By: Bikal Dhungel
The aim of this article is to highlight the health sector during
violent conflicts like that in Nepal from 1996-2006. Also the case of
Nepal will be taken as a case study but this can be generalised to
other places of least developed countries.
In 1977, three writers, Blaikie, Cameron and Seddon wrote a book called 'Nepal in Crisis' which
signaled some prophetic crisis coming in Nepal. They have analysed
the present scenario and predicted the future based on that scenario.
Nepal was terribly poor country that time. It was a dictatorship
where the government restricted the freedom of expression. There was
very high inequality. Poverty was rampant. Access to healthcare and
education was very low. A large majority of people relied on
subsistence farming. There were only handful of infra-structures,
like highways, bridges, hospitals and schools etc. In such a
scenario, sooner or later, there will be a violent conflict.
Even though Nepal had a democratic transition, poverty and
inequality remained. Also caste based discrimination remained.
Finally in 1996, conflict began and lasted until 2006 with over
16,000 deaths, thousands of widows, orphans, handicaps and hundreds
of thousands of internally and internationally displaced. That caused
a dire consequences on health sector. Over one thousand sub health
posts were destroyed directly by the guerrillas. So, the people had
nowhere to go when they needed healthcare. The health workers ran
away fearing their lives. The danger of attacks also cause other
health workers to flee from rural areas. During that time, new born
children could not get any vaccinations, so they are prone to many
diseases. The maternal mortality rate increased due to lack of health
workers in times of birth. As roads were blocked and bridges were
damaged, medical supplies could not be brought to rural areas. Even
basic things like Paracetamols and Anti-biotics were lacking in rural
areas. There was no electricity as the power lines were bombed,
hence, the medicines could not be stored well. Those who died during
the war, not because of bombs but because of the lack of medicine,
because of the lack of healthcare will not be taken into statistics
but if so, in Nepal's case, far many people died due to the war.
The leading Red Cross surgeon Marco Baldan puts, 'One of the first
victims of war is the healthcare system itself '. There will be more
demand of healthcare during the war due to injuries. Sickness is a
frequent process in human life, it doesnt take a break when there are no doctors. In the absence of health workers,
even a minor disease can take life. The Red Cross Society mentions
that health workers, who go to conflict areas to save others lives
are under threat themselves. Many health workers have died till date.
Reports says that dozens of health workers died during the Maoist led
Civil War in Nepal and there were many cases of kidnappings,
harassment, prosecution by both Maoist and government side. Health
awareness program could not be performed in such a situation and
public health campaigns were limited in the cities. Those who were
not vaccinated for example not only put their own lives in risk but
also the lives of others. When millions were displaced, they are also
the transmitters of diseases like HIV when they move from one place to another.
When the mass emigrate to urban areas, they put additional
pressure to the health sectors there. For example the hospitals in
Kathmandu only have capacity for certain number of people but once
they are overwhelmed by injured ones from rural areas, the health
system suffer anyway but also the people from urban area suffer due
to long waiting time, lack of hospital bed, non-timely supply of
medicines etc. If there were no disturbances in health sector, the
health of Nepalese nation would have been much better today. Apart
from destruction, the health and development budget had to be
diverted towards buying new weapons causing another long term impact.
Economists calculated that, the opportunity cost of the conflict has
been about 4% of Nepal's GDP directly. Indirectly, it will go higher.
Disruptions in trade, loss in revenues from tourism, lost investment,
security costs, the costs of the guerrilla fighters education, those
who lost their parents and were driven to poverty, all these things
can not be measured.
So, the cost of a war is not just a direct cost but also others
connected to it which can never be calculated precisely. If
governments, guerrilla leaders think of these consequences before they
go to war, they would at least think of alternative ways to solve the
problem. Moreover, the experience from around the world is enough to
think about it. Trying to solve problems with military way is
fundamentally wrong. The reconciliation time can go on for decades if
it does not destroy the country fully. Along with other countries,
Nepal will be on the list of places that can give a lesson to the
rest of the world but also to itself, for future leaders of any
particular party. Big scale conflict should be avoided at any cost.
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