Manmade earthquake: the hidden health effects of a blockade-induced fuel crisis in Nepal

Correspondence to Shyam Sundar Budhathoki; [email protected] My friend’s uncle in his 50s living in Hetauda, Nepal had severe left-sided chest pain while working one evening. His colleague took him on a motorbike—twowheeler in local parlance—to a nearby hospital, arriving 45 min after the pain had started. The ECG and cardiac enzymes suggested an acute ST-elevated myocardial infarction. The hospital had no cardiologist or specialised services, and referred him to a hospital in the capital city, Kathmandu, 87 km away. However, no local ambulances were available for transporting the patient to Kathmandu. After frantically calling all contacts, a private ambulance from a city an hour away agreed to transport him on the condition that the patient supply 30 L of diesel. After an hour of searching, 25 L of diesel from the home of a local food retailer was arranged, at three times the regular price. Simultaneous with the search for fuel, the hospital staff was searching for a portable oxygen cylinder in the city to be sent with the ambulance, but ultimately failed. In the end, the patient travelled to Kathmandu without oxygen support. Thankfully, he reached the hospital, survived and is back to work in Hetauda. This makes sense as a heroic story in the days after the devastating earthquake in Nepal in April 2015. But in fact, this happened in January 2016. It was a consequence of an entirely manmade disaster that barely caused a ripple in the international press: a blockade at the border inspired by India’s unhappiness with provisions of Nepal’s new constitution. The specific reason for the blockade was never satisfactorily explained, but it lasted for more than 5 months and caused severe difficulties in all facets of daily life. This is because Nepal, a landlocked country with no railroad, depends almost exclusively on petroleum driven transport, and petroleum and all other imports come into the country over the road from India. The national financial loss due to the blockade is estimated at US$5 billion, not so different from the losses incurred by the earthquake (US$7 billion). Even less reported than the recent blockade was a 13-month blockade of Nepal by India 26 years ago, in 1989, also after a major earthquake. We suspect that the results were equally or more damaging, but frustratingly little was ever written about it. 3 The 2015 earthquake killed almost 9000 and displaced 3.5 million people in rural mountainous and hilly areas, and in the densely populated capital city. In severely affected districts, more than 90% of the health facilities were either destroyed or seriously damaged. This destruction came on the heels of a decade of civil unrest that ended in 2008. The blockade affected every aspect of life, bringing the country nearly to a standstill. People lined up for days just to receive a few litres of fuel. Factories shut down completely, schools and colleges were closed, and telecommunication services were on the verge of closing down. While there were ongoing political and diplomatic talks between Nepal and India, distribution of food and shelter aid to those affected by the earthquake was halted. No reconstruction materials could be provided. The ongoing humanitarian crisis Summary box