The Nepal earthquake was a disaster waiting to happen. The rising death toll is a sad confirmation of my fears when I first heard of the earthquake. And the full scale of things is not yet known, as there will be considerable under-reporting due to the remoteness of some of the affected communities and the lack of reliable casualty reporting systems.
Experts have warned for years of a likely earthquake striking the area. Indeed it was predicted that such an event would have catastrophic consequences due to the toxic combination of risk factors that make the country vulnerable. In recent decades there has been a massive growth of the urban population in and around Kathmandu leading to dense overcrowding in the city. This is coupled with poor building practices meaning a lot of buildings were not earthquake-proof. Public utilities infrastructure is limited as is the capacity of the health system and emergency services to respond to a disaster.
While there have been some pockets of good practice, such as disaster preparedness training in some schools, pre-positioning of emergency stores, and some community-based disaster preparedness projects, this has not been systematically rolled out across the country. Indeed, a consequence of the political turmoil in Nepal over the past decade has been the lack of investment and strong political leadership necessary to drive the disaster preparedness and mitigation programmes so desperately needed.
Key challenges ahead
First and foremost in the coming days is the need for access to sufficient quantities of clean water and sanitation. Delivering this in disaster affected urban areas is extremely challenging in view of the scale of the response needed.
In addition, in a country where diseases such as cholera and dysentery are endemic, the risk of epidemics breaking out in the aftermath of the disaster will be high. This risk is likely to increase substantially with the monsoon, which starts in a few weeks. This will potentially lead to a rise in infectious diseases, as well as hampering movement around the country.
The problem of infectious diseases is also worsened by the limited capacity of Nepal's healthcare system to respond to outbreaks, as well as the lack of an effective surveillance system to detect the outbreaks in the first place. Put simply, the health system will be blind and lame in responding to outbreaks. By the time they are recognised, their extent may be considerable and likely to overwhelm local health services. Outbreaks of vaccine-preventable diseases such as measles are also a possibility as routine immunisation programmes are compromised.
There will also be a need for food and supplies of other essential goods including medicines, as existing stocks run out. However, the logistics of moving vast supplies to the disaster affected areas is especially challenging in Nepal because there is only one major arterial trunk road into the country from India. The existing road is neither wide nor in good repair and will struggle to cope with the high volume of haulage vehicles required to move supplies into the Kathmandu Valley.
Airlift is unlikely to be sufficient to bring in the tonnage of supplies required, and is limited by the fact that the country has only one major airport with a runway long enough to accommodate heavy-lift aircraft. Remote communities in the mountains are likely to be cut off and starved of aid. This is one situation where there is a clear role for foreign military assistance, as only the military has the logistics capability to transport the volume of supplies required, and the helicopters for accessing remote communities with no road access. This is not a task one can expect non-governmental organisations to successfully fulfil.
There are also longer-term threats on the horizon. Flooding will be frequent once the monsoon rains set in between June and August. Building appropriate shelter is therefore another imminent priority. It will be virtually impossible to supply enough temporary shelters and tents to all those affected by June, let alone before winter comes.
Exposure to the elements is a lethal threat to the most vulnerable in society such as the young, the elderly and the ill. Once again, remote communities in mountainous areas are likely to be most in need and yet least likely to receive enough aid in view of the challenges in accessing them.
The disaster will also have set the country's development back by years and there will be adverse economic effects. Poverty ensures the people continue to live in vulnerable situations.
Undoubtedly some Nepalis will already have begun the process of rebuilding destroyed homes. It is essential that they are enabled to rebuild disaster resilient homes.
This is not a short-term endeavour but will require international aid for years to come. Failure will lead to the same risky conditions being replicated and a repeat situation down the line. In view of the complexity and multitude of needs and challenges in Nepal, there is an urgent need for rapid global assistance, both technically and materially. Substantial contributions and effective coordination of all actors involved will be key in ensuring aid gets to where it is needed most.
• Andrew Lee is Senior Clinical University Teacher at University of Sheffield.