Years of war have destroyed Burundi's economy

The MSF report said a government move to get people to start paying for treatment, tests and drugs meant many now went without them altogether.

Burundi's impoverished government withdrew free health care to its 6.9 million citizens two years ago.

More than 10 years of civil war have left the country's economy in tatters.

The survey by MSF showed that, in a country where most people live on less than a dollar a day, many avoid seeking medical treatment until their illness becomes an emergency.

A further 20% surveyed said they do not seek treatment at all.

Debt problem

MSF warns of a looming humanitarian disaster if international attention does not turn to Burundi.

Meine Nicolai, one of the report's authors, described how about three million people have entered debt to pay for treatment, besides the one million that cannot afford it all.

"We've heard stories, we've spoken with a lot of people, they even have to sell their lands, their harvests, their livestock," he said.

"They have to go into debt and sometimes they have to go into forced labour to be able to pay the debts to the health centre."

Cost-cutting measures

The agency says even a simple medical consultation in a basic health centre was equivalent to the wages earned from 12 days of agricultural labour.

It cited cases where patients were detained in hospital and prevented from leaving because they could not pay up.

Under the cost-cutting measures introduced two years ago, Burundi's government pays for infrastructure and wages in the health care system but leaves patients to pay for consultation, treatment and medication.

In five of Burundi's 17 provinces, foreign donations continue to prop up a free health care system.

MSF estimates it will cost international donors $10m to pay for a free health care system for the entire country.