), but they sent me to Mpilo for radiotherapy treatment. I saw a doctor for some time, but then the doctors went on strike and they discharged me with painkillers," she said."Yesterday, they re-admitted me because I was in a lot of pain, but all I had was one drip and some pain eeze [a painkiller]. Last night, I slept in pain because there were very few nurses in the ward so there was no one to give us any medication. They say it's better for me to go home and I know without nurses there is really nothing for me here - but now where will I get money for this list of pills I have to buy?" she said.Mkhwananzi, an unemployed villager, hails from a remote village in Gwanda South near the South African border. A month after being referred to a hospital in the second city of Bulawayo, junior and middle doctors went on a month-long strike demanding salary increases and better working conditions.Solwayo Ngwenya, the clinical director of Mpilo Hospital, said the outpatient department and the centre was only handling emergencies, relying on non-striking staff to fill the gap."The hospital has been using skeletal staff to man critical departments. Patients from the outpatients unit have been inconvenienced as a result of the strike, but mortality [deaths] remain under control. Nurses not on strike are working overdrive to save lives," he said.Frustrated nationBut the hospitals' struggle to cope with the patient backlog has frustrated relatives of patients.Flatsa Mzima, an unemployed driver, told Al Jazeera, that his family took a decision to move their relative, Thandiwe, after six weeks of suffering from tuberculosis throughout Mpilo's disgruntled workers' actions."It's painful to see Sis'Tha [Thandiwe] in so much, there is no one to attend to her at night, there are only student nurses but they can't give any medication. We can't rely on those nurses because they only work at night and during the day there's no one to bathe her or change her."The nurses have a duty to make sure patients get the right care, but there is no one here. How can we say we are a free country if we can't even get the support we need?"A nurse can't be thinking of their own suffering while patients are dying. I can't blame them, but I blame government for this mess," he said.At UBH, emergency staff are on duty, but the wards are understaffed.Student Rachel Tembu, whose 72-year-old grandmother was admitted on Saturday, the day the labour action began, said the family hoped a solution would soon be found as the elderly woman required long-term care."We aren't expecting her to come out any time soon, she has arthritis and her condition is complicated so we hope the staff can do their best to minimise the situation and return things to normal," she said.