Nepal’s government should urgently act to manage a rapidly escalating Covid-19 emergency in the country, Human Rights Watch said today. Senior public health officials have described in interviews a health system at the breaking point, with the number of recorded infections doubling every three days among a largely unvaccinated population.

The Nepali government, with assistance from foreign donors, should increase the availability of emergency medical supplies including bottled oxygen, ventilators, and therapeutic drugs.

“Nepal’s under-resourced public health system is strained beyond capacity,” said Meenakshi Ganguly, South Asia director. “Large volumes of oxygen equipment and other medical supplies are urgently needed to avert a Covid-19 catastrophe in the country.”

Health experts fear that the surge in Covid-19 cases in neighboring India has spread to Nepal. “People are dying literally because of lack of oxygen and there are no hospital beds,” a senior government medical official told Human Rights Watch. He said that the army had been brought in to manage dead bodies but “they are also becoming overwhelmed,” and briefly ran out of body bags.

The government’s response to the second wave of the Covid-19 pandemic in Nepal has been slow and poorly managed, said officials and medical workers. Some government doctors believe that a lockdown in the capital, Kathmandu, that began on April 29, 2021, was imposed 10 days or two weeks too late. The infrastructure for oxygen supply was “not prepared,” said one. “They were taken by surprise.”

Government officials and health workers said the most urgent need is for oxygen cylinders. Nepal’s oxygen production capacity is also becoming overstretched. Dr. Roshan Pokharel, chief specialist at the Health Ministry, said: “We are in a very dire situation right now. We are running out of oxygen supplies. Our oxygen plants are not working properly. The number of cases is increasing rapidly, and the age group of patients is quite young.”

The government’s Health Sector Emergency Response Plan for the Covid-19 Pandemic outlines that hospitalization with oxygen support should be available for 15 percent of confirmed cases. With 6,700 new confirmed cases on May 5 alone, it is evident the existing infrastructure will not be sufficient.

Government officials said that Nepal also urgently needs to bolster supplies of therapeutic drugs like Remdesivir, consumables such as oxygen tubes and masks, and ventilators and other critical care facilities. Nepal has about 560 ventilators, less than half of what may be needed according to donor agency estimates seen by Human Rights Watch. Not all are in working order and in some parts of the country there is a lack of trained staff able to operate them.

Officials emphasized that oxygen equipment and other supplies – including vaccines – are needed, not funding. “Money is no use,” one said, referring to the impossibility of obtaining supplies in neighboring India due to the Covid-19 emergency there. Supplies from China, such as a recent order of 20,000 oxygen cylinders, may take two to three weeks to arrive by road, officials told Human Rights Watch.

Kanchan Jha, a social activist in Birgunj in southern Nepal, said that due to the lack of oxygen cylinders, “we are not being able to manage or distribute oxygen fairly.” A senior national health official said the crisis in hospital capacity is most acute in Kathmandu and in several towns close to the Indian border, including Nepalganj, Butwal, and Birgunj. In Birgunj, Covid-19 patients are sharing hospital beds due to lack of hospital capacity.

Private hospitals are also operating near or beyond capacity, doctors said. Private treatment, which may cost between US$80 to $420 per day, is beyond the means of most people in a country where the average annual income per capita is around $1,000. The government is investigating allegations that private hospitals have increased their prices during the emergency.

Through April 26, the World Health Organization (WHO) reported a case-positivity rate of 37 percent across the country, and officials told Human Rights Watch that an alarming 45 to 50 percent of Covid-19 tests are being returned positive. “Even 10 percent would be a high number,” said one doctor. However, official figures are widely believed to underrepresent the scale of the crisis. For example, the Birgunj region has only one testing center, and health workers are reporting clusters of people suffering high fever and deaths in several villages. “No one is tracking these cases,” a social worker said.

Global Covid-19 vaccine scarcity is undermining vaccination efforts in Nepal, particularly after the Indian government halted vaccine exports. “If we want to stop this transmission, we need vaccines,” said Dr. Lhamo Sherpa, an epidemiologist. Less than 10 percent of the population in Nepal has received one dose of vaccine, and supplies are not available to provide a second dose to many of those who are awaiting one. Dr. Pokharel said, “We are not getting vaccines from anywhere, although we do have the money.”

The government of Nepal has supported India and South Africa’s proposal at the World Trade Organization’s TRIPS Council. The October 2020 proposal would temporarily waive certain intellectual property rules on Covid-19-related vaccines, therapeutics, and other medical products to facilitate increased manufacturing to make them available and affordable globally. The United States and New Zealand have recently indicated their support for the TRIPS waiver. Other influential governments such as the United Kingdom, Japan, Australia, and the European Union should drop their opposition, Human Rights Watch said.

The government’s willingness to devote its attention to the crisis remains unclear. The prime minister, K.P. Sharma Oli, has repeatedly recommended herbal remedies, such as guava leaves, as a cure for Covid-19. International NGOs have been unable to transfer funds to the government because the bureaucracy is unable to complete paperwork due to Covid-19 cases among ministers and officials.

Nepal’s international development partners, who have supported the government’s health infrastructure for decades, have also not adequately prepared. In discussions among development agencies in the final week of April, seen by Human Rights Watch, international officials spoke of a lack of clarity from the government as to its priority needs, and also a lack of information among themselves about such basic matters as the country’s medical oxygen infrastructure. “We are still in the information gathering phase,” one said. “In hindsight, this could have been started in December,” said another.

“Nepal’s healthcare system was in no condition to confront an emergency on this scale, and the government needs to act to protect all Nepalis’ right to health,” Ganguly said. “To avert a terrible disaster it is critical for the Nepali government and donor countries like the US, UK, and the EU to urgently make life-saving oxygen equipment and vaccines equitably available.”

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