The aftermath of Nepal’s earthquake—health sector response

The massive earthquake on 25 April has already claimed over 7000 lives across several districts in Nepal. Many villages have been completely flattened, while some are left with only a few standing houses. Physical destruction and damage aside, this mega-disaster has left the Nepalese people mentally and emotionally drained.

Kathmandu Valley, which includes the capital city, was hardest hit. In addition, adjoining districts of Kathmandu: Nuwakot and Rasuwa (northwest), Sidhupalchowk (northeast), Dhading and Gorkha (west) were some of the other hardest hit districts.

This is Nepal’s first experience in responding to a major disaster in eight decades. Needless to say, no one was adequately prepared to deal with damage on such a large scale. Communication towers were badly affected, landslides blocked the road access to affected areas, and the geographic terrain limited air transport options (for evacuating the severely injured and supplying relief materials) to helicopters of a particular size. Despite its best efforts, the government’s capacity was too limited to effectively manage the enormity of the situation.

Day one: The Nepalese Army, Nepal police, and the Armed Police Force responded immediately with search and rescue operations in the worst affected areas and by providing medical care to the injured. The government set up 16 sites in the open spaces of Kathmandu Valley to provide temporary shelter to residents. A good coordination of Nepal’s Ministry of Health and Population (MoHP) with the medical command centre of the Nepalese Army was one of the facilitators in the response of the health sector. All tertiary hospitals were flooded with cases of injuries and a number of casualties. Public hospitals and teaching hospitals of medical schools were seen to be attending to the highest number of patients, much beyond their capacity.

Day two: The first foreign medical teams (FMTs) to arrive in the capital were the National Army teams from India and China. Bhutan Army team, with its self-sustained field hospital set up in Nuwakot, was one of the most helpful because they spoke Nepali.

Day three onwards until the sixth day: There were more FMTs registering with the MoHP, with the total number reaching 40.

Existing hospitals, health facilities, and mobile camps have been continuously functioning. FMTs from across the world (Asia, Europe, America) are in Nepal to provide services in the earthquake affected areas. At the time of publication, the Ministry of Home Affairs has reported 7557 deaths. Reports of more than 14 000 injuries and trauma cases so far must be an underestimation because of the gaps in communication with hard to reach villages in different corners of affected districts. By 30 April, the MoHP reported already having treated 14 764 patients.

Major challenges in managing the FMTs

Firstly, a lack of information often leads to poor decisions when deploying medical teams to affected areas. Collating healthcare information on the areas affected within districts has been the most difficult task because of very limited (or no) means of communication with several district health offices. Therefore, at times we have had to ask the FMTs to go to the district headquarters or an affected area based on limited information and act accordingly.

Recently, the Central Committee for Disaster Response at the MoHP has appointed the directors of its different divisions as central coordinators for the 12 most severely affected districts, so that they can personally go there to facilitate information exchange. This has improved the committee’s communication and coordination with the districts and we hope that it will improve the response in the next few days.

Secondly, hospitals—including the tertiary care and central level hospitals—often lack the medical and surgical supplies required to manage the huge number of trauma cases, particularly major orthopaedic surgical interventions. Even the major stores in the country are reported to be short of these surgical supplies. While a few FMTs are self-sustained and have come stocked with supplies to manage up to 3000 patients, most FMTs offer human resource services only.

Recently, different global agencies have offered to provide medical supplies, including surgical supplies, which will help improve the response to some extent in the coming days.

Finally, the difficult geographic terrain of the country and its limited transport options mean that response/volunteer groups, including the FMTs, have to come prepared to walk several hours to days to reach the remote hilly areas to provide services.

Although we are gradually reaching most areas that have been hit hardest by the earthquake, health infrastructure has been destroyed in many villages. As a result, we urgently need help in reconstructing health facilities and setting up temporary health facility sites. Medium and long term services in patient care—and capacity building in public health specialties such as health information systems, disaster management, and epidemiology—are also needed.

Finally, there seems to be enough offers from FMTs in specialties such as orthopaedic surgery, emergency medicine, plastic surgery, neuro-surgery, etc. However, there is an acute shortage of resource in areas such as mental health, post-disaster and post-surgical rehabilitation, physiotherapy, as well as a lack of equipment and supplies for surgical and emergency care. We appreciate the international community’s response to Nepal’s emergency needs, and we believe that sustained medium and long term support for post-disaster care will also be offered.

Meanwhile, we are gearing up—albeit slowly—to prepare ourselves for health risks after a major disaster: outbreak/epidemic. In collaboration with the Chinese epidemic prevention team, 300 local volunteers were trained on the prevention of communicable diseases. These volunteers will immediately work to spread awareness on water, sanitation, and hygiene—they will also provide water purification kits in affected areas. In the next few days, we will continue to focus on collecting information, deploying medical response teams based on need, and expanding epidemic prevention activities to the rural areas—including districts outside of Kathmandu Valley.

We believe that this experience will improve our system for better disaster management in the future.

Disclaimer: The views and opinions expressed are solely of the authors and do not represent the views of their institutions.

Krishna Aryal is a research officer at the Nepal Health Research Council, Government of Nepal, Ministry of Health and Population. He is also a member of the FMT coordination team for current disaster response. 

KA declares he has no conflict of interest.

Agya Mahat is a global health professional, working as a freelance consultant with various organisations, such as the World Health Organization and the World Bank. She is also a member of the FMT coordination team for current disaster response. 

AM declares she has no conflict of interest.

Meghnath Dhimal is the chief research officer at the Nepal Health Research Council and a climate change and health expert. He is also a member of the FMT coordination team for current disaster response. 

MD declares he has no conflict of interest.