Neglect of the rural health system and poor preparedness result in thousands of avoidable diarrhoea-related deaths annually in Nepal, health analysts warn.
“The diarrhoea epidemic has repeated again due to the government’s lack of effective preventive measures which we have been reminding the officials of every monsoon,” Prakash Amatya, director of NGO Forum for Water and Sanitation, told IRIN.
Most deaths occurred in remote villages in the mid-west region where a large percentage of the population remains vulnerable due to poor sanitation, unsafe drinking water and illiteracy. Many are uneducated about basic hygiene and healthcare.
In addition, there are issues of access, with aid workers struggling to reach these villages because of impassable roads made worse by the rains.
“Our concerns are access and logistics. The affected areas are without electricity, there are no facilities for the health teams coming out,” Wendy Cue, head of the UN Office for the Coordination of Humanitarian Affairs (OCHA) told IRIN in Kathmandu, the capital.
Even helicopters struggle to land there, she said.
While much of the mid-west was affected, worst hit was Jajarkot district (400km northwest of the capital), where 106 people have reportedly died since 1 May, according to the District Public Health Office, followed by Rukum, about 300km northwest of Kathmandu, where 25 people died between 29 June and 13 July.
Deaths have also been reported from the region’s remote Dailekh, Salyan, Dang and Doti districts.
According to local NGOs, thousands of villagers are vulnerable to diarrhoea in several other districts as well.
The mid-west is one of five regions (east, west, central, mid-west and far west) with the highest concentration of rural poor. While the number of people living on less than US$1 per day in Nepal is 31 percent, that jumps to 45 percent in the mid-west, according to the International Fund for Agricultural Development, a UN agency.
Nearly 14 percent of the country’s 27 million people live here, despite limited access to health, education, roads, telephones, electricity, water supply and sanitation services.
The region has long been isolated from development initiatives, held back by a decade-long armed conflict and political instability.
[Nepal] In the capital Kathmandu, a group of boys smile to the camera. [Date picture taken: 03/17/2006]
Photo: David Swanson/IRIN
Children are often the biggest victims of diarrhoea
Children worst affected
According to the UN Children’s Agency (UNICEF), about 13,000 children under five die annually from diarrhoea because of poor hygiene and sanitation.
A government report, Nepal Country Plan for International Year of Sanitation 2008 estimated that only 46 percent of the population had access to basic sanitation.
More than 14 million people, mainly in rural areas, do not have access to latrines, states the report, while over 30 percent do not have access to potable water, according to the Department of Water Induced Disaster Prevention.
“We have failed to take basic health to the remote areas where the situation remains the same as it was decades back,” Bharat Adhikari, an officer with the Nepal Water for Health NGO.
“This problem would have never existed if more attention was paid to improving health hygiene and sanitation situation in the rural areas,” Pitamber Sharma, director of the disaster department of the Nepal Red Cross Society (NRCS) [see: http://www.nrcs.org/], the largest national humanitarian agency in the country, told IRIN.
There was no time to lose, he warned, noting the need for long-term planning rather than short-term emergency interventions after scores of people had died.
But relevant government officials were unavailable to comment for just that reason, as many had left to provide humanitarian assistance in the remote diarrhoea-affected villages.
“The epidemic repeated again this year and has put a big question as to whether those responsible for decades of health education have failed to reach the most vulnerable populations,” Amatya said.
But according to the UN: "It doesn’t help to blame but to look at what needs to be strengthened, what could have been done in terms of prevention and to make this a priority for our development partners," said OCHA’s Cue.
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This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions