In parts of Asia, life has largely returned to “normal” as the strict lockdowns, tracing, testing, and other measures adopted by states including China and South Korea have largely paid off. Parts of South Asia, however, have not been so lucky. Few need to be reminded for instance of the crisis that ensued as India faced its second wave of Covid-19, complicated by the presence of the highly contagious Delta variant, lack of medical supplies, and lacklustre enforcement of Covid measures. While the case of India was, and still largely is, dire, there is a crisis that has been unfolding just next door This other crisis is as if not more severe than the circumstances in India, but which has not received nearly as much attention. Specifically, Nepal has been facing a major Covid-19 crisis for the past several weeks, which developed largely alongside the crisis in India. Yet, the situation in Nepal has hardly received the same extent of coverage as India. The lack of attention in these situations is particularly problematic because global public pressure and calls for action have recently become increasingly essential to encouraging the mobilization of national and international resources to aid those struggling. This article aims to bring more attention to the situation in Nepal, the development conditions in Nepal, the Covid-19 outbreak and how this interacts with developmental circumstances, the vaccine crisis, and how Nepal has attempted to handle the situation.
Before going into the specifics of the Covid-19 outbreak in Nepal, it is important to say a bit about Nepal in general, and about its level of development in particular. For many years, Nepal has been classified as one of the forty-eight least developed countries in the world by the United Nations Development Program. Here, development is conceptualized broadly, referring to economic growth, the eradication of poverty and illiteracy, protection of human rights and freedoms, and quality governance, among other things. Nepal has faced a myriad of challenges to its development over the years, ranging from geographic to political. First, Nepal is a landlocked and mountainous country, which makes external trade or other relations challenging. Related to this, Nepal has a high rate of natural disasters including earthquakes, which keep the country in a less than desirable position in terms of development. Furthermore, up until the 1950s, Nepal had been ruled by a host of extractive regimes. Consequently, illiteracy and other forms of low education remained high, and when compounded with other factors, this resulted in dangerously low human and physical capital. This touches on another substantial development barrier Nepal has encountered, namely, political turmoil. In the past two decades, Nepal has undergone a tumultuous and still contentious transition from a monarchy to multiparty democracy, while also dealing with armed and other conflicts.
Combined, these and other challenges have kept Nepal classified as a less than developed state. Although recently Nepal was reclassified from a least developed to a developing country, it is overall a country whose people are living in less than optimal circumstances at a surface level. In 2019, Nepal was one of the thirty poorest countries in the world by Gross Domestic Product, with a GDP per capita of roughly 1,071.05USD with a population of nearly thirty million. Even though the government of Nepal has worked to reduce poverty, with extreme poverty declining from roughly fifteen percent in 2010 to four point three per cent in 2019, the population as a whole still lives on relatively low incomes in work that relies on personal presence. As of 2020, Nepal’s Human Development Index score was medium at 0.602. Furthermore, though it has increased in recent years, only approximately sixty per cent of youth in Nepal were enrolled in secondary school and less than fifteen per cent in tertiary school in 2019, with less than those amounts completing the respective education level. Illiteracy also remains prevalent among certain segments of the population. Problems of poverty are particularly prevalent amongst the relatively large rural population, most of which relies on subsistence farming for their livelihoods, and lack access to health care, education, or water/sanitation services.
Additionally, Nepal’s health care system is largely considered to be below international standards. Yet, it is also important to note that due to Nepal’s topography, epidemics and natural disasters have consistently overwhelmed Nepal’s healthcare system, making it difficult to manage both the crisis caused by the disasters and the process of rebuilding the system afterwards. As of 2012, the most recent year for which data is available, there are roughly zero point three hospital beds per one thousand people, and only approximately 102 hospitals in the country. Overall, accessing medical assistance, particularly specialized care, is difficult for many people of Nepal, particularly those living outside of the capital. However, in some regards, the healthcare system of Nepal has been relatively effective, for instance in relation to its universal vaccination program, the National Immunisation Program, which has successfully managed to vaccinate the overwhelming majority of the population against common diseases including Tetanus and Polio.
The economic, medical, educational, poverty-related, and other issues faced by Nepal left it in a particularly vulnerable position in regards to Covid-19, and hence it is no surprise that the country has been hit extremely hard by the pandemic, particularly in the wake of India’s devastating second wave. As of 26 June, Nepal has reported 1,174 new cases, bringing the total to 632,326 Covid-19 infections, but this is expected to be a substantial underestimate due to the difficulty of accessing rural areas. However, this is a significantly lower daily total than just a few weeks ago, when Nepal was deep in a deadly Covid-outbreak. In April, Nepal was reported around 100 cases per day. Yet in May, those numbers skyrocketed, reaching beyond 8,600 cases per day, and on most days Covid-deaths averaged between one and three hundred. Crematoriums were overwhelmed with the number of dead and struggled to keep pace. The medical system was also collapsing under the sheer load of Covid-19 cases they were facing, leaving many without proper access to treatment. While the way in which the crisis unfolded and the broad impacts resemble the case of India, the extent of damage has been more severe in Nepal due to its weaker health infrastructure.
The raises the question: How did it get to the point that a crisis did unfold? For that, there are three primary factors that contributed to the situation. First, the fact that Nepal shares a busy and overall laxly-regulated border with India, is believed by some to have contributed to the crisis. In the weeks leading up to the situation in Nepal, this open border was particularly busy with many travelling for work, to escape the crisis already unfolding in India, receive medical treatment in Nepal, and the like. As a result, some have claimed that this travel brought not only large amounts of Covid-19 but also the particularly contagious Delta variant.
Additionally, government inaction is thought to have contributed significantly to the outbreak. As in India, lockdown measures remained relatively lax for quite some time, with Nepalis gathering both at home and in India to celebrate religious holidays with crowds of others. Prime Minister K. P. Sharma Oli also held a large gathering to inaugurate a new Dharahara to replace one destroyed in a 2015 earthquake. Furthermore, Oli downplayed the severity of the virus and advocated for a variety of “home remedies”, including gargling with guava leaves or consuming spices to build their immune systems. It was not until the number of daily cases reached highs of 4,800 that the government imposed a two-week lockdown in the capital. This extremely delayed response and a relatively mild one at that is thought to have contributed to the severity of the Covid-19 outbreak by leaving the possibility for the virus to spread as people gathered in large crowds and no form of quarantine system was established.
The final substantial contributing factor to the crisis was the sheer weakness of Nepal’s medical infrastructure. Although substantial progress has been made in recent years to build up the health system in Nepal as mentioned earlier, as a whole, the country still faces a severe shortage of medical equipment and experts. During the crisis, the entire state of Nepal had only 1,127 ICU beds, 1,555 high-dependency units, and 453 ventilators for roughly 30 million people, which is less than India. Furthermore, there are only roughly 0.7 physicians per one hundred thousand people in Nepal, less than India’s 0.9 per one hundred thousand residents. Not only that, but Nepal is also unable to produce its own oxygen and for several weeks was facing shipment delays of oxygen from India as a result of border closures. This further lessened the capacity of hospitals to take in and treat Covid-19 patients on top of the severe bed shortages the country was already facing. This was all topped off by a testing shortage that made it difficult to know whether or not one was Covid-positive until it was too late.
In sum, the border with India, lack of effective government regulations, and weakness of the medical system contributed both to the outbreak and severity of Nepal’s Covid crisis. In many ways the situation in Nepal resembled the situation in India, but its impacts were overall more severe. However, the crisis in India received far less attention, both in the media and in the international diplomatic arena, and as a result, the crisis was prolonged as Nepal waited to receive future resources.
Not only was the situation in Nepal a crisis of Covid-19 itself, but Nepal has also struggled to carry out its vaccination campaign, despite the fact that Nepal has built up quite a successful vaccination program. For months, less than three per cent of Nepal’s population has been fully vaccinated against Covid-19, and less than nine per cent has received at least one dose. This is not because Nepal does not have the capacity to vaccinate- in recent decades dedicated medical workers and volunteers have worked to raise Nepal’s vaccination rates to ninety per cent for many diseases. What Nepal does lack is supply. To attain the vaccine, Nepal has relied primarily on China, India, and the COVAX program. Due to shipment delays and the Covid-19 outbreak in India however, and the overall slow take-off of COVAX, Nepal has struggled to attain the number of vaccines it needs to provide many with a second dose and provide any doses to the remaining ninety-eight per cent of the population that has not yet been vaccinated. This has added another complicating layer to the pandemic in Nepal that will likely delay a speedy recovery for Nepal.
As this crisis was unfolding, the government of Nepal put out a plea to the international community for some form of aid, but the nature of Covid politics and Nepal’s lesser diplomatic standing relative to neighbours such as India meant that receiving the aid requested took longer than expected. In early May, the United Nations made an appeal for roughly $84 million for assistance to the people of Nepal as they were facing a devastating Covid-19 crisis. Towards the end of May, the European Union mobilized 2 million Euros in humanitarian funding to support the people of Nepal by providing equipment and other essential resources. Additionally, Nepal activated the EU Civil Protection Mechanism, which aims to facilitate cooperation between the EU and six Participating States on civil protection. Through the Mechanism, states including Finland have offered masks, medical gloves and gowns, and other materials. The American USAID organization has contributed $15 million to the government of Nepal to help them get the outbreak under control. President Xi Jinping of China also committed to providing Nepal with one million Covid-19 vaccine doses at the end of May.
While Nepal’s Covid-19 numbers have begun to decline again, what little health infrastructure did exist in Nepal has been absolutely overwhelmed by this still ongoing crisis. Recovering from the damage that has been done in addition to getting Covid-19 under control in Nepal will be quite the challenge.
In times of global crises, existing inequalities between states are exacerbated, with drastic repercussions. The global Covid-19 pandemic is no exception, and the already vulnerable positions of many developing countries, including Nepal, has resulted in dangerous escalations of cases. In these moments of crisis, media attention is often a crucial resource for these states to garner the international attention needed to attain vital resources. For Nepal, its crisis has been largely overlooked by international media while also being overshadowed by the crisis in India, and so it was not until far into its crisis that the international community provided assistance. Yet, if the international community learned anything from the onset of the global pandemic, it should have been this: We as an international community are all in this together. No one state can have truly overcome the pandemic until everyone has because any state being left behind will bring negative consequences for those states far removed from the immediate situation. It is not clear how long it will take for Nepal to fully rebuild and recover, but what should be clear is this: The world is not out of the pandemic yet, and we cannot all move on until we ensure vulnerable states have the means to.