While the coronavirus surge in India has dominated global attention, a parallel crisis has been unfolding largely in the shadows in neighbouring Nepal, pushing a beleaguered health system to the brink.
The Himalayan nation has a fraction of India’s population – and of its health resources – but its weekly coronavirus cases and deaths are among the highest in the world on a per capita basis. Nepal has recorded roughly 163 cases per 100,000 people over the last week, according to World Health Organization figures. India, where a second wave triggered rounds of emergency aid pledges, recorded about 98.
Nepal’s hospitals have been crammed to capacity or beyond for the last month. There are shortages of oxygen, medicine, and vital equipment – all usually sourced from India.
New daily cases have levelled off in recent days, but some 38 percent of tests are still coming back positive, while inadequate testing may be hiding a spiralling crisis in Nepal’s remote rural regions.
“The situation is very dire,” said Mona Sherpa, the interim country director for CARE in Nepal. “The health system has collapsed.”
Humanitarian groups say donor funds are stretched, partly due to the overwhelming needs in India.
“Definitely, India is of priority [for donors]. And I understand: This is not a competition; there is a need, too,” Sherpa said. “However, at the same time, we cannot deny the fact that Nepal is definitely going through a similar situation.”
“The scenes we are witnessing in South Asia are unlike anything our region has seen before.”
Nepal is also desperate for vaccines. Some 1.7 million people are in danger of missing their second doses, amid a supply vacuum driven by shortages in India, the world’s leading vaccine manufacturer. Nepal also faces a political crisis in the middle of the pandemic: The prime minister, Khadga Prasad Sharma Oli, has called for elections after losing a parliamentary confidence vote earlier in May.
Nepal’s health emergency is part of a broader coronavirus wave that has swept through South Asia in recent weeks. Countries like Afghanistan, Bangladesh, Pakistan, and Sri Lanka are also facing ballooning cases, overwhelmed health systems, or vaccine shortages. The Maldives has the world’s highest weekly infections per capita, though it has also bucked regional trends with relatively high vaccination rates.
“The scenes we are witnessing in South Asia are unlike anything our region has seen before,” UNICEF’s regional director, George Laryea-Adjei, said last week in appealing for $164 million for oxygen and supplies across the region. “We are faced with a real possibility of fragile health systems collapsing.”
Nepal has called for international aid, and is urging aid groups to divert their resources from other programming. The UN in Nepal this month released an $84 million appeal to fill gaps in the healthcare system and address a wider crisis sparked by new lockdowns and lost wages.
But humanitarian funding – in the pandemic’s second year – is stretched across the globe. Aid groups in Nepal say there’s little new money available as needs rise, and local NGOs in particular are feeling the budget pressure even as they respond closest to the ground.
Packed hospitals, funding shortfalls
Nepal’s coronavirus front line crosses areas like Banke district in the country’s mid-west. Its emergency wards are filled with patients – many who stream in from remote areas outside the district.
“Sometimes, beds are not available in the hospital. So patients are living on the ground outside, waiting for treatment,” said Dammar Sunar, who heads the Bheri Environmental Excellence Group, a local NGO that has pivoted to helping the health system source equipment and supplies during the second wave.
Last week, patient queues dipped enough that 26 of the district’s roughly 850 beds were available, Sunar said, but he worries the situation won’t stabilise for weeks.
The district shares a long and porous border with India. Thousands of migrant workers returned home to Nepal as India’s second wave grew, but local municipalities were slow to set up border screening and quarantine centres.
“Due to the unavailability of quarantine and holding centres, people who came from India go directly to their homes,” Sunar said. “They could not apply any health protocols or protective measures, which resulted in people who do not have any travel history becoming affected.”
“We’re not learning from our past experience. We’re not being well-prepared.”
Despite the seriousness of the situation, humanitarian NGOs say donors have been cautious about promising new funding.
“What we have heard so far [from donors] is that there’s positive inclination, but also, at the same time, there’s a lack of resources,” Sherpa said. “Globally, the aid is shrinking.”
Instead, many groups are shifting existing funding around: revising ongoing projects and moving already committed money towards emergency health responses.
This trickles down to local NGOs, who receive the bulk of their funds through larger international groups rather than directly from donors. Sunar said several local organisations he knows have seen their budgets diverted or cut. “Funding is the biggest concern for local organisations,” he said.
Human Rights Watch said both the government and aid groups were slow to prepare for what should have been seen as an inevitable second wave.
Sherpa said the severity of today’s healthcare shortages was preventable, given how coronavirus waves have hit other nations.
“We saw how it went in Europe, and also in South Asian countries,” she said. “This is the problem of health governance. We’re not learning from our past experience. We’re not being well-prepared.”
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