Nepal’s Next Disaster

KATHMANDU, Nepal — When an earthquake measuring 7.8 on the Richter scale hit Nepal’s central region and rumbled across Kathmandu valley on April 25, the carnage was devastating.

Much of this Himalayan country of roughly 27 million people sits on a tremulous fault zone; in 2005, a quake struck nearby Kashmir, killing more than 80,000 people. Nepal was never going to be adequately prepared: Nine years after the end of a decade-long Maoist insurgency, the government remains in disarray. In the years leading up to this weekend’s earthquake, building codes were seldom observed, while a stunting fatalism dominated much of the country’s muddling bureaucracy.

And so, in the hours after the quake, and amid a series of bone-shaking aftershocks, Kathmandu turned into a horror show: dusty bodies emerging from the wreckage with severed limbs, emergency wards with hallways that looked like rivers of blood. And the death toll from the initial quake shows no signs of stopping, starting from an estimated 1,500 on April 25, to 4,000 and rising as of April 27.

But emergency workers say Nepalis are now facing the prospect of a second, equally devastating crisis: an epidemic of cholera, dysentery, and other water-borne diseases, as people either with nowhere to go or reluctant to return indoors set up makeshift campsites throughout the city — camps that could turn central Kathmandu into a cesspool. “If people stay in the camps for a longer time we will have a crisis of sanitation,” said Anu Gautam, UNICEF’s chief water, sanitation, and hygiene coordinator in Kathmandu.

At present, said Gautam, approximately 15,000 people are camped-out in Tundikhel, an area in the middle of the city of roughly 1 million people, and the main site where people sleeping outside have gathered. Roads and footpaths throughout the capital have become campsites for residents too terrified to return home, or whose houses have been demolished by the quake. “We are staying here,” Sonu Kumar Jaiswal, a 16-year-old from central Kathmandu, said on April 26, in Tundikhel. “Why take the risk of [going home]?” he said. “It’s too risky.”

As of noon on Monday, emergency latrines in Tundikhel’s Ratna Park were overflowing, with feces baking in the pre-monsoon heat — the earthquake knocked out an unknown number of the pipes supporting Kathmandu’s sewage system. Dipendra Pandey, a resident orthopedic doctor at the Bir Trauma Center, a new medical center opposite Ratna Park, said that the draining system for his hospital is completely non-functional.

Relief agencies like UNICEF and World Vision said that as of Monday morning, those sleeping outdoors have yet to resort to open-air defecation. But according to Sagar Kharel, a gangly, youthful 26-year-old restaurant worker whose house remains uninhabitable, when it gets dark people avoid the overflowing latrines set up by the government, and are instead resorting to relieving themselves in the open.

“Some people at night, they are using the open ground for the toilet,” he said on April 27, while waiting roughly 90 minutes for potable water delivered by trucks on Ratna Park’s grounds. Others nearby lined up waiting for the government agencies handing out food.

The health effects of poor sanitation following a disaster can linger for years: Though overwhelming evidence points to United Nations peacekeepers as the source of the cholera outbreak following 2010’s devastating Haiti earthquake, a lack of sanitation, drinking water, and health care in the weeks and months after the quake compounded the country’s already precarious sanitation scenario. The outbreak killed more than 8,000 and sickened hundreds of thousands of others.

In addition to sanitation concerns, officials are also grappling with a recent outbreak of H1N1 influenza, more commonly known as swine flu. With so many in close proximity in the camps, and with little chance of putting victims in isolation, the disease could easily find a foothold, Gautam said.

Authorities came under scathing criticism in the days before the earthquake for failing to react quickly to an outbreak of swine flu in the hamlet of Jajarkot, in western Nepal. The disease killed at least 24 and infected thousands before authorities could control its spread. Many saw the slow response as symptomatic of the country’s broken bureaucracy — and a worrying sign of government’s ineptitude in providing service and medical care to regions outside the capital.

The lack of health-related infrastructure in outlying districts will compound difficulties in areas outside of the Kathmandu valley. Prominent international NGOs, including the Red Cross, remain unable to gather reliable data on the full extent of the unfolding crisis as a result of landslides that have blocked roads and barred access to regions throughout the country. Problems of water, sanitation, and hygiene “will be an issue everywhere, not just Kathmandu,” said Alina Shrestha, communication manager at World Vision Nepal, the local arm of the global Christian relief organization. And outside of the capital it could be far worse, said Shrestha: “At least in Kathmandu there are facilities to treat people with water-borne diseases.”

Governments around the world have mobilized to aid Nepal in the aftermath of the quake, sending money, equipment, and emergency rescue teams. But whether Nepal’s beleaguered government will be able to mobilize this influx of resources effectively remains to be seen. At least four Indian aircraft were reportedly turned away from Kathmandu airport on April 27 as its runways were too full with planes helping people evacuate the country.

As the tremors continue — the country was still experiencing strong aftershocks as of late Monday evening local time — so, too, does the time spent in makeshift camps. At the tent camp in Tundikhel, the restaurant worker Kharel said that while they are getting water to drink, it can take up to an hour and a half to receive it, and that the food is inadequate. “We are not happy,” he said plainly.

PRAKASH MATHEMA/AFP/Getty Images

Correction, June 2, 2015: Overwhelming evidence points to U.N. peacekeepers in Haiti as the source of the cholera outbreak following the 2010 earthquake in that country. An early version of this story mistakenly stated that the situation in squalid camps in Haiti led to the outbreak.