Jajarkot: One month after the earthquake

A rapid assessment of the epicentre of the earthquake that hit just before midnight on 3 November shows that lack of accurate information about the status of survivors and their needs continues to be a challenge.

Our trip to the hardest hit areas from Khalanga to Nalgad in this remote district in the mountains of western Nepal involved the rescue of a month-old infant whose mother was reported to have died from the cold. 

There has been inaccurate and sensationalised reporting in the media after people died from the cold. While it is true that winter has set in the mountains and the long term illnesses can be exacerbated by the cold, stress or unhygienic conditions, many of the deaths have been due to acute illnesses and existing preconditions.

There have also been reports of relief items being stuck in bureaucratic bottlenecks and piling up in municipal offices instead of being distributed to those in need. While that may have happened in the early days of the earthquake, on this week’s trip that was not what we saw. 

In any natural disaster, it is important to recognise that the scenario for relief can rapidly change from day to day, thus making a rapid response and clear communication channels vitally important. 

We are concerned that inaccurate journalism based on hearsay without fact checking can foster an environment of cynicism and criticism, discouraging collaborative efforts. It can also affect the morale amongst first responders, spreading distrust. 

Read also: Learning from Jajarkot what we didn't after 2015, Sushil Gyewali

Relief must be survivor-centred and not be sensationalised or politicised with fake news. A centralised database that can foster collaboration is being put up with accurate and up to date information on the Jajarkot Earthquake Response website.

Partners on the ground can also fact-check and debunk false reports, and we urge reporters to seek out these primary sources instead of relying on sensationalised clickbait.

Rubble and destruction 

As we approached the epicentre with three vehicles filled with jackets, sanitation kits, blankets, the destruction was shocking. Even in the relatively accessible areas like the district headquarter of Khalanga the houses are still in ruins. A month after the earthquake the rubble still has not been cleared.

Things get worse the deeper we go into the mountains. On the way to Nalgad, there are rows upon rows of destroyed houses. Most people are living under tarp and bamboo tents, in one of them there were seven members of a family huddled inside. One man in Kalanga had broken his arm, and was sifting through the rubble of his home with his other hand. He was sheltering in a nearby school with many other neighbours. 

A school in Nalgad was still functioning, and students were attending classes in tents. Their school was damaged and there was fear of aftershocks. 

Multiple political groups and nonprofits are helping clear the rubble in places, but no active rebuilding has started yet. 

Read also: Grief-stricken survivors are cold and hungry, Sagar Budathoki

CGI-based temporary homes might be better than tents for this winter. But rapid, affordable, earthquake resistant and sustainable rebuilding must start as soon as possible using the experience and plans developed after the 2015 earthquake.

Rural municipalities must be key partners in all rebuilding efforts. Relief organisations can divide up their efforts to avoid duplication. There are prototypes for winterised temporary shelters and long term solutions for reconstruction:

Immediate Relief and Humanitarian Aid 

Nepal has a one-door policy currently to manage aid coming into disaster zones. Each district’s disaster relief committee is led by the Chief District Officer (CDO), who is in charge of relief items coming to the region. Jajarkot district has received tons of relief material, and local distribution was initially the bottleneck. There are still reports of items not getting to those that live in remote and roadless areas. 

We saw this week that the distribution management appeared to have improved. Items lying in municipality offices and district offices were in the process of being delivered. The municipal system makes it easy to coordinate with local ward chairs to find the areas of acute need. 

Our trucks had to be registered with the CDO with an itemised list and approved for further transport deeper into the district. The process seemed seamless. In Nalgad municipality, where few relief organisations are present, the mayor’s office and the Nepal Army have coordinated with NGOs to distribute blankets, clothes to more remote regions. 

Read also: Earthquake vacates villages in Nepal, Anita Bhetwal

The municipalities are coordinating better, and working closely with relief aid partners. But there is still a need for logistics management and strategic distribution of relief material to difficult to reach villages. Special care must be given to villages at higher altitudes where it will soon start snowing.

Relief organisations must respect the one-door policy, and not bypass this effort to coordinate relief and avoid waste and overlap. The Ward chairs have their feet on the ground and are the best source for exact need. They should be made partners in all aid distribution locally. 

Healthcare 

Jajarkot has a well-equipped district hospital, and each municipality has a  health centre. There are smaller health posts in wards within the municipality. The nearest high level facility with ICU capacity is in Surkhet. 

Jajarkot district hospital had a large number of traumas during the first weeks after the earthquake. The hospital has five medical officers, and one MDGP (consultant) physician, and can provide basic emergency care, maternal and child care including caesarean section and vaginal delivery, and has a robust pharmacy. The hospital’s patient census was not impressive during our visit. 

The Nalgad municipality health centre was busy with only one medical officer available. Large tents from UNICEF had been erected outside for additional inpatient ward and emergency space. There seems to be a gap from the district to support the local municipality's needs. 

We came across many groups coming to Jajarkot to conduct health camps. Though increased engagement has benefits, it is not so useful to have camps near the health centres or the district hospital as there are already facilities there.  Doctors told us that they had extreme excess of certain supplies and not enough of others. 

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Groups organising health camps should focus on two areas: 1) bring specialist care that otherwise does not exist in this region, 2) reaching areas away from local health infrastructure. They must also coordinate with the district hospital and municipality health centre to assess their utility. Funds used for health camps could instead help strengthen local health facilities.

The districts should divert some of their resources (doctors, nurses, etc) to some of these busy health centres in local municipalities like Nalgad. It does not make sense for one doctor to see a large number of patients in Nalgad, while the district hospital is not busy. 

Safeguarding Women and Children

There are a large number of pregnant and postpartum women in the most affected areas in Nalgad, Rukum and Kuse. Recent news items have used false narratives to gain viewership, but there is a real need for access to appropriate ante-natal and postnatal care, which was an issue that existed before the earthquake in underserved areas of western Nepal.

Jajarkot hospital, the municipal health centres are both equipped to care for most of these women. Various groups are providing warm clothes for the most vulnerable and prioritising these women for safe winterised shelters is a must. 

There are child protection units and National Child Rights Council (NCRC) offices at each municipal office. When a child, adolescent, pregnant or postpartum woman is in potential or imminent danger, it is critically important that officers be notified immediately. 

The NCRC works directly with government bodies, police, licensed shelters, and relief agencies to ensure that the woman or child is taken out of danger. NCRC and Kopila Valley are able to work together directly to safeguard the children in distress. The involvement of NCRC also prevents child smuggling and safeguards against family separation, exploitation, and human trafficking.

The use of trained trauma informed social workers and child protection officers is critically important when discerning information and keeps the child’s rights and protection at the centre. 

Available health centres must be equipped with in-facility and outreach programs to identify and care for the most vulnerable in the region. This disaster could be used as an opportunity to equip and build a system around the municipal health centre and district hospitals to create innovative models like Nyaya Health Nepal’s community health care model in Achham, where community health workers are trained and equipped to provide care at home.

Read also: Rebuilding resilience 7 years later, Anil Pokharel

When someone is really ill, taking the patient to Surkhet might be the only way but the road is long and hard. A streamlined approach to access government services like helicopter rescue must be available in this post-disaster setting. 

A robust ambulance and EMS service from either the municipal health centre and/or Jajarkot district hospital must be made. 

Water and Sanitation 

Even before the earthquake, Jajarkot and surrounding districts were hit by a cholera epidemic in 2009 that killed over 300 people, many of them children. Running water and sanitation has always been a major concern and this danger has been exacerbated with the earthquake aftermath in the dry season. 

None of the temporary tents and shelters we saw had appropriate water access and hand washing stations. Donor agency temporary toilets were dirty with no hand washing. Water and hygiene must be a priority for development groups going forward. Relief groups must put WASH in their priority. 

After meeting survivors, relief workers and local elected officials we saw a resilience and a determination to bounce back. The items we took to Nalgad are being strategically distributed in coordination with municipality offices to reach those in most need. 

We were able to locate the one-month-old infant in Nalgad municipality’s Ward 8. The infant is now getting safe ICU level care now in Surkhet, and is doing better. 

Read also: Shaking things up, Editorial

Resources for aid information and reporting can be found here.

Important phone numbers: 

National Child Rights Council: 01-5550121 

Chief Minister Karnali: 985804444 

Chief District Officer Jajarkot: 9858047777 

Mayor Nalgad: 9842236335 

Mayor Kuse: 9858937755 

District Hospital Khalanga: 089-430188 

Ambulance: 102 

AIN (Federation for NGOs): 01-4468128 

Poison information center: 01-450-2011 

Suicide Hotline: 1166 

Police: 100

Ramu Kharel ([email protected]) is an emergency medicine physician with global health and public health expertise, and decade long experience in disaster response within Nepal. He is an assistant professor at Brown University, and is founder of HAPSA Nepal.

Maggie Doyne is the co-founder of the BlinkNow Foundation and, and has worked for 18 years in the Karnali region caring for at-risk children through community development efforts. She is a CNN Hero and author based in Surkhet.