Nepal is steadily bracing its health sector for a long-predicted mega-earthquake, but disaster experts say most facilities are still ill-prepared.
The capital, Kathmandu, is consistently ranked among the world’s most earthquake-prone cities and in the event of an 8.1-magnitude (Richter scale) quake, some 80 percent of hospitals are expected to become non-functional, according to the National Society for Science Technology (NSET).
NSET estimates such an earthquake could kill as many as 100,000 people and injure another 300,000. “Heavy casualties are expected and health preparedness really needs lot of attention now - and we need to move faster,” said NSET’s deputy executive director, Ramesh Guragain.
Officials have known how vulnerable health facilities are to natural disaster since an assessment in 2001 by the Ministry of Health, the UN World Health Organization (WHO) and NSET.
“Recommendations were made but there were no favourable responses on the mobilization of resources needed to implement them,” Damodar Adhikari, national programme officer of the WHO emergency and humanitarian action programme, based in Kathmandu, told IRIN.
After 13 years with scant follow-up and little investment, experts fear the situation has deteriorated even further. WHO conducted a study of 59 hospitals across the country in 2012-13, but it has yet to be published. A donor conference focused on health preparedness is to be held for the first time at the end of 2014, and Adhikari said 21 of these hospitals have been selected for detailed assessment in the coming months.
Of the country’s 130 hospitals, 71 are in the capital (51 private and 20 public), and experts say almost all need strengthening. Less than half of all facilities have a surgical capacity and almost all of these are in the capital. So far, only a handful of the biggest hospitals have been retrofitted, or reinforced, to improve their ability to survive and continue providing services during a disaster.
“We are making every effort to strengthen the hospitals, including the structural and non-structural aspects,” the Ministry of Health and Population (MOHP) hospital administration chief, Gunaraj Lohani, told IRIN.
The government recently told administrators to retrofit hospitals by strengthening the beams, columns, slabs, load-bearing walls, braces and foundations within two years, or they would forfeit their licenses. It also issued a directive saying all health facilities must prepare disaster management plans and organize earthquake simulations.
“The challenge is still enormous in the event of a huge earthquake, and we have still a lot to prepare for,” said Paban Sharma, director of Patan Hospital, a governmental hospital in the capital.
Patan was the first hospital in Nepal to create its own disaster management plan in 2001. It has 500 beds, of which over 90 percent are usually occupied, and sees 1,000 out-patients daily. Following a quake, experts estimate this number could multiply 10-fold.
Haiti’s earthquake in 2010, in which most health infrastructure in the impact zone was damaged, serves as a stark warning to Kathmandu, a city of around one million people.
Experts say some key lessons learnt were the need to have effective coordination among humanitarian agencies, strong health information management, pre-positioned hospital stocks, a roster system for medical workers and volunteers, a rehabilitation system for trauma victims, and widely available trauma counselling.
In a few weeks, the government is expected to launch its Health Emergency Operation Centre, which will have a national database of human resources in the health sector that disaster response agencies will be able to access, and warehouse space for medical stocks. Centre officials are mapping all health centres in the country on a geographic information system (GIS).
“The impact on hospitals will be huge and we can expect many to be non-functional, and this is why we are also focusing on tented hospitals, as they can be… [set up] to deal with mass casualties,” said Dhruba Devkota, senior humanitarian programme coordinator of Save the Children in Nepal.
The Ministry of Home Affairs has identified 83 open spaces across the capital and its outskirts for positioning inflatable hospitals, a hub for humanitarian agencies, storage containers for relief supplies, and camps for displaced people.