Rebuilding Nepal
Authors: Zoë Mullan
Journal: The Lancet Global Health (2015)

Nepal is a country of immense variety: from its flat southerly regions in the Ganges plain to the roof of the world atop Mount Everest, this landlocked nation nestles between India and China and is home to 125 ethnic groups and castes speaking almost as many languages. 6 months ago, however, a shared catastrophe struck—on the morning of April 25, a 7·8-magnitude earthquake hit the centre of the country, its shockwaves rippling outwards and affecting an estimated 6 million of the 31·5 million population. The capital Kathmandu, home to 1 million people and a UNESCO World Heritage Site, was severely damaged, and scores of rural villages were utterly destroyed. Nearly 9000 people were killed and half a million families were made homeless. Help arrived quickly. Médecins Sans Frontières staff were on the scene in 48 hours and, finding a robust local response already underway in Kathmandu, chose to focus their efforts on communities stranded in the mountains. Helicopters were the only way to reach these stricken villages and were in short supply. The Japanese Red Cross Society managed to reach one of the worst-affected districts, Sindhupalchoke, on April 30, and set about supporting the badly damaged primary health centre, treating patients in the open air. Foreign trekking companies even began providing assistance in the way of food, basic medicines, and shelters to local mountain guides and their communities. In short, the immediate emergency response was as swift and effective as might have been hoped given the damaged and rudimentary infrastructure and the threat of ongoing aftershocks (one of which killed a further 153 people). But what of longer-term reconstruction efforts? Of “building back better”? In June, international donors pledged about US$3 billion to help Nepal's recovery effort. Nepal's neighbours China and India led the support, with the Asian Development Bank, World Bank, Japan, the USA, and EU also pledging substantial figures. However, Nepal's decision to require donations to be routed via a yet-to-be formed body known as the National Reconstruction Authority (NRA), although positive in terms of country ownership, led to concern over corruption and delays to disbursement. Unfortunately, the latter concern seems to have been borne out. News reports in late September claimed that the Government was yet to spend any of the promised funds and that the Bill that would have seen the NRA come into existence was still languishing in parliament—a victim, perhaps, of the Government's preoccupation with trying to pass a Constitution that had been gestating since the abolition of the monarchy in 2008. That was finally adopted on Sept 20, and perhaps now clears the way for the NRA and some concrete action. The delay is nevertheless frustrating to say the least. Yet the Government has not done nothing. As Víctor Aguayo and colleagues from UNICEF report in a Comment in this issue, it successfully coordinated an Emergency Nutrition Response for children and pregnant women in the first 3 months after the earthquake. Chief among the strategies used was a Child Nutrition Week, based on the Child Health Day approach, which involved village-based distribution of nutritional supplements such as multiple micronutrient powders, iron-folic acid, and vitamin A; and identification and treatment of children with severe acute malnutrition. The intervention reached more than 400 000 children and pregnant or breastfeeding women and likely saved lives. Going forward, however, the Government should grasp the opportunity to make a progressive commitment to universal health coverage (UHC), argue Buddha Basnyat and colleagues in a further Comment. Nepal began introducing free health care for all at the health post level in 2008, and has since expanded it to primary health-care centres and outpatient clinics. However, inpatient, emergency, and referral services are still only freely available to targeted groups. Rebuilding efforts should keep the concept of UHC in sight, and be bold and innovative rather than replicative of what went before, the authors assert. Sanitation is another issue in need of bold action. Although 92% of the population had access to clean water before the earthquake, less than half had access to improved sanitation. With its new secular Constitution passed, Nepal must focus now on releasing the recovery funds held up and on instituting a future-proof strategy for rebuilding. With whole villages still managing under tin-roofed temporary shelters, and with donor support readily available, now is the time to literally rebuild Nepal from the ground up, starting with sanitation. Delivering essential nutrition services for children after the Nepal earthquakeOn April 25, 2015, a powerful 7·8-magnitude earthquake struck Nepal. The Nepalese Government declared 14 of the country's 75 districts as severely affected (ie, 5·6 million people). As of July 25, 2015, the confirmed number of casualties was 8897 with a further 22 310 people injured, and 887 356 houses fully damaged.1 Full-Text PDF Open AccessPost-earthquake Nepal: the way forwardOn April 25, 2015, an earthquake measuring 7·8 on the Richter scale shook Nepal. This (together with strong aftershocks) resulted in about 9000 deaths, more than 23 000 injured, and about 2 million displaced people. To find the way forward for Nepal it might be useful to examine aspects of the 2010 earthquake and its aftermath in Haiti—a similarly impoverished country. That earthquake killed at least 230 000 people and displaced about 1·5 million. Reconstruction has been a very slow process in Haiti. Full-Text PDF Open Access