When militant Islamists kidnapped more than 200 Nigerian schoolgirls in April, it raised Americans’ awareness of Boko Haram, the violent group responsible.

Scott Pyles and his wife, Lee, didn’t need that lesson.

Living in northern Cameroon, near Nigeria’s border, they administer a 100-bed missionary hospital founded in 1994 by members of Baton Rouge-based The Chapel on the Campus. They lived and worked in the village of Meskine, about 5 miles west of the area’s largest city, Maroua.

But not now. With Boko Haram activity getting closer and better organized, the Pyles and six other Western volunteers have fled the village. The hospital remains open, staffed entirely by Cameroonians.

“We are the only American institution in northern Cameroon,” Scott Pyles, the hospital’s administrator, said Monday by telephone from Ngaoundere, Cameroon, about an eight-hour drive south of Meskine. “If Boko Haram knew that we were American-based, we knew we would be their next target, without a doubt.”

Since 2010, Boko Haram has committed numerous shootings, bombings and kidnappings in its effort to establish an Islamic state. Initially, its activities were limited to Nigeria.

But more recently, the danger has crept into Cameroon. In February 2013, Pyles said Boko Haram kidnapped a family in the northern tip of the country. In November, a priest was captured closer to Meskine, but still about a three-hour car ride away. After that, the U.S. Embassy in Cameroon contacted Pyles.

“That’s the first time the American government asked us to consider leaving,” he said. “At that point, we all felt strongly that our call and our purpose there of God was more important. We still felt like the risk was still at arm’s length, so to speak.”

Pyles had workers raise the height of the wall surrounding the hospital and reinforced the outside of the compound’s buildings. He and other Westerners took online courses to train them how to handle a hostage situation. In early April, Boko Haram kidnapped a Canadian nun and two Italian priests about 10 miles away from Meskine. Cameroon assigned the hospital three armed soldiers for round-the-clock security. The hospital sent home three of its short-term volunteers.

On May 16, Boko Haram attacked a work site in northern Cameroon. Pyles said from 50 to 75 militants reportedly were involved in the attack.

“What’s different this time is they came in force,” he said. “There were many Boko Haram militants that attacked a military-protected work camp. They purposely went in with a firefight and kidnapped 10 Chinese road crew workers and carried them off, as well as they stole two pickup trucks with dynamite. What that attack showed us is Boko Haram had the force, had the means to do whatever they wanted to do. In this case, their goal was to get the dynamite.”

Two days later, Pyles and the remaining Westerners left.

“We determined that the risk was not worth the reward for anybody to stay there at this point,” said Cheryl Yennie, executive director of Medical Centers of West Africa, the organization that oversees the hospital. MCWA is headquartered in Baton Rouge. “The situation in terms of the threat has only deteriorated more since we departed, and the BBC reported this weekend that there are Cameroonians that have been kidnapped in the province where our hospital is located. It has deteriorated, and we are further away from returning than we were when we left.”

The hospital is staffed by Cameroonians, including about a half-dozen doctors and about 40 nurses. The soldiers remain on guard.

“This is the first time in the history of our hospital that the missionaries have not been there to supervise,” Pyles said. “I maintain almost a daily contact with the leadership, and I am overwhelmed and humbled by how well they are doing and how well the hospital continues to function. Our goal from the beginning was to basically work ourselves out of our jobs and Cameroonianize — if I can use that word — everything. This is a very good test for that, and so far it’s going very well. Our people are doing great. We’re very thankful.”

While he waits to return to the hospital, Pyles said he is looking for other opportunities for evangelistic ministry in Cameroon.