KATHMANDU – Just outside Nepal’s capital, in the ornate temple town of Bhaktapur, residents line up to be sprayed head to toe with disinfectant they believe will save them from the onslaught of disease.
“There is still no fresh water, so we must be extra careful,” said 21-year-old physics student Anil Panta, as he directed eager locals to a man wearing a plastic backpack filled with liquid sanitizer.
A week has passed since a devastating earthquake killed more than 6,000 people and flattened scores of villages in Nepal, and now this impoverished Himalayan nation is bracing itself for a major health epidemic. Panta is one of hundreds of volunteers motivated by the need to help their fellow Nepalis in the crisis.
With thousands of people still sleeping in outside tents in the capital Kathmandu, and estimates that hundreds of thousands are displaced in rural areas, access to fresh water and sanitation is extremely poor. UNICEF has warned that 1 million children are in need of urgent humanitarian assistance. Both Nepali and international medical and aid groups say with certainty that waterborne diseases, particularly cholera, and lesser so, typhoid, are on the brink of appearing. In children displaced by the 7.8-magnitude quake on April 25, diarrhea is already common, as are cough and flu-like symptoms, doctors and locals say.
Visits to Kathmandu’s scattered tent cities and to the small town of Sindhupalchowk were met with the stench of raw sewage, made worse under the relentless mid-day sun. This is often succeeded by nightly rainfall at this time of year, making the cesspits worse. “The rain is creating health problems,” said Dr. Biplap Ghimire, who worked in the nearby hospital before it was flattened by the quake. “Cholera is a massive issue for us right now,” he said, adding that the fact he has yet to encounter a case “means nothing.”
Anger at the Nepali government from those affected by the quake is swelling, and hundreds have protested outside parliament in Kathmandu, demanding more free buses out of the capital to their remote hometowns, which suffered the brunt of the damage. They also want more food and medical supplies, complaining that the government response has been too slow and inadequate. Foreign medical aid teams have complained of delays in getting their cargo planes to the country’s beleaguered and sole international airport.
In sharp contrast, community-based action has sprung into force. Under a pale blue awning in central Kathmandu this week, Nepali doctors, paramedics and students were busy sending water purification tablets and hand sanitizers to camps in the capital and rural areas. They came together under the auspices of the Federation of Nepalese Chamber of Commerce and Industry (FNCCI), the country’s largest private-sector organization.
“We are extremely worried by the sanitation crisis,” said Dr. Bishal Dhakal, 37, one of the group’s leaders. “We’re reaching out to the Nepali diaspora around the world, urging them to help us, to donate, to come.”
A trained cardiac surgeon cum health entrepreneur, Dhakal said around 200 FNCCI volunteers are working around the clock, helping families living outdoors in the capital and dispatching teams to the harder hit, rural areas. In addition, the organization has raised $50,000, Dhakal said, significant in a country where the annual average salary is $730.
With ongoing aftershocks, some as powerful as 4.9 on the Richter scale, many people are staying outdoors. They have no home to go to, or are too scared. The earthquake is the worst to hit Nepal since a 1934 quake that killed 18,000 in the region.
Beside Dhakal stood 30-year-old volunteer paramedic Rajendra Kunwar, clad in a fluorescent yellow vest. Before the earthquake, he worked for the country’s ambulance service. Now, like other volunteers at the makeshift center, Kunwar is working without compensation. “I’d say 99% of the people we’ve helped are poor and struggling to make ends meet,” he said, adding that they were hoping to get tents, food, and large water tanks to the rural areas around the quake’s epicenter in one week from now. “After that, the corridor to prevent disease gets much smaller.”
The fear of cholera, which is already endemic to Nepal, is very real. The monsoons, or rainy season, are expected to begin around the middle of next month. If the hundreds of thousands of displaced people are still living in camps then—which seems likely—the monsoons will contribute to the spread of infected waste in the water supply. “Rain will pour in for 3 months, non-stop. This could trigger floods, and severely worsen the sanitation situation,” warned Bhishma Subedi, executive director of the Asia Network for Sustainable Agriculture and Bioresources, a Kathmandu-based NGO.
We’ve seen this before. Cholera outbreaks in Nepal date to the early 19th century. As recently as 2009, an outbreak of the deadly bacterial infection claimed 500 lives in Nepal. (International medical relief teams here are quick to point out a bitter irony: Nepali U.N. peacekeepers unwittingly exported the disease to Haiti after its quake five years ago, leading to a cholera outbreak 10 months later that ended up killing 9,000.)
Amit Aryal, an advisor to the Ministry of Health, said diarrhea is not yet at the “outbreak level," but concern over cholera is mounting, especially with rain approaching.
In Sindhupalchowk, about 20 miles northeast of Kathmandu through rugged and difficult terrain, the remnants of brick and cement houses, now mounds of rubble, dot the dirt road. Local springs were damaged in the quake, and fresh water has run out. The town’s men alternate the daily 1-hour walk to buy small bottles of water. “But we are running out of money,” said Devraj Giri, 35, a construction worker who has been out of work for a week. “My three kids have diarrhea, and one of them has fever,” he said angrily. A fourth child, his three-year-old son, was killed in the earthquake.
Nepal’s army has launched a massive relief effort, practically involving its entire force, airlifting the critically injured out of rural areas to already-inundated hospitals in Kathmandu. Most are crush injuries—typical of earthquakes—and Sindhupalchowk’s injured lay about with bandages wrapped around their heads and feet. Others had spinal injuries and broken arms and legs. They are attended to by Ghimire’s skeleton staff, who helped set up a small white tent where they disinfect and stitch together wounds.
Back in Kathmandu, cadres of international medical teams have descended on the capital, replacing the scores of journalists who are beginning to move on to the next breaking news story. Helping the US-based JRM Foundation is Nepali marketing assistant professor Rupesh Krishna Shrestha. “Volunteering was an easy decision,” he said beside a swarm of American physicians organizing an immediate visit north, near Sindhupalchowk. Shrestha is providing logistics support and crucial local knowledge. “There is a lot of goodwill from abroad but also a lot of miscommunication on the Nepali side. Locals have no choice but to help.”
Amie Ferris-Rotman is a journalist based in London. Twitter: @Amie_FR. This is her first article for Global Health NOW.
This article was supported by the International Reporting Project