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Protests and bombing disrupt health care in Nepal

BMJ 2006; 332 doi: (Published 04 May 2006) Cite this as: BMJ 2006;332:1052
  1. Kaushal Pandey
  1. Kathmandu

    Healthcare services in Nepal have been severely disrupted in the 19 days of recent protests, the country's medical association said. Sixteen people are reported to have died after protestors took to the streets of Kathmandu and other cities. Many of the protestors were ordinary people demanding a more democratic government, although they included Maoist rebels who have been fighting for the past decade to overthrow the monarchy.

    “We could not carry out routine services to patients owing to the lack of access resulting from curfew and transportation halt,” said Sudha Sharma, the president of the Nepal Medical Association. “Instead we focused more on providing effective emergency service to the protest victims,” she added.

    The medical association formed a committee of doctors, nurses, and paramedics to provide first aid at the site of injury and transfer the patients to hospital, added Dr Sharma. “Doctors were overworked in treating protest victims,” said Sarita Pandey, the head of emergency services at Kathmandu Model Hospital. This hospital alone treated 631 protest victims. “Most doctors and nurses worked continuously for 36 hours. I had to work continuously for three days and could return home only on the fourth day.”

    Dr Pandey described the situation as war-like: “The patients were brought by ambulances continuously one after another, and we were rushing to attend to each patient. Our hospital alone received 150 patients with all kinds of injuries—head injuries, fracture, bullet injuries, and tear gas suffocation in just one day.”

    Government troops used both live and rubber bullets, as well as batons and tear gas, in an attempt to quell the demonstrations.

    “We had to work in an environment of fear as armed police surrounded our hospital and took away three dead bodies of victims without permission from the hospital,” said Dr Pandey. This may have been to conceal the final number of deaths, she suggested.

    The hospitals in Kathmandu followed a disaster management plan because of the large number of injured people. News reports said that more than 5000 protesters were injured. Eight had bullet injuries to their eyes and 24 were disabled, including one who has quadriplegia after a bullet injury to the spinal cord. At least 16 protesters were killed.

    People from all walks of life have set up a fund of more than 16 million Nepalese rupees (£120 000; 荤180 000; $220 000) for free treatment. “I am happy that people supported my treatment bills after I got injured in the protest,” said Bikram Atreya, a college student.

    Routine operations are seriously affected, said Dr Sharma. “It will be very hard to accommodate the missed elective operations in the future as most hospitals have tight operations schedules for the next few months,” she said.

    On 23 April, Maoists bombed a district hospital in Chautara, a district headquarters about 100 km east of Kathmandu. This is the first time a healthcare facility has been affected so badly in 10 years of conflict. A 20 year old patient and his visiting 68 year old father died in the blast. The Maoists used the hospital as cover to launch an attack on government security offices. The hospital has had to provide services for outpatients in an open space because of the destruction.

    King Gyanendra restored multiparty democracy to Nepal on 24 April by reinstating the dissolved parliament and handing over sovereignty to the people. The protests ended after the restoration of democracy. Doctors too took part in the protests demanding restoration of democracy (BMJ 2006;332:931, 22 Apr). Maoist rebels announced a unilateral ceasefire for three months on 26 April. They have said that they would end armed insurgency if an unconditional election for constituent assembly is announced.

    “The conflict has affected the public health and this opportunity should be utilised to establish permanent peace in the country,” said Dr Sharma.

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