The 2015 Nepal earthquake and worsening air pollution in Kathmandu
Authors: Anup Uprety, Akihiko Ozaki, Asaka Higuchi, Claire Leppold, Tetsuya Tanimoto
Journal: The Lancet Planetary Health (2019)

The air quality in Nepal was reported to be the worst among 180 countries in 2018.1Environmental Performance IndexYale University.https://epi.envirocenter.yale.edu/epi-country-report/NPLDate accessed: April 26, 2018Google Scholar It was three ranks down from 2016, when the country was ranked 177th, showing that Nepal has failed to respond to the worsening air pollution in recent years. The extent of air pollution is particularly high in the Kathmandu Valley, where the capital city of Nepal is located,1Environmental Performance IndexYale University.https://epi.envirocenter.yale.edu/epi-country-report/NPLDate accessed: April 26, 2018Google Scholar and is likely affected by population growth and urbanisation. The 2011 population census2Ministry of Population and EnvironmentAir quality management action plan for Kathmandu Valley.http://doenv.gov.np/files/download/Report%20on%20AQM%20Action%20Plan%202017.pdfDate: June, 2017Date accessed: April 29, 2018Google Scholar reported that 2·5 million people inhabited the valley, with an annual population growth rate of 4·2%.2Ministry of Population and EnvironmentAir quality management action plan for Kathmandu Valley.http://doenv.gov.np/files/download/Report%20on%20AQM%20Action%20Plan%202017.pdfDate: June, 2017Date accessed: April 29, 2018Google Scholar, 3UN HabitatUrban mobility in Kathmandu: status and trend.http://unhabitat.org.np/?publications=urban-mobility-in-kathmandu-status-and-trend-maya-factsheet-1Date accessed: April 29, 2018Google Scholar Similarly, for the last 10 years the number of vehicles that run on fossil fuels in the area has increased annually by 12%.3UN HabitatUrban mobility in Kathmandu: status and trend.http://unhabitat.org.np/?publications=urban-mobility-in-kathmandu-status-and-trend-maya-factsheet-1Date accessed: April 29, 2018Google Scholar Air quality is also impaired by intensive road construction, large-scale installation of pipes for water supply, and smog from brick factory kilns.2Ministry of Population and EnvironmentAir quality management action plan for Kathmandu Valley.http://doenv.gov.np/files/download/Report%20on%20AQM%20Action%20Plan%202017.pdfDate: June, 2017Date accessed: April 29, 2018Google Scholar However, on April 25, 2015, an earthquake measuring 7·8 on the Richter scale struck large areas of the country, which led to the destruction of numerous buildings made from fragile bricks. In the past, it has been suggested that natural and man-made disasters could worsen air pollution in both the short and long term. In the aftermath of the 2001 terrorist attacks on the World Trade Center, intense dust exposure led to a long-term increase in asthma attacks.4Brackbill RM Hadler JL DiGrande L et al.Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack.JAMA. 2009; 302: 502-516Crossref PubMed Scopus (283) Google Scholar After the 2011 Great East Japan Earthquake and tsunami, dust and sludge contributed to short-term impairment of respiratory health.5Yamanda S Hanagama M Kobayashi S et al.The impact of the 2011 Great East Japan Earthquake on hospitalisation for respiratory disease in a rapidly aging society: a retrospective descriptive and cross-sectional study at the disaster base hospital in Ishinomaki.BMJ open. 2013; 3: e000865Crossref PubMed Scopus (50) Google Scholar The notable difference with such disasters in developed countries is that in Nepal scraps and collapsed buildings still remain around residential areas due to delayed clean-up and restoration work under the logistics and insufficient resources of the Nepali Government. Given these conditions, there is a great potential for severe health effects, although little has been studied regarding possible associations between the earthquakes and the health implications due to worsened air quality. The health burden of non-communicable diseases (NCDs) in Nepal is a particularly important area of research regarding both the earthquake and increasing air pollution. An article published in 2015 suggested that NCDs constitute 44% of the deaths and 80% of the outpatient burden in Nepal.7Mishra SR Neupane D Bhandari PM Khanal V Kallestrup P Burgeoning burden of non-communicable diseases in Nepal: a scoping review.Global Health. 2015; 11: 32Crossref PubMed Scopus (66) Google Scholar The burden of chronic obstructive pulmonary diseases was particularly large, representing 43% of hospital visits, followed by cardiovascular diseases (40%), and diabetes (12%).7Mishra SR Neupane D Bhandari PM Khanal V Kallestrup P Burgeoning burden of non-communicable diseases in Nepal: a scoping review.Global Health. 2015; 11: 32Crossref PubMed Scopus (66) Google Scholar Because air pollution can increase the risk of diabetes and respiratory and cardiovascular diseases,2Ministry of Population and EnvironmentAir quality management action plan for Kathmandu Valley.http://doenv.gov.np/files/download/Report%20on%20AQM%20Action%20Plan%202017.pdfDate: June, 2017Date accessed: April 29, 2018Google Scholar, 6Yang BY Qian ZM Li S et al.Ambient air pollution in relation to diabetes and glucose-homoeostasis markers in China: a cross-sectional study with findings from the 33 Communities Chinese Health Study.Lancet Planet Health. 2018; 2: e64-e73Summary Full Text Full Text PDF PubMed Scopus (127) Google Scholar the health burden of NCDs could have been accelerated by the earthquake. A unique point of the recovery work in Nepal is that, despite challenges for population health after the earthquake, some positive signs have been observed, and could pave the way for improvements in air quality.8Parajuly K Pollution: clean up the air in Kathmandu.Nature. 2016; 533: 321Crossref PubMed Scopus (12) Google Scholar For example, a large number of brick kilns in Kathmandu Valley were damaged after the earthquake; it is estimated that approximately 95% of them required repairs.9weADAPTBrick kilns in Nepal: building back better after the 2015 Earthquake.https://www.weadapt.org/knowledge-base/sdc-climate-change-environment-network/building-back-better-after-the-2015-earthquakeDate: June, 2017Date accessed: April 29, 2018Google Scholar Because kilns are a major source of sulphur dioxide, multiple organisations have used this opportunity to upgrade the standard of the brick kilns that were damaged. These improvements have led to a reduction in pollutant emissions—mainly sulphur dioxide but also carbon dioxide and carbon monoxide.9weADAPTBrick kilns in Nepal: building back better after the 2015 Earthquake.https://www.weadapt.org/knowledge-base/sdc-climate-change-environment-network/building-back-better-after-the-2015-earthquakeDate: June, 2017Date accessed: April 29, 2018Google Scholar This example shows one of the many avenues that the post-earthquake phase has opened for building back better: a government initiative that focuses on making safer and earthquake resilient structures by helping people build houses that adhere to the country's house building codes.9weADAPTBrick kilns in Nepal: building back better after the 2015 Earthquake.https://www.weadapt.org/knowledge-base/sdc-climate-change-environment-network/building-back-better-after-the-2015-earthquakeDate: June, 2017Date accessed: April 29, 2018Google Scholar The government of Nepal set a target to reduce premature deaths caused by NCDs by a third by 2030 as a part of chieving the Sustainable Development Goals.10Kurmi O Regmi PR Pant PR Implication of air pollution on health effects in Nepal: lessons from global research.Nepal J Epidemiol. 2016; 6: 525Crossref PubMed Google Scholar It is imperative for the government to take meaningful steps to combat the ongoing problem of air pollution through comprehensive assessment and timely responses, with the 2015 constitution of Nepal guaranteeing people's right to live in a clean and healthy environment.10Kurmi O Regmi PR Pant PR Implication of air pollution on health effects in Nepal: lessons from global research.Nepal J Epidemiol. 2016; 6: 525Crossref PubMed Google Scholar Now is the time to not only prioritise air pollution as a public health issue, but also to act effectively and use this opportunity to build back better following the earthquake. AO and TT report personal compensation from MNES Inc, outside the submitted work. All other authors declare no competing interests.